Recurrent Miscarriages

Recurrent pregnancy loss can be categorised into two types:

• Primary recurrent pregnancy loss occurs in women who have never had a live baby.
• Secondary recurrent pregnancy loss occurs in individuals who have given birth to a live baby.

Recurrent pregnancy loss presents with symptoms that are often similar to those of miscarriage:

• Vaginal bleeding is a common sign
• Cramping or pain may accompany pregnancy loss

However, in some cases, pregnancy loss occurs silently without any noticeable symptoms.

Recurrent pregnancy loss can be attributed to many factors, the most common of which include:

• Chromosomal abnormalities involve genetic issues that make it impossible for the embryo to develop properly; these account for more than half of the cases.
• Uterine abnormalities arise from structural problems in the uterus, such as uterine fibroids, scar tissue, or an abnormally shaped uterus, which can prevent the pregnancy continuation. Approximately, 10‒15% of the women with multiple pregnancy losses have uterine anomalies.
• Hormonal imbalance occurs in conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and luteal phase defects, which disrupt reproductive hormones (luteinising hormone (LH), insulin, thyroid-stimulating hormone (TSH), and progesterone) and complicate pregnancy maintenance.
• Blood clotting disorders (Thrombophilia) cause blood to clot more easily (blood clotting disorders), resulting in interference with the ability of the placenta to nourish the baby. These conditions are therefore a major cause of pregnancy complications, including recurrent pregnancy loss.
• Immune system disorders such as lupus may cause the mother’s immune system to consider the paternal and ‘self’ molecules as foreign and thus attack the foetus.
• Maternal health conditions such as diabetes or unmanaged hypertension increase the risk of recurrent pregnancy loss.

In some cases, the cause of recurrent miscarriages may remain unknown (idiopathic) even after thorough testing.

Doctors use several tests to determine the cause of recurrent pregnancy loss:

• Ultrasound helps identify uterine abnormalities such as fibroids, polyps, or septum that may contribute to miscarriage.
• Hysteroscopy involves inserting a small camera into the uterus to detect structural abnormalities.
• Hormonal tests measure levels of progesterone, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), prolactin, oestradiol, and anti-Mullerian hormone (AMH) to identify any hormonal imbalance.
• Blood clotting tests help detect clotting disorders that are linked to recurrent pregnancy loss.
• Autoimmune tests screen for lupus anticoagulant, anti-beta2 glycoprotein I (IgG and IgM), and anticardiolipin antibodies (IgG and IgM) to check for immune mediated attacks on maternal or foetal tissues.
• Genetic testing (such as parental karyotyping) identifies chromosomal abnormalities that may underlie recurrent pregnancy loss.

The choice of treatment depends on the underlying cause:

• Chromosomal issues may preimplantation genetic testing (PGT) during IVF may be recommended to ensure that only healthy embryos are implanted.
• Uterine abnormalities can often be corrected through surgery, particularly in cases involving fibroids or septa.
• Hormonal imbalance can be managed with medications to regulate hormone levels and support a healthy pregnancy.
• Blood clotting disorders may be treated with blood thinners such as aspirin or heparin, to improve placental blood flow, thereby reducing the risk of miscarriage.
• Autoimmune problems may be managed with treatments that reduce immune overactivity.

Additionally, lifestyle modifications such as maintain a healthy weight, managing diabetes, and quitting smoking can improve pregnancy outcomes.

You should seek medical advice after experiencing two or more consecutive miscarriages, as early evaluation and intervention improve the chances of a successful pregnancy.

Although recurrent pregnancy loss cannot always be prevented, some measures may reduce risk. Maintaining overall health, following medical advice, and addressing chronic conditions before and during pregnancy can support better outcomes.

Women with recurrent pregnancy loss should consult a gynaecologist or a reproductive endocrinologist, who can provide targeted diagnostic evaluation and treatment.