Recurrent Miscarriage: When to Seek Further Investigation

Experiencing a miscarriage can be physically and emotionally difficult. When pregnancy loss happens more than once, it is understandable to wonder why it is happening and whether further investigation could provide answers.

While miscarriage is common, repeated losses may warrant a closer look at your reproductive health. Recurrent miscarriage can have several possible causes, from chromosomal changes to uterine or medical conditions, although sometimes even no specific cause is identified.

Understanding when to seek advice and what recurrent miscarriage testing may involve can help you make informed decisions about your next steps.

Definitions vary, but current Australasian guidance defines recurrent pregnancy loss as at least two clinical pregnancy losses before 20 weeks.

Recurrent miscarriage symptoms are generally the symptoms associated with an individual miscarriage rather than a separate set of symptoms. These can include miscarriage bleeding, cramping and the loss of pregnancy symptoms, although experiences can differ between pregnancies.

Importantly, having more than one miscarriage does not necessarily mean you will be unable to have a healthy pregnancy in the future.

If you have experienced two or more pregnancy losses, it may be appropriate to discuss your history with your doctor or a fertility specialist.

Drawing on almost two decades of experience in fertility care, Dr Joseph Sgroi notes that miscarriage is relatively common, with around one in six pregnancies ending before 20 weeks. Recurrent pregnancy loss is less common, with approximately 2% of women experiencing three or more consecutive early miscarriages.

Seeking advice does not necessarily mean you will require IVF or another fertility treatment. The first step is usually understanding your medical and pregnancy history and determining whether miscarriage investigations or broader fertility testing may be appropriate.

Testing should be tailored to your individual pregnancy and medical history rather than applying every available test routinely.

Blood tests

Blood tests may assess factors such as thyroid function, relevant hormone levels and antiphospholipid antibodies.

Genetic testing

Chromosome testing may be considered for both partners in selected circumstances to identify genetic changes that could contribute to pregnancy loss.

Ultrasound and uterine assessment

A pelvic ultrasound can assess the uterus for structural differences, fibroids and other abnormalities. Further assessment, such as hysteroscopy, may sometimes be recommended.

Testing pregnancy tissue after a miscarriage

Where appropriate and available, pregnancy tissue can undergo chromosome analysis. This may help determine whether a chromosomal abnormality contributed to the loss.

Are other fertility tests needed?

Additional testing may be considered based on your circumstances, including assessment of ovarian reserve, egg quality and sperm quality. Not every person experiencing recurrent miscarriage will require the same fertility investigations.

The next step depends on what the investigations identify.

Miscarriage treatment may involve managing an underlying medical condition, addressing certain uterine abnormalities or developing a plan for monitoring a future pregnancy. Where fertility factors are also present, treatment options may include assisted reproduction such as IVF or IUI.

The aim is to develop an individual plan tailored to you and both your history and test results rather than treating recurrent miscarriage as a single generic condition with one solution.

Yes. Experiencing recurrent miscarriage does not mean that future pregnancies will also end in miscarriage.

Your individual chance of a successful pregnancy depends on factors including age, number and timing of previous losses and whether an underlying cause is identified. Dr Joseph emphasises that most women who experience miscarriage will go on to have a baby. Even after recurrent pregnancy loss, there can still be a strong chance of a successful future pregnancy, particularly with appropriate investigation, ongoing care and support tailored to the individual.

If you have experienced repeated pregnancy loss, you do not need to work through the possible causes on your own.

Dr Joseph Sgroi provides assessment and personalised care for recurrent miscarriage, including appropriate investigations and discussion of potential treatment options based on your individual circumstances.

Book an appointment with Dr Joseph Sgroi to discuss your pregnancy history, fertility and the next steps that may be appropriate for you.