Recurrent miscarriage is usually defined as having three or more miscarriages in a row, whether or not you have had any healthy pregnancies. If this has happened to you, you should be offered tests to see if there is an underlying cause or causes.
You might be offered tests after two early miscarriages if you are in your late 30s or 40s or if it has taken you a long time to conceive. You should also be offered tests if your baby died after 14 weeks of pregnancy. You’ll find information about tests for late loss here.
The strain on NHS services due to the coronavirus pandemic means that most investigation appointments and processes are on hold for the time being but (as at 18.5.20) they are due to be reintroduced gradually in the next few weeks. We know how distressing this delay will be for many of you but hope you’ll understand the reasons for this.
It may sound obvious, but tests for recurrent or late miscarriage should always be based on known or likely causes of these losses, unless they are part of clinical research.
We provide information here about the known causes of and tests for recurrent miscarriage, based on current UK recommended practice. The UK’s Royal College of Obstetricians and Gynaecologists also provides very helpful patient information, which will be updated in 2021, along with new guidance for doctors. You might also want to read the European guideline on recurrent pregnancy loss, published by ESHRE in January 2018. This guideline differs from current UK practice and we write about it here.
Answers – or not
It’s important to know that having tests does not necessarily mean that a cause or causes will be found. About half of the couples who have investigations don’t come out with any clear reason for their miscarriages. This can be very frustrating, but it is also positive news because it means that there is a good chance of the next pregnancy being successful, without any treatment at all.
If a problem is identified, there may still be a good chance of having a successful pregnancy. This will depend on what is found and whether there is any treatment to reduce the risk next time. For example:
- Some miscarriages are caused by chance (e.g. a chromosome abnormality in the baby) and cannot be predicted or prevented. Fortunately, they are not very likely to happen again.
- Some causes of miscarriage cannot be treated because as there is no way of changing the basic problem (e.g. a problem with the parents’ chromosomes), but parents may be advised to consider other options (like using donor eggs or sperm).
If you are found to have a problem which has a clear treatment plan, that can be very positive news. Even so, your doctor should warn you that treatments don’t always work – especially if a pregnancy miscarries for a different reason from the one being treated. In this case, you may be encouraged to try the treatment again in another pregnancy.
Sometimes treatments are sometimes offered in the hope that they may help. These might include treatments being carefully researched or others where there is no clear evidence one way or another.
There are some treatments which appear to be largely ineffective, but some doctors may offer them anyway on the grounds that they won’t harm; and sadly, there are some that may actually be harmful. We provide information about treatments here.
When there are no answers
It can be very difficult to cope with not knowing why you have had repeated miscarriages and you may well not accept that there aren’t any answers. You might see stories in the media about a new treatment for miscarriage and there’s also a great deal of information on the Internet about miscarriage causes and treatments.
The problem is that it can be difficult to judge how accurate this information is, as many investigations and treatments which are reported have not been properly studied or assessed. Some, as we’ve said above, may even be harmful.
Research into recurrent miscarriage …
Information on the causes and treatment of miscarriage doesn’t stand still and you might want to find out about research that is being done. There may be clinical trials taking place that you can take part in – something that many women find to be a positive experience. We report on recent and current trials here, and we also publish a discussion from 2016 with Professor Arri Coomarasamy about key issues in miscarriage research.
… and support
We know that going through miscarriage after miscarriage can be devastating for women and their partners. Our helpline staff aim to offer support, information and a listening ear, and you might also find it helpful to join our online forum, which has a section for people with recurrent loss. We also have a separate page where we talk more about the emotional impact of recurrent loss, with links to personal stories. You’ll find more information about how we and others can help here.