Understanding Repeated Miscarriage: Causes, Treatment, and Next Steps

Experiencing a miscarriage is heartbreaking, and for couples trying to start or expand their family, the pain can feel unimaginable. But when miscarriages happen repeatedly, it’s an entirely different level of emotional and physical toll. Repeated miscarriage, also known as recurrent pregnancy loss, is a condition that affects roughly 1% of couples, and it comes with many questions, uncertainties, and misconceptions.

If you’ve gone through more than one miscarriage, you’re not alone—and more importantly, there are ways to find out what’s causing them and what you can do next. In this article, we’ll walk you through the causes of repeated miscarriages, the treatments available, and what steps you can take to move forward.

What is Repeated Miscarriage?

Repeated miscarriage, also known as recurrent pregnancy loss (RPL), is defined as having two or more consecutive miscarriages. While miscarriage in general is common—occurring in about 10-20% of pregnancies—repeated miscarriage is less so and can be a sign that there’s an underlying issue affecting your ability to carry a pregnancy to term.

It’s important to note that many women who experience repeated miscarriages do go on to have healthy pregnancies with the right diagnosis and treatment. The key is finding the cause, which isn’t always obvious but is often treatable.

Common Causes of Repeated Miscarriage

While not every case of recurrent pregnancy loss can be pinned to a specific cause, many can. Here are some of the most common factors that contribute to repeated miscarriages:

1. Chromosomal Abnormalities

One of the leading causes of repeated miscarriage is chromosomal abnormalities in the fetus. These abnormalities can happen randomly, often during the development of the egg or sperm, leading to embryos that are not viable. Most miscarriages that occur in the first trimester are due to chromosomal issues, and while it can be devastating, it’s a natural way for the body to end a pregnancy that wouldn’t result in a healthy baby.

In cases of repeated miscarriage, chromosomal testing (such as karyotyping) of both parents can be done to determine if there’s a genetic issue contributing to the losses. Some couples carry balanced translocations, which means part of one chromosome has switched places with another. This doesn’t typically affect the parents, but it can cause pregnancy loss.

2. Uterine Abnormalities

Structural issues with the uterus can also play a role in recurrent miscarriages. Conditions such as a septate uterus (a congenital malformation where a wall divides the uterine cavity) or fibroids (non-cancerous growths in the uterus) can interfere with the implantation or growth of the embryo. These structural abnormalities make it difficult for a pregnancy to develop properly and are often associated with second-trimester miscarriages.

A thorough evaluation, typically using ultrasound, hysterosalpingography (HSG), or MRI, can detect these uterine abnormalities. If a structural issue is found, it’s often correctable with surgery, improving the chances of a successful pregnancy.

3. Hormonal Imbalances

Hormonal imbalances, especially related to the function of the thyroid or progesterone, can also contribute to repeated miscarriage. Thyroid dysfunction (both hypothyroidism and hyperthyroidism) can disrupt the hormonal balance necessary to sustain a pregnancy. Progesterone, often called the “pregnancy hormone,” plays a crucial role in maintaining the uterine lining where the embryo implants. A lack of progesterone can lead to early miscarriages.

In some cases, women may have polycystic ovary syndrome (PCOS), which can result in hormonal imbalances that affect ovulation and increase the risk of miscarriage. Hormonal testing is part of the standard evaluation for recurrent pregnancy loss, and treatment options, like hormone replacement therapy, can help regulate levels and support a pregnancy.

4. Immune System Disorders

While it may sound surprising, your body’s immune system can sometimes mistake a pregnancy for a threat and attack it, leading to miscarriage. Conditions like antiphospholipid syndrome (APS) and lupus are autoimmune disorders where the immune system mistakenly targets the pregnancy. APS, in particular, causes blood clots to form in the placenta, cutting off oxygen and nutrients to the developing fetus, which can result in miscarriage.

Testing for immune system disorders is typically done through blood tests, and if diagnosed, medications like blood thinners or low-dose aspirin can help reduce the risk of miscarriage.

5. Infections

Certain infections can increase the risk of miscarriage. Bacterial or viral infections, such as those caused by sexually transmitted diseases (STDs), can affect the reproductive system and the ability to carry a pregnancy to term. While most infections during pregnancy don’t result in miscarriage, chronic or untreated infections like chlamydia, gonorrhea, or even a urinary tract infection (UTI) can increase the risk of recurrent loss.

Testing for infections is part of the standard workup for repeated miscarriages, and if an infection is detected, treatment with antibiotics or antivirals can be effective in preventing further losses.

6. Lifestyle Factors

Lifestyle factors such as smoking, alcohol consumption, excessive caffeine, or drug use can increase the risk of miscarriage. Maintaining a healthy lifestyle is key to supporting a healthy pregnancy, and couples trying to conceive should aim to eliminate harmful substances, maintain a balanced diet, and manage stress.

While lifestyle factors alone aren’t usually the sole cause of recurrent miscarriages, they can play a significant role in overall reproductive health.

Diagnosing Repeated Miscarriage: What Tests Can You Expect?

If you’ve experienced repeated miscarriages, it’s time to seek answers. Diagnosing the cause of recurrent pregnancy loss usually involves a series of tests and evaluations, which may include:

• Genetic testing: Both partners may undergo genetic screening to detect chromosomal abnormalities or translocations.

• Hormonal tests: Blood tests to check for thyroid function, progesterone levels, and other hormonal imbalances.

• Uterine imaging: Ultrasounds, hysteroscopy, or MRI scans to look for abnormalities in the structure of the uterus.

• Blood clotting tests: These tests check for conditions like antiphospholipid syndrome, which can cause blood clots during pregnancy.

• Infection screening: Tests for infections that may affect fertility or pregnancy outcomes.

These tests can provide valuable information about the underlying causes of your miscarriages, allowing your doctor to create a tailored treatment plan for you.

Treatment Options for Repeated Miscarriage

Once you’ve identified the cause (or causes) of your repeated miscarriages, your doctor will discuss treatment options. Some of the most common treatments include:

• Hormone therapy: If hormonal imbalances are detected, treatment with hormone replacement therapy, such as progesterone supplements, can help support early pregnancy.

• Surgery: If you have a uterine abnormality, surgery may be recommended to correct the issue and improve the chances of a successful pregnancy.

• Medications for blood disorders: For conditions like antiphospholipid syndrome or other blood clotting disorders, blood thinners (such as heparin) or low-dose aspirin can help improve blood flow to the placenta and reduce the risk of miscarriage.

• Lifestyle modifications: Quitting smoking, reducing alcohol intake, maintaining a healthy weight, and managing stress can all improve fertility and pregnancy outcomes.

• IVF with genetic screening: In cases where chromosomal abnormalities are a concern, in vitro fertilization (IVF) with preimplantation genetic testing (PGT) can help identify healthy embryos before they’re transferred to the uterus.

Emotional Support and Moving Forward

Going through repeated miscarriages can be emotionally and physically exhausting. The loss of multiple pregnancies often leaves couples feeling isolated and grieving. It’s important to acknowledge that these emotions are valid and to seek support—whether from friends, family, or professional counseling.

Support groups can be incredibly beneficial, as they connect you with others who have experienced similar losses. In some cases, simply knowing that you’re not alone can be a source of comfort.

While it’s easy to feel defeated after recurrent miscarriages, many couples go on to have successful pregnancies with the right treatment. Remember that there’s hope, and you don’t have to face this journey alone.

Final Thoughts

Repeated miscarriage can be one of the most challenging experiences for couples trying to conceive, but it’s important to know that answers and solutions are available. By understanding the causes, seeking medical evaluation, and exploring treatment options, many couples find a path forward to a healthy pregnancy.

If you’ve experienced recurrent pregnancy loss, don’t hesitate to reach out to a healthcare professional to begin your journey toward answers. Early intervention, proper diagnosis, and a tailored treatment plan can make all the difference in helping you achieve the family you’ve been dreaming of.