Recurrent pregnancy loss
Recurrent pregnancy loss means two or more pregnancy losses. It is painful, and often comes with guilt and fear that are not deserved. At EVE Women and Fertility Clinic in Gunjur, Bangalore, Dr. Swati Shree offers a careful, kind evaluation based on the ESHRE 2022 guideline, looks for causes that can be treated, and supports you through the next pregnancy.
At a glance
- Definition (ESHRE 2022)
two or more pregnancy losses
- How common
about 1 to 3 percent of couples
- Treatable causes
antiphospholipid syndrome, uterine abnormalities, thyroid disease, diabetes, and some others
Why it happens
A single miscarriage is common, affecting about 1 in 4 pregnancies, usually because of a chromosome error in the embryo. Having two or more is less likely by chance, so doctors look for a cause. Known causes include:
- Antiphospholipid syndrome (APS): an autoimmune condition that causes clots and is treatable
- Uterine abnormalities: a septum, polyps, fibroids that distort the cavity, or adhesions
- Chromosome rearrangements in one partner (in about 2 to 5 percent of couples)
- Thyroid disease and uncontrolled diabetes
- High prolactin
- Lifestyle factors: smoking, heavy alcohol, high caffeine and obesity
- Age: the risk of loss rises with the woman's age
- Often, no cause is found, called unexplained recurrent loss
What tests are recommended
Dr. Swati follows the ESHRE 2022 guideline. Tests may include:
| Test | Looks for |
|---|---|
| Antiphospholipid antibodies, repeated after 12 weeks if positive | APS |
| Pelvic ultrasound, 3D scan or hysteroscopy | Uterine shape, septum, polyps, fibroids |
| Thyroid function and thyroid antibodies | Thyroid disease |
| HbA1c or glucose | Diabetes |
| Prolactin | High prolactin |
| Karyotype (both partners) | Chromosome rearrangements, in selected couples |
| Testing tissue from a loss, if available | Chromosome error in the embryo |
Tests not routinely advised include inherited thrombophilia, NK cell tests and many immune panels, because they do not change care. See Reproductive immunology.
Treatment
- APS: low-dose aspirin and heparin in pregnancy, which improves outcomes
- Uterine septum or polyps: removal through hysteroscopy
- Thyroid and diabetes: treatment before pregnancy
- Lifestyle: quitting smoking, limiting alcohol and caffeine, healthy weight
- Unexplained loss: supportive care, with early scans and regular reviews, which is associated with good outcomes. Dr. Swati explains where progesterone may be considered, such as in women with bleeding in early pregnancy and a history of loss.
- IVF with embryo testing is not routinely recommended for unexplained loss, but may be discussed in selected cases.
Outlook and emotional care
Many couples with recurrent loss, even with no cause found, go on to have a healthy pregnancy. The outlook depends on age and the number of past losses, and Dr. Swati discusses your own picture with care. The grief of a loss is real, even when it is early. If you are overwhelmed, tell us. We can suggest counselling and support.
When to see a doctor
- After two or more pregnancy losses, ideally before trying again
- After one loss at a later stage, after 10 weeks, or with a known risk factor
- If you are planning a pregnancy and have a history of loss
When to get help straight away. Heavy bleeding, severe pain, fainting, or fever in early pregnancy need emergency care. Call 108 or 112.
FAQs
How many miscarriages count as recurrent?
The ESHRE 2022 guideline defines recurrent pregnancy loss as two or more pregnancy losses. Earlier definitions required three. Doctors now start the evaluation after two, so that treatable causes are found sooner.
Is it my fault?
No. Most miscarriages happen because the embryo has a chromosome error, which is chance and not caused by work, stress, exercise, a fall, or anything you did. Please be kind to yourself. A medical evaluation looks for causes that can be treated.
Will I be able to carry a pregnancy to term?
Many couples with recurrent loss do, including those with no cause found. The chance depends on age, the number of earlier losses and any cause found. Dr. Swati reviews your history and explains your outlook honestly, without false promises.
What tests should I have after two miscarriages?
Usually antiphospholipid antibodies, a pelvic ultrasound or hysteroscopy, thyroid and blood sugar tests, prolactin and sometimes karyotyping of both partners. Dr. Swati chooses based on your history. Tests that guidelines do not support are not recommended.
Can I take any treatment during my next pregnancy?
Treatment depends on the cause. In confirmed APS, aspirin and heparin help. For some women with bleeding and earlier loss, progesterone may be considered. For unexplained loss, supportive care and early scans are advised. Dr. Swati explains the evidence for any option.
When can I try again after a miscarriage?
Many couples can try again after one normal period, once physical and emotional recovery allow. If you have had two or more losses, getting evaluated first is wise. Dr. Swati can guide the timing and the early scan.
Sources
- ESHRE Guideline: Recurrent pregnancy loss (2022)
- RCOG Green-top Guideline No. 17: Recurrent first-trimester and second-trimester miscarriage
- ASRM Practice Committee, Evaluation and treatment of recurrent pregnancy loss
