Recurrent miscarriages

What is recurrent miscarriages?

Recurrent miscarriages is defined as having two or more miscarriages. 1% of women experience this. Current guidelines recommend that investigations are done after the third miscarriage, but this depends on each couple’s circumstances. 

What causes recurrent miscarriages?

There can be a variety of causes; in many women, no cause can be found. The most common is that of abnormal chromosomes in the embryo – older mothers are at a higher risk of this. Most of the time, this happens due to a random error during embryo formation. Sometimes, this occurs because one or both partners have genetic translocations (a small piece of chromosome attached to another chromosome) which pass on to the embryo and result in abnormal chromosomes. 

Other causes may include:

• Uterine abnormality: related to abnormal shape due to septum or double uterus. This is more commonly linked with late miscarriages.
• Cervical weakness e.g. short cervix.
• Medical conditions e.g. antiphospholipid syndrome (autoimmune condition where one’s immune system turns onto itself), blood clotting disorders (thrombophilia), diabetes, polycystic ovary syndrome (PCOS).

What tests do I need if I have recurrent miscarriages?

Your gynaecologist will need to take a detailed medical and reproductive history, and perform a physical examination. A transvaginal ultrasound will be done to check your uterus and ovaries. A hysteroscopy may be advised if uterine abnormalities are suspected. You will be advised for blood tests to check your immune system. If tissue from your miscarriage is available, karyotyping (checking if there is the correct number of chromosomes) is recommended. Depending on the results, you and your partner may need to do genetic tests and see a geneticist. 

Is there treatment available?

This depends on the cause – you should discuss with your gynaecologist about the options suitable for you.

For structural abnormalities related to the uterus, surgery is usually recommended for correction. Women with recurrent miscarriages diagnosed to have autoimmune conditions such as antiphospholipid syndrome can be treated with blood-thinning medications e.g. aspirin and heparin to reduce their risk of miscarriage. For genetic issues, there is an option of doing in-vitro fertilisation with pre-implantation genetic testing. For women with cervical weakness/short cervix, there are options of monitoring the cervical length during pregnancy, progesterone supplementation, and possible cerclage.

Regardless of whether or not there is treatment involved, pre-conception care remains important – remember that 65% of women with no cause found will go on to have a successful pregnancy subsequently, with no extra treatment needed.