About one in six pregnancies ends in miscarriage, and most women who experience one go on to have a straightforward pregnancy afterwards. For a smaller group, around 2% of women, miscarriage happens three or more times in a row. This is called recurrent miscarriage, and it’s a different experience to a single loss, one that usually calls for a closer look at what might be causing it.
Recurrent miscarriage is generally defined as three or more consecutive pregnancy losses before 20 weeks. Some specialists now recommend investigation after two losses, particularly for women over 35 or where a loss involved a confirmed heartbeat.
Recurrent miscarriage symptoms are usually the same as any single miscarriage, including miscarriage bleeding, cramping and the loss of pregnancy symptoms, but occurring across more than one pregnancy. What sets it apart isn’t how any single loss presents, it’s the pattern over time.
Recurrent miscarriage causes vary, and in around half of all cases no clear cause is ever found. Where a cause is identified, it usually falls into one of a few categories.
Most early miscarriages happen because of a chromosomal abnormality in the embryo, most often a one-off random event rather than an inherited issue. Less commonly, one partner carries a chromosomal rearrangement that doesn’t affect their own health but raises the chance of an embryo receiving an unbalanced set of chromosomes. Genetic testing of both partners, and sometimes of pregnancy tissue, can help identify this.
Uterine abnormalities, such as a septum (a band of tissue dividing the uterus), fibroids, or scarring from previous surgery, can affect how well an embryo implants and grows. Some of these are present from birth, others develop over time.
A hormone imbalance, including thyroid conditions and PMOS (Polyendocrine Metabolic Ovarian Syndrome), can affect the uterine lining and early pregnancy support. Immune factors are also involved in some cases: antiphospholipid syndrome, an autoimmune condition that increases blood clotting, is one of the more treatable causes of recurrent miscarriage once identified.
Maternal age is one of the strongest predictors of miscarriage risk, largely because egg quality declines over time and increases the likelihood of chromosomal abnormalities. Sperm quality can also play a role, particularly where sperm DNA fragmentation is high, though this is a less common focus of investigation than egg quality.
Risk increases with maternal age, particularly after 35. Women with known uterine abnormalities, a diagnosed hormone imbalance, or an autoimmune condition are also at higher risk, as are those who have already experienced one or more losses.
Lifestyle factors such as smoking and untreated thyroid disease can also increase the risk of recurrent miscarriage in some people. Smoking has been linked to reduced egg quality and changes to the uterine environment, while untreated thyroid disorders can affect hormone balance and the body’s ability to support a healthy pregnancy. The good news is that many of these factors can be identified and managed with appropriate medical care.
However, it’s important to remember that many women with recurrent miscarriage have no identifiable risk factor, and the absence of a clear cause does not mean there are no options for investigation or treatment.
Recurrent miscarriage testing usually starts with a review of medical and pregnancy history, followed by a set of targeted investigations. Miscarriage investigations commonly include:
A recurrent miscarriage diagnosis isn’t always possible. In around half of cases, testing doesn’t identify a specific cause, which can be frustrating, but it isn’t a reason to stop investigating future pregnancies.
Miscarriage treatment depends on what testing finds. A uterine abnormality may be corrected surgically. Antiphospholipid syndrome and other blood clotting disorders are often managed with blood-thinning medication during future pregnancies. Thyroid and other hormonal causes can usually be treated with medication before trying to conceive again, and where a chromosomal cause is identified, options may include genetic counselling or assisted reproductive technologies like IVF with preimplantation genetic testing (PGT).
If you keep asking why do I keep miscarrying without an answer, it’s worth knowing that a fertility specialist for recurrent miscarriage can still offer supportive management even without a confirmed cause, including closer monitoring in early pregnancy.
Most women who experience recurrent miscarriage go on to have a healthy pregnancy, particularly once any underlying cause has been identified and managed. Close monitoring, early reassurance scans and a clear pregnancy plan can make a meaningful difference, both medically and emotionally. Fertility testing and reproductive health checks before trying again can also help identify anything that wasn’t picked up in earlier investigations.
Dr Joseph Sgroi provides personalised investigation and support for recurrent miscarriage in Melbourne, working through the fertility testing process with you rather than in isolation from your broader reproductive health. Book an appointment with Dr Joseph Sgroi to discuss your history and next steps.
Recurrent miscarriage is generally defined as three or more consecutive pregnancy losses before 20 weeks, though some specialists recommend investigation after two.
Chromosomal abnormalities in the embryo are the most common identifiable cause, though uterine, hormonal and immune factors also contribute. In around half of cases, no clear cause is found.
Testing usually includes genetic testing of both partners, a pelvic ultrasound or hysteroscopy, blood tests for thyroid function and clotting disorders, and, where possible, testing of pregnancy tissue.
Yes. Most women who experience recurrent miscarriage go on to have a healthy pregnancy, especially once any underlying cause has been identified and managed.
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