Defined as the loss of two or more pregnancies, recurrent miscarriage can be devastating. Specialist investigation and treatment may improve chances of a successful next pregnancy.
Recurrent miscarriage, also known as recurrent pregnancy loss, affects a small proportion of couples trying to conceive. While repeated pregnancy loss can feel overwhelming, it is important to know that many people who experience recurrent miscarriage go on to have a healthy pregnancy with appropriate investigation, support, and care.
Recurrent miscarriage refers to two or more pregnancy losses. Most miscarriages occur during the first trimester, although recurrent miscarriage can also include losses later in pregnancy, up to 20 weeks’ gestation. In Australia, repeated miscarriage affects up to 4% of couples trying to conceive.
Experiencing one miscarriage is relatively common and does not necessarily indicate an ongoing fertility problem. However, when pregnancy loss occurs repeatedly, further investigation is recommended to identify whether an underlying cause can be treated.
There are many possible reasons why recurrent miscarriage may occur. Sometimes a single factor is identified, while in other cases multiple factors may contribute. In up to half of recurrent pregnancy losses, no explanation can be found. This can be particularly frustrating and difficult to accept but despite the lack of an identifiable cause, fertility treatment can still be an effective way forward.
Around two-thirds of early miscarriages occur because the embryo has an abnormal number of chromosomes. These changes usually happen spontaneously during conception and are often not inherited.
As the age of the female partner increases, the risk of chromosomal abnormalities in embryos also increases. This is because the quality of an egg naturally declines with age.
Structural differences affecting the uterus may increase the risk of miscarriage. Such conditions include uterine septums, fibroids that distort the uterine cavity, scar tissue, or other congenital uterine abnormalities.
Hormone-related conditions such as thyroid disorders, poorly controlled diabetes, and some ovulation disorders may contribute to pregnancy loss in some women.
Certain autoimmune conditions can increase the risk of miscarriage. One example is antiphospholipid syndrome, a blood clotting disorder that can interfere with the function of the placenta.
In some cases, one partner may carry a balanced chromosomal rearrangement that does not affect their own health but may result in an embryo being formed with an abnormal amount of chromosomal material.
Smoking, excessive alcohol consumption, obesity, and some environmental exposures may affect fertility and pregnancy outcomes.
Couples who have experienced more than one pregnancy loss are recommended to seek the care of a fertility specialist, who can conduct the right investigations and offer an appropriate treatment to improve the likelihood of a positive outcome for the next pregnancy.
Dr Anna’s assessment for recurrent miscarriage will begin with a comprehensive review of your medical history, including details of previous pregnancies, any existing medical conditions, lifestyle factors, medications, and your family history.
Next steps will be guided by contributing factors that may have been flagged at your initial consultation. Testing for recurrent miscarriage can include:
Effective treatment for recurrent miscarriage is based on treating the underlying cause, where one can be found. Treatments may include medications for hormone or endocrine conditions, lifestyle modifications, or surgery to manage uterine conditions.
For some couples, fertility treatment may be considered as offering the most appropriate solution, particularly for those experiencing unexplained recurrent pregnancy losses.
IVF is an assisted reproductive technology often used to manage many causes of fertility challenges. In the context of recurrent pregnancy loss, conception through IVF provides the opportunity to have greater control over the fertilisation process and also to have genetic testing on your embryos or use donor eggs or sperm.
PGT may be used alongside IVF to assess embryos for certain chromosomal abnormalities, and is often considered for other reasons as well as for managing recurrent miscarriage. Identifying which embryos have a complete set of normal chromosomes allows transfer of an embryo with a genetic fault to be avoided. There are a few types of PGT; the most appropriate test is determined by your medical history, family history, and results of relevant genetic tests already done.
If genetic abnormalities in you and/or your partner’s eggs and sperm are determined to be contributing to repeated pregnancy loss, using donor eggs or sperm may help to overcome this problem. Age-related egg quality decline can be managed using donated eggs from young women. All donors accessed through a clinic-recruited donor program have been thoroughly screened, and you will also have the opportunity to undertake PGT on these embryos conceived through donor sperm/eggs and IVF.
