Recurrent miscarriage, also known as repeated miscarriage, is defined as the loss of three or more pregnancies during the first trimester (the first 12 weeks of pregnancy). These miscarriages do not have to happen consecutively, and can occur even if you have previously had a successful pregnancy.
We understand that experiencing repeated pregnancy loss can be distressing, but investigations may help identify possible underlying causes – and guide the next steps towards a successful pregnancy.
What is a Miscarriage? Sporadic vs Recurrent Pregnancy
A miscarriage is typically defined as the loss of a pregnancy before 24 weeks. Most miscarriages occur during the first trimester, and can happen for several reasons, although the exact cause is not always known.
Miscarriages are generally classified as either sporadic or recurrent, depending on how frequently pregnancy loss has occurred. Let’s look at more detail on what these definitions mean
| Sporadic Miscarriage | Recurrent Miscarriage |
| Definition: A single or occasional pregnancy loss. | Definition: Three or more early miscarriages, which do not have to occur consecutively. |
| Frequency: Relatively common, with around 1 in 5 women experiencing an early miscarriage. | Frequency: Less common, affecting approximately 1 in 100 women. |
| Common causes: Often linked to random chromosomal abnormalities in the developing pregnancy. | Common causes: May involve genetic, hormonal, anatomical or blood-clotting factors, although many cases remain unexplained. |
| Medical investigations: Extensive investigations into underlying causes are not routinely recommended after a single early miscarriage. | Medical investigations: Further testing is recommended after three early miscarriages, although investigations may begin sooner where clinically appropriate. |
Understanding the distinction can help determine whether further fertility investigations may be beneficial. If you have experienced repeated pregnancy loss, a fertility specialist can assess your medical history and recommend appropriate tests to investigate possible causes.
Key Causes and Risk Factors of Recurrent Miscarriages
There are several possible causes of recurrent miscarriage, although in some cases, no clear explanation is found. Some factors relate to underlying medical conditions or genetic abnormalities, while others, such as age and lifestyle, may increase the risk of pregnancy loss.
- Genetic and chromosomal abnormalities: Chromosomal abnormalities are a common cause of early miscarriage, occurring when an embryo has too many or too few chromosomes. In some cases, a parent may carry a chromosomal rearrangement that increases the risk of repeated pregnancy loss.
- Hormonal and endocrine conditions: Poorly controlled diabetes, thyroid disorders and polycystic ovary syndrome (PCOS) may be associated with an increased risk of miscarriage. Identifying and managing these conditions can help improve pregnancy outcomes.
- Uterine and cervical abnormalities: Structural differences in the uterus, such as a septate uterus, can sometimes contribute to recurrent miscarriage. Cervical weakness may also increase the risk of pregnancy loss during the second trimester.
- Age and lifestyle factors: Miscarriage risk increases with maternal age, particularly after 35. Smoking, excessive alcohol consumption, high caffeine intake and being significantly underweight or overweight may also increase the risk.
Unexplained recurrent miscarriage is also common, with investigations sometimes unable to identify a specific underlying cause. However, many women who experience recurrent pregnancy loss go on to have a successful pregnancy, even when no cause is found.
When Should You Seek Investigation for Recurrent Losses?
A single early miscarriage is relatively common, and does not usually require further fertility investigations – particularly when there are no other known risk factors.
However, investigations are generally recommended after three early miscarriages. Your fertility specialist may also recommend testing earlier if:
- You have experienced two miscarriages and an underlying medical condition is suspected.
- You have experienced a miscarriage after a baby’s heartbeat was confirmed, alongside other clinical concerns.
- You have experienced a second-trimester miscarriage.
At Concept Fertility, we assess each patient’s circumstances individually to determine whether further testing may be beneficial.
Summary of Recommended Diagnostic Tests and Screenings
Investigating recurrent miscarriages may involve a combination of blood tests, ultrasound scans and genetic screening to identify potential underlying causes.
The tests recommended will depend on your medical history, previous pregnancies and individual circumstances.
| Diagnostic Test | Purpose and What It Involves |
| Blood tests and clotting disorder screening | Checks for conditions such as antiphospholipid syndrome (APS). Thyroid function, diabetes and other hormonal conditions may also be assessed. |
| 3D pelvic ultrasound scan | Examines the shape and structure of the uterus to identify abnormalities, such as a uterine septum or fibroids, that may contribute to pregnancy loss. |
| Genetic and chromosomal testing | Examines pregnancy tissue or, where appropriate, the chromosomes of both partners to identify genetic abnormalities associated with recurrent miscarriage. |
Your fertility specialist will discuss which investigations are appropriate, and explain how the results may help guide future treatment or pregnancy monitoring.
Asked Questions About Recurrent Pregnancy Loss (New)
Can progesterone prevent miscarriage?
Progesterone treatment may help reduce the risk of miscarriage in certain circumstances. NICE recommends offering vaginal progesterone to women who experience bleeding in early pregnancy, have previously had a miscarriage and have an intrauterine pregnancy confirmed by ultrasound. However, progesterone is not proven to prevent all miscarriages, and should only be used under medical guidance.
What is a first trimester pregnancy loss?
A first trimester pregnancy loss is a miscarriage that occurs during the first three months of pregnancy, generally within the first 12 weeks. It is the most common type of miscarriage, and often occurs because of chromosomal abnormalities that prevent the pregnancy from developing normally.
Can you have a successful pregnancy after recurrent miscarriages?
Yes, many women who experience recurrent miscarriages go on to have a successful pregnancy, even when no underlying cause is identified. The likelihood depends on factors such as age, medical history and previous pregnancy losses.
Can recurrent miscarriages be treated?
Treatment of recurrent miscarriage depends on the underlying cause. For example, women diagnosed with antiphospholipid syndrome (APS) may benefit from prescribed medication, while some uterine abnormalities may be treated surgically. Where no cause is identified, specialist support and early pregnancy monitoring may still be beneficial.
Next Steps: Accessing Specialist Recurrent Miscarriage Clinics
If you have experienced repeated miscarriages, seeking specialist advice can help you understand the possible causes. You can speak to your GP about a referral to a recurrent miscarriage clinic, or contact a fertility specialist directly to discuss whether further investigations may be appropriate.
Before your initial consultation, it can be helpful to:
- Gather your medical records: Bring details of previous pregnancies, ultrasound scans, blood tests and any investigations or treatments you have received.
- Keep a record of your symptoms: Note when previous miscarriages occurred, any bleeding or pain you experienced, and other relevant details about your pregnancy history.
- Prepare your questions: Consider what you would like to know about potential causes, recommended tests, and options for future pregnancy care.
At Concept Fertility, our specialists can assess your individual circumstances and help you understand the next steps. Book an initial consultation to discuss your pregnancy history, and whether further investigations could be beneficial.
