What is Recurrent Miscarriage?
💡 Recurrent miscarriage = ≥2 pregnancy losses before 24 weeks. Affects 1–2% of couples. Main causes: embryo chromosomal errors (most common, ~50%), antiphospholipid syndrome (APS), uterine anomalies (septum, fibroids, polyps), thrombophilia, parental karyotype abnormality, thyroid disorders. Investigation: both partners. Treatment: cause-specific. PGT-A in IVF reduces recurrence.
Recurrent miscarriage (recurrent pregnancy loss / RPL) is defined as the loss of two or more pregnancies before 24 weeks of gestation. It affects approximately 1–2% of couples trying to conceive. While a single miscarriage is most commonly caused by a sporadic chromosomal error in the embryo, recurrent losses indicate an underlying cause that warrants investigation in both partners.
🇮🇳 India Context: Recurrent Miscarriage is widely assessed and treated across major Indian fertility centres including Chennai, Mumbai, Bangalore, Delhi, and Hyderabad.
What are the key characteristics of Recurrent Miscarriage?
- Definition: ESHRE/ASRM: ≥2 losses (many centres investigate after 2 losses in women over 35, or 3 in younger women); losses before 10 weeks = biochemical/early miscarriage; 10–24 weeks = late miscarriage
- Embryonic chromosomal errors: ~50% of recurrent losses are caused by de novo chromosomal aneuploidy in embryos — increases sharply with maternal age; not correctable but PGT-A (preimplantation genetic testing) in IVF can select euploid embryos
- Antiphospholipid syndrome (APS): most important treatable cause; antiphospholipid antibodies (anticardiolipin, anti-β2-glycoprotein I, lupus anticoagulant) cause placental thrombosis; treatment: aspirin 75mg + LMWH (heparin) from positive pregnancy test; reduces miscarriage rate by ~50%
- Uterine anomalies: septate uterus (most common congenital anomaly — hysteroscopic metroplasty corrects it); submucous fibroids; intrauterine adhesions (Asherman syndrome); endometrial polyps — all reduce implantation and increase miscarriage
- Parental karyotype: 2–5% of RPL couples carry a balanced translocation (either partner); managed with PGT-SR in IVF
- Thrombophilia: inherited (Factor V Leiden, prothrombin G20210A, MTHFR, protein C/S/antithrombin deficiency); role in early RPL controversial; LMWH may be offered empirically; more clearly associated with late losses and stillbirth
- Thyroid: TSH should be maintained <2.5 mIU/L in women with RPL; thyroid peroxidase antibody (TPO-Ab) positivity associated with higher miscarriage risk even with normal TSH
- Unexplained RPL: 50% of RPL couples have no identifiable cause after full workup; empirical supportive care (aspirin, progesterone, dedicated RPL clinic) improves live birth rates through psychological support and early monitoring
How does Recurrent Miscarriage work?
Why does Recurrent Miscarriage matter in fertility?
Recurrent miscarriage is one of the most emotionally traumatic fertility conditions — the couple achieves pregnancy repeatedly but cannot sustain it. The most important clinical contribution is establishing a cause where possible, because treatable causes (APS, uterine septum) have highly effective interventions. Even in unexplained RPL, the prognosis is good — studies show 65–75% live birth rate in subsequent pregnancies with supportive care alone. PGT-A is the most powerful tool for couples with age-related embryo aneuploidy or confirmed prior aneuploid losses.
What are related terms to Recurrent Miscarriage?
Karyotyping
Karyotyping is a genetic test. A blood sample is taken and the chromosomes are s…
Hysteroscopy
Hysteroscopy is a procedure used to examine the inside of the uterus. A thin, li…
Progesterone
Progesterone is a hormone produced by the corpus luteum — the structure left in …
IVF (In Vitro Fertilisation)
IVF (In Vitro Fertilisation) is an assisted reproductive technology (ART) in whi…
FAQs about Recurrent Miscarriage
What causes recurrent miscarriage?
Causes include embryonic chromosomal aneuploidy (most common), uterine abnormalities (septum, polyps, adhesions), antiphospholipid syndrome, thrombophilia, thyroid disorders, and parental chromosomal translocation. A cause is found in ~50% of cases.
How many miscarriages before investigation?
Most guidelines recommend investigation after 2 consecutive miscarriages. Some couples may be investigated after 2 losses if risk factors (age, prior ectopic, irregular cycles) are present.
Can IVF help with recurrent miscarriage?
Yes. IVF with PGT-A (preimplantation genetic testing) screens embryos for chromosomal abnormalities before transfer, significantly reducing miscarriage risk in women with recurrent aneuploidy-related losses.
Is recurrent miscarriage common?
Recurrent miscarriage (2+ consecutive losses) affects approximately 1–2% of couples trying to conceive. It is distinct from sporadic miscarriage, which affects up to 15–20% of recognised pregnancies.
What tests are done for recurrent miscarriage?
Standard investigations: parental karyotype, antiphospholipid antibodies, uterine cavity assessment (sonohysterogram or hysteroscopy), thyroid function, thrombophilia screen, and products of conception karyotype if available.
What is the success rate after recurrent miscarriage?
Even without identified cause, 65–70% of couples with recurrent miscarriage will achieve a successful live birth in their next pregnancy. With treatment of identified causes, success rates improve further.
🏥 Find Specialists for Recurrent Miscarriage in India
Connect with verified fertility specialists who can guide you through recurrent miscarriage.