What is recurrent miscarriage?
If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have recurrent miscarriage, you should be referred to a specialist doctor called a gynaecologist. She will try to find out whether or not there is a cause for your losses.
Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. But if you can, try to draw comfort from the fact that many women who experience recurrent losses do go on to have a baby.
How common is recurrent miscarriage?
About one woman in 100 experiences recurrent miscarriage. For a third of women who have recurrent miscarriage, no reason for it happening will be found. But there can be problems that cause some women to miscarry again and again.
What causes recurrent miscarriage?
When you have endured recurrent miscarriage, the one question you’ll probably want answered is: “Why is this happening?” Sometimes, sadly, you may not be able to have an answer. But if no reason is found for the miscarriages, it does mean there’s the chance of a successful pregnancy happening next time.
Some conditions are known to lead to miscarriage. Others have been linked to it but it’s not fully understood how or why they may play a part. Experts are finding out more about what causes recurrent miscarriage all the time. Conditions that can lead to recurrent miscarriage are often rare. They include:
- Genetic problems. You or your partner may have an abnormality on one of your chromosomes, which doesn’t cause a problem until it is passed on to your baby.
- A problem which makes your blood clot when it shouldn’t. This is called antiphospholipid syndrome (APS) It can cause miscarriage, stillbirth or premature birth.
- An inherited blood-clotting disorder. This is known as thrombophilia and means that your blood may be more likely to clot than normal. This could cause miscarriage but its role in recurrent miscarriage is not yet clear.
- Problems with your uterus (womb). You may have a uterus that has an abnormal shape, fibroids or cervical weakness.
- A problem with your hormone levels. Some conditions, such as polycystic ovaries have been linked to recurrent miscarriage. But, as yet, it’s not fully understood why they are linked and how well treatments work. It may simply be that your age is having an effect. The older you are, the more likely you are to experience early miscarriage. This is very common and is often caused by a one-off problem with the developing embryo.
From about the age of 35, the quality of your eggs starts to decline more quickly. This can make the genetic material in your eggs more likely to go wrong during fertilisation. A chromosomal abnormality in your baby is therefore more likely to happen and this, in turn, increases the likelihood of miscarriage.
Despite all these possible causes, it often turns out that a reason for recurrent miscarriage cannot be found. This is called unexplained recurrent miscarriage. As more is discovered about what causes recurrent miscarriage, the number of unexplained cases may fall.
What tests and treatment can I have?
If you have had three or more miscarriages in a row, your GP should refer you to a specialist doctor, called a gynaecologist. She will to try to find out why you keep miscarrying. You may be offered the following:
You may have a blood test to check for antiphospholipid syndrome (APS). Tests will look for particular antibodies that go with the condition. Antibodies are chemicals our bodies produce to fight infection. It takes two tests, at least six weeks apart, to give a clear answer. You can still have a successful pregnancy with APS, although you will need to be carefully monitored. The condition should be treated next time you’re pregnant with blood-thinning medicines such as asprin and heparin.
You and your partner can have blood tests to check for chromosome abnormalities. This is called karyotyping. If a problem is discovered, you and your partner should be referred to a clinical genetics specialist and for genetic counselling.
A counsellor can explain what the abnormality is and what your chances are of having a normal pregnancy. Depending on the exact problem, one option may be to have IVF (in vitro fertilisation) and for your embryos to be tested before they are transferred into your uterus.
Like many other women, you may never find out what is behind your pregnancy losses, despite thorough investigations.
To help find more answers, it may be suggested that tests are carried out if you have another miscarriage. You may consent to tests.These tests can look for chromosome problems or tissue from the placenta may be tested for signs of a problem. If an abnormality is discovered then there is a better chance of you having a successful pregnancy next time.
You may have an ultrasound scan to check whether there is an abnormality of your uterus. Depending on the abnormality, it may be possible for you to have a successful pregnancy.
If you have a suspected weak cervix, you may be offered extra scans in your next pregnancy. If your cervix is starting to shorten, widen and open too soon, it may be possible to put a stitch in to try to stop you from miscarrying again. There are pros and cons to this procedure, which your doctor will explain to you.
Both abnormalities of the uterus and cervical weakness are rare conditions.
What are my chances of having a healthy baby?
If your miscarriages are unexplained, then you have a good chance of having a successful pregnancy in the future. You’ll be given extra support and scans. A dedicated team will look after you, and this close care in itself increases your chances of a successful pregnancy. About three quarters of women who have unexplained recurrent losses have a healthy baby eventually.
If you or your partner has a chromosome problem that’s causing the miscarriages, it is hard to say what your chances of having a healthy baby are if you just keep trying. Some problems are not passed on every time you conceive. Every couple is different, so you’ll be referred to a doctor who specialises in genetic disorders.
Some of the conditions that cause recurrent miscarriage are treatable. Your gynaecologist is the best person to ask about your chances of success. She won’t be able to tell you for sure; nobody can. But she’ll be able to take your medical history, your age and test results into account when discussing your chances with you.
All information on this website, and advice and support offered by the charity team is on a non-medical basis. The charity advises that anyone going through baby loss, medical treatment or health issues, should seek advice from their own GP, Consultant, Midwife or Healthcare Professional.Download the Saying Goodbye Support Leaflet (PDF)