Having one miscarriage can be devastating enough, but having one after another is often a very traumatic experience. The very thought of trying again can feel like an uphill struggle, with many couples already expecting another loss before the pregnancy has begun. Any future pregnancies will be full of hope but also tinged with a high level of anxiety. Investigations into a possible reason for recurrent miscarriage is advisable after the third recurrent miscarriage.
There are many possible causes for recurrent miscarriage, including: genetic and hormonal problems; infection and thrombophilic (blood-clotting) defects; uterine problems and cervical weakness. Unfortunately, even after investigation, it’s not always possible for doctors to identify the cause for recurrent miscarriage. However, most couples who have had recurrent miscarriage have a good chance of having a baby in the future.
Where possible, couples should be referred to a specialist unit dedicated to managing recurrent miscarriage.Often good supportive antenatal care in these circumstances makes a big difference; there is some evidence that attending an early pregnancy unit can reduce the risk of further miscarriages.
Causes of recurrent miscarriage
- Genetic: In a small number of cases, one partner may repeatedly pass on an abnormal chromosome, causing recurrent miscarriage.Both you and your partner should be offered a blood test to check for chromosomal abnormalities (known as karyotyping). If the tests show a problem, you should be referred to a clinical geneticist for further testing.
- Hormonal: In some rare cases an imbalance in pregnancy hormones can lead to conditions such as polycystic ovaries, multiple cysts on a woman’s ovaries caused by high levels of LH (luteinising hormone) and testosterone, which can cause miscarriage. Healthcare professionals can discuss the pros and cons of medical treatment for this.
- Blood clotting disorders: Some blood clotting disorders, such as systemic lupus erythematosus and antiphospholipid syndrome can cause ‘sticky blood’ and recurrent miscarriage. These rare disorders of the immune system affect the flow of blood to the placenta and may cause clots that prevent the placenta from functioning properly, depriving the baby of essential oxygen and nutrients, which may lead to miscarriage. Treatment may involve taking aspirin and/or heparin therapy, which both help to thin the blood (research shows that in women who have recurrent miscarriage, their blood has an increased tendency to clot, blocking the flow of nutrients to the baby).
- Uterine problems: An abnormally shaped womb can increase your risk of recurrent miscarriage and premature birth. There are a number of ways to investigate the shape of the uterus and depending on the findings, surgery may be recommended.
- Cervical weakness: If you are considered at risk of cervical incompetence or cervical weakness, you may be offered a scan or be advised to have stitch or cervical cerclage early in the pregnancy.
Plan of care after recurrent miscarriages
Following recurrent miscarriages, you will usually be offered certain blood tests and a scan to try to identify the problem. Where possible, you will be referred to a specialist unit dedicated to managing recurrent miscarriage. Often, good supportive antenatal care in these circumstances makes a big difference; there is some evidence that attending an early pregnancy unit can reduce the risk of further miscarriages.
Blood tests: Blood tests may be used to check for complications, such as blood clotting disorders; polycystic ovaries and high levels of certain antibodies that can interfere with the pregnancy by affecting the placental blood supply or causing abnormal placental attachment in the womb.
Uterine investigations: An abnormally shaped womb can increase your risk of recurrent miscarriage and premature birth. There are a number of ways to investigate the shape of the uterus and depending on the findings, surgery may be recommended.
Knowing what and what not to say to people after the loss of a baby can be difficult. We have come up with a list to help you better comfort a bereaved loved one.
If you lose your baby after the first 12 weeks of pregnancy, but before 24 weeks, this is known as a late miscarriage.
Miscarriage is by far the biggest cause of pregnancy loss in the UK, and it’s also the least understood.
I couldn't relax and felt constantly terrified that something would go wrong. At every scan we were shocked and delighted to see that little baby growing bigger and stronger.
There is always someone worse off but it matters to you, so embrace the grief, worry and ultimate joy as it's yours and it's part of your story.
Life is full of unhappy moments and mine happened to be miscarriages.
- RCOG (2011) The Investigation and treatment of couples with Recurrent First-Trimester and Second Trimester Miscarriage. Green Top Guideline No 17, London Royal College of Obstetricians and Gynaecologists.
ℹLast reviewed on August 1st, 2016. Next review date August 1st, 2019.
By Anonymous (not verified) on 19 Jan 2017 - 19:52
Myself and my beautiful wife, besides to start a family shortly after we got married (Aug 15)
As we are in a same-sex relationship, we decided to go for IUI treatment, less intrusive and a slight more natural process.. If you can call it that?!
After blood tests, scans and counselling we were ready to start the process. In April 2016, we headed abroad for our first treatment. We have the treatment and hated every minute of the 2 week wait.
Finally, 2 weeks were over and we tested ........... pregnant! Wow who would have thought it, no medication, a fancy turkey baster technique. 5 weeks along, everything was going so well, amazingly actually!
A week later, everything went from amazing to devistating! We lost the pregnancy very early. "Do worry, it is a one off" they told us. Happens to 1 in 4.
Advised to wait and saving pennies, we aheaded off again to have our second insemination- again the dreaded 2 week wait. Finally the day arrived, we tested, yet again pregnant!
Fast forward- 10 weeks my wife had been bleeding, we were told "it's normal" we knew it wasn't. We have an early scan and saw a heartbeat, wow! Supposedly, I had seen, once there is a heartbeat and risk of mc is reduced. After begging for a scan at 10 week , we see clearly, our pregnancy was no long viable.
My wife planned to have the fetous removed sergically, but that night the heavy bleeding began and so did my heart.
We headed off two months later, again, without a medical cycle, again another two weeks, but this time something unexpected happened- we got a neg result- what a kick in the teeth we wasn't successful, we didn't get over the first hurdle!
The following month, we jumped on the plan and this was our last shot, with everything crossed, we undertook the last treatment. My this time, we are £10k down and nothing to show for it.
We enjoyed the city while we were there and tried our best to relax. The two week wait wasn't so bad at all. I had a lot going on. My fathering-in-laws 60th, my grandmother in hospital and my wife already knew she was pregnant, very early on. We didn't need to test.
Then the dreaded blood make an appearance- it wasn't fresh, which is a look sign, so we have been told. Two days later we have a scan "a strong heartbeat" the sonographer said. "Stop worrying, blood isn't always a bad sign" well in our case blood, whatever it's colour, Is not good news!
Sadly my wife had another missed miscarriage and it due to have surgical intervention, the same day I am burying my grandmother.
This have been emotional tourcher and I don't feel I am able to support my beautiful wife the way I should.
By Midwife @Tommys on 20 Jan 2017 - 10:25
I am so sorry to hear about the journey you and your wife are going through and the miscarriages you have been through. For you to write your story shows such courage, I cannot being to imagine what you are going through. Please know that we are here to support to you both. If you would like a chat or a listening ear, here we have a phone line 0800 0147 800 and email email@example.com. It is confidential, Monday to Friday 9-5pm service x
By Anonymous (not verified) on 20 Jun 2016 - 21:00
I also too have 1 tube left after an ectopic. I have a son who is 5 so I know I can carry. I have recently had my 5th miscarriage and everytime there is a different issue... Had all the blood tests and biopsy done on me to find nothing wrong. The only thing I have not yet tried is the NK killer cells test which I will have to pay for privately.. £350!! Fingers crossed for both of us. I'm 36 and not getting any younger. I'm
Determined not to give up. Good luck honey x
By Anonymous (not verified) on 18 Jun 2016 - 00:50
I have had 10 miscarriages and one ectopic pregnancy that ended in me losing my right fallopian tube after that followed a million different blood test and a patentce test we find out that after all those test and my husband had genetic blood test done to they say they dont know why this keeps happening so some times u never find out why but the trick is to keep faith that when its supposed to happen it will my left side is patent and after all that loss and believe me ladies it never gets better but i will still get out of bed everyday and get dressed and go on with my life and have faith that it will happen someday it had always been taboo to talk about miscarriage but im here to say all my babies matter and we need to speak out woman need support especially with something like this there was times i wanted to just die and get it over with im no longer at that point but i still have my good and bad days my whole point is that if u have had a miscarriage or multiple plz dont let it eat u inside speak out and speak up vent get it out do not hold all that hurt in it can be very hard to even feel like u can talk about it because some ppl may make u feel like theres something wrong with u but theres not most of the time im not saying theres never a reason for recurring miscarriage but as in my case theres no reason they can find so just keep the faith and stay strong .......wow that was a novel lol