All about recurrent miscarriage

Recurrent miscarriage describes the loss of three or more pregnancies and can be an overwhelming experience for those affected. Although distressing, advances in diagnostic testing and tailored treatment mean that many people can go on to have successful pregnancies.

In this article, Ms Neelima Dixit, renowned consultant obstetrician and gynaecologist in Chichester, takes a look at understanding potential causes and knowing when to seek specialist care can be an important first step in moving forward.

What is recurrent miscarriage?

It’s the spontaneous loss of a pregnancy before 24 weeks. Most miscarriages occur only once and are often due to chance genetic problems in the developing embryo. Recurrent miscarriage is defined by repeated losses and usually prompts a more detailed evaluation. It can occur at any stage in the first or second trimester and may or may not involve obvious symptoms. Early assessment provides an opportunity to identify factors that may be contributing to repeated losses.

What causes recurrent miscarriage?

Recurrent miscarriage has many possible explanations and in some cases the cause remains unclear. Common contributing factors include:

Chromosomal problems, where one partner carries a balanced genetic rearrangement that increases the chance of miscarriage
Structural differences in the uterus, such as a septum or fibroids
Immune and clotting conditions, including antiphospholipid syndrome
Hormonal imbalance, for example thyroid disease or poorly regulated diabetes
Lifestyle factors, including smoking or high alcohol intake
Age-related egg quality decline, particularly after the mid thirties

A specialist evaluation usually includes blood tests, imaging and occasionally genetic analysis to build a clear picture of the possible reasons for pregnancy loss.

What to do after repeat pregnancy loss?

Anyone who has experienced recurrent miscarriage is encouraged to seek specialist support. A consultation provides space to discuss the pregnancy history and outline what investigations may be helpful. Tests might include a pelvic ultrasound, hysteroscopy, screening for clotting and immune conditions and assessment of thyroid function. Emotional wellbeing is also an important aspect of care and many people benefit from counselling while undergoing investigations.

Is treatment available for repeat pregnancy loss?

Treatment for recurrent miscarriage depends on the results. Surgical correction of uterine abnormalities, management of thyroid or metabolic conditions and specific therapies for immune or clotting problems can all improve the chance of carrying a pregnancy to term. In some cases, assisted conception may be suggested, particularly when there are significant fertility factors.

I offer a wide range of highly specialised services including the following:

Recurrent implantation failure: It can be emotionally challenging. It Includes highly-specialised semen testing, such as sperm DNA fragmentations.
CD138 staining endometrial biopsy: I also offer this service in order to understand the lining of the womb characteristic and the reasons for recurrent miscarriages.

Can recurrent miscarriage be prevented?

Not all miscarriages can be prevented, but stabilising underlying health conditions and making certain lifestyle changes can reduce risk. Maintaining a healthy weight, stopping smoking and moderating alcohol intake are all advised. Taking folic acid before conception and throughout early pregnancy supports healthy development. When a clear medical cause has been identified, treatment before conception is often key to prevention. For example, women with antiphospholipid syndrome may benefit from specific medicines during pregnancy to improve outcomes.

What does recovery look like?

Recurrent miscarriage has physical and emotional effects. Most people can try to conceive again once investigations are complete and any treatment plans are in place. With specialist care and a personalised approach, many individuals affected by recurrent miscarriage are able to achieve a healthy pregnancy in the future.

Arrange a consultation with Ms Dixit, who privately practises at Nuffield Health Chichester Hospital, St. Richard's Hospital and the Meyer Clinic, via her Top Doctors profile.