Recurrent miscarriage
Losing a pregnancy is painful, and losing more than one can make it hard to try again. Tests for both partners can sometimes find a cause that can be treated, and support is there in the next pregnancy.
With Datuk Dr. Navdeep Singh Pannu, FRCOG, at Alpha IVF & Women's Specialists, Kota Damansara
- When to ask
- After two or more miscarriages
- Tests
- Blood tests, a scan of the womb, and sometimes chromosome tests
- Both partners
- Checked together
- Often
- No single cause is found, and that can still be hopeful
What it is
Most single miscarriages happen because the embryo has the wrong number of chromosomes, which is a matter of chance and becomes more common with age. When losses repeat, it is worth looking for something that keeps happening.
Known causes include antiphospholipid syndrome (an immune condition that makes the blood clot more easily), a difference in the shape of the womb such as a septum, fibroids that bulge into the cavity or scar tissue, thyroid problems, poorly controlled diabetes, and a chromosome rearrangement carried by one partner. High levels of DNA damage in sperm may also play a part.
Often no cause is found. That can feel frustrating, but many couples in this position go on to have a healthy pregnancy, especially with early support.
Who it can help
- Two or more miscarriages, one after the other or not
- A miscarriage after 12 weeks
- Losses after IVF, including after embryo transfers
- A family history of a chromosome rearrangement
- Couples already pregnant again who would like closer care
How it works
-
Your history
Each pregnancy is gone through: how far along it was, what happened, and any tests done at the time. Results from the pregnancy tissue are helpful if you have them.
-
Blood tests
Tests for antiphospholipid antibodies (repeated after 12 weeks if positive), thyroid function and blood sugar, and others depending on your history.
-
A look at the womb
A detailed ultrasound, and a hysteroscopy if the shape of the womb or the cavity needs a closer look.
-
Chromosome tests if needed
Blood tests for both partners to look for a balanced chromosome rearrangement, and a sperm DNA test in some cases.
-
A plan
Treatment for anything found, such as low-dose aspirin and blood-thinning injections for antiphospholipid syndrome, or thyroid treatment. Surgery for a septum may be discussed, though its benefit is less certain. With a chromosome rearrangement, IVF with PGT-SR may be discussed.
Good to know
Side effects and risks
- Some treatments offered for miscarriage have little evidence behind them; you will be told which are worth it for you
- Blood-thinning injections can cause bruising where they are given
- A hysteroscopy carries small risks, such as infection or, rarely, damage to the womb
It is not your fault
Work, exercise, a stressful day or sex did not cause the miscarriage. Most losses are beyond anyone's control.
In the next pregnancy
Let the team know as soon as you have a positive test. Early scans can give reassurance, and progesterone may be suggested if you have bleeding in early pregnancy after a past miscarriage.
Grief is real
Allow yourselves time, and ask for support when you need it. Mental health during treatment.
Questions people ask
Why do I need tests after only two miscarriages?
The ESHRE guideline supports tests after two losses, and the RCOG guideline leaves room for them after two when a cause is suspected. After two, tests can find a treatable cause, and if nothing is found that is useful to know too.
Should my partner be tested as well?
Yes. A chromosome test may be advised for both of you, and sometimes a sperm DNA test.
Will IVF stop me miscarrying?
Not on its own. IVF with PGT can help in some situations, such as a chromosome rearrangement in one partner, but it is not needed for most couples.
How soon can we try again?
Physically, usually after your next normal period. Emotionally, it is fine to wait until you both feel ready.
Further reading
This page is general information and does not take your personal circumstances into account. Please speak to your doctor for advice that is right for you. Disclaimers