Recurrent Miscarriage

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Women's Wellness
Recurrent Miscarriage

Medically Reviewed April 2023, by Mr. Bryan Mayou (GMC: 1414396) - founder of the Cadogan Clinic and one of the world's leading plastic surgeons

What is Recurrent Miscarriage?

A miscarriage, when a pregnancy is lost within the first 23 weeks, is a devastating experience.

Recurrent miscarriage is the term used to describe three or more miscarriages in a row. This is rare and something that affects an estimated 1% of couples in the UK. Nevertheless, having multiple miscarriages can be a traumatic experience, prompting misplaced feelings of guilt and self-blame.

There are a number of things which may be responsible for recurrent miscarriage, including uterine problems, blood clotting disorders, thyroid problems and cervical weakness. A blood test and scan can be carried out to determine what is causing recurrent miscarriage and help doctors to decide on a course of action. However sometimes there is no obvious reason for multiple miscarriages, which can be very difficult to accept.

You may be experiencing grief or shock and multiple miscarriages can trigger mental health problems, such as depression or anxiety. If you are struggling to process your emotions following recurrent miscarriages, then you should speak to your doctor or seek help from organisations such as Tommy’s, which supports families after baby loss.

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What are the risk factors of Recurrent Miscarriage?

There are two main risk factors which may increase the likelihood of multiple miscarriages.

Age: The risk of miscarriage is the highest among couples where the woman is 35 years old or above and the man is over 40. However this doesn’t mean that all couples in this demographic will experience miscarriage.
Previous miscarriages: Unfortunately the risk of miscarriage increases after each successive loss. In the case of recurrent miscarriage, women who have experienced three miscarriages in a row will have a 40% chance of having another one.

If you suffer from certain health conditions, this can make multiple miscarriages more likely.

What causes Recurrent Miscarriage?

Recurrent miscarriage causes are not always known, but there are some conditions which may be responsible.

Blood clotting disorders: Some blood clotting disorders, such as systemic lupus erythematosus and antiphospholipid syndrome can affect the flow of blood to the placenta, causing clots that prevent it from working properly. This blocks the flow of essential oxygen and nutrients from reaching the baby.
Abnormally-shaped uterus: If you have an abnormally-shaped womb, then this may be what is causing your multiple miscarriages. This may include a heart-shaped or a T-shaped uterus.
Cervical weakness: If your miscarriages are occuring later on in pregnancy, then a weak cervix may be responsible.
Genetic cause: The presence of an abnormal chromosome may be behind recurrent miscarriages. This chromosome may be found in one or both parents.
Thyroid problems: If you do not have a healthy thyroid function before getting pregnant then this may cause miscarriage or pregnancy complications.
Thyroid antibodies: Thyroid antibodies attack the thyroid, causing it not to work properly. If the thyroid is not functioning as it should, then this can heighten the risk of miscarriage.
Natural killer cells: Some fertility experts believe that so-called natural killer cells present in the uterus can cause miscarriage. There are tests available which can detect the presence of these cells.

How are Recurrent Miscarriages investigated?

If you have experienced multiple miscarriages, then the doctor will want to investigate further. You will be asked to undergo a blood test, which will show up problems such as blood clotting disorders, polycystic ovary syndrome, thyroid issues or the presence of any abnormal chromosomes. A blood test will also detect high levels of antibodies which can interfere with pregnancy by affecting the blood supply to the placenta or affecting the way the placenta attaches in the uterus.

If an abnormally-shaped uterus is believed to be causing reccurrant miscarriage, then the doctor will want to carry out some scans to take a closer look inside your body. This may include a hysteroscopy, where the uterus is flushed through before a small camera is placed inside, a laparoscopy, which involves putting a camera and a light source into the body via small incisions in the abdomen, or a pelvic ultrasound scan which uses sound waves to view the uterus. This may be carried out by using a scanner over the stomach or a probe may be inserted into the vagina to allow for a better view of the uterus and ovaries. This is known as a transvaginal ultrasound scan.

Treatment and Management

Once the doctor has discovered what is causing recurrent miscarriage, then they can decide on treatment and management. Recurrent miscarriage treatment may include the following:

Blood thinners: If blood clotting is causing multiple miscarriage then taking asprin and anticoagulant heparin can help to thin the blood. This will help to prevent blood clots, allowing the blood to flow freely in the placenta, ensuring the baby gets essential nutrients and oxygen.
Thyroid medication: If thyroid problems are causing your recurrent miscarriages, then this is easy to treat. Thyroid medication will help to regulate your thyroid levels. Once you have been tested and the doctor is sure that you have a healthy thyroid function then you can try for a baby.
Cervical cerclage: If a weak cervix is causing you to miscarry later on in pregnancy, your doctor may advise you to have a cervical cerclage, otherwise known as a cervical stitch, either before or during the pregnancy.
Surgery: If scans show that you have an abnormally-shaped uterus which is causing recurrent miscarriages, then surgery may be recommended.
Progesterone treatment: This is a relatively new recurrent miscarriage treatment. Progesterone is a hormone that thickens the uterine lining and helps the mother’s body to accept the growing baby. Women who have experienced bleeding in early pregnancy and have a history of miscarriage may benefit from progesterone treatment. This particular recurrent miscarriage treatment is administered as pessaries, which will need to be taken twice a day via the vagina.

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Frequently Asked Questions

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What should I do if I have recurrent miscarriages?

If you have suffered three or more consecutive miscarriages, you should go to the doctor to find out exactly what is causing this to happen. As part of their investigations, the doctor will take a blood sample for testing and may order a number of scans to be carried out. The results of these tests and scans will determine what needs to happen next with regards to treatment. If you are struggling with depression or anxiety, you should seek additional mental health support.

Does sperm influence recurrent miscarriage?

Contrary to popular belief, miscarriage is not always prompted by a female health issue. Sperm can have an influence on recurrent miscarriage. The presence of an abnormal chromosome can cause miscarriage and this may come from the male partner’s sperm. Therefore it is important that the male partner is also investigated if a couple has experienced recurrent miscarriages in the same way that male fertility should also be investigated if a couple are having difficulty conceiving.

What is a missed or delayed miscarriage?

A missed or delayed miscarriage is a miscarriage that is only spotted during a routine scan carried out as part of your routine antenatal care. The scan may reveal that the baby has no heartbeat or that the baby is too small in size for the delivery date.

If this is the case, then the next step will be to wait for the pregnancy tissue to pass out of the uterus naturally or you may need to take medicine to cause the tissue to pass out of the uterus. Sometimes the pregnancy tissue may need to be surgically removed.

What support is available for recurrent miscarriage?

If you have experienced multiple miscarriages, it is important that you seek appropriate support to help you through this difficult time.

The Miscarriage Association is a charity that offers support to people who have lost a baby. Their helpline number is 01924 200 799 or you can email info@miscarriageassociation.org.uk to be put in touch with a support volunteer.

Cruse Bereavement Care helps people understand their grief and cope with their loss. The charity also has a helpline (0808 808 1677) along with a network of local branches which can offer support.

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