Introduction: When Loss Keeps Repeating
Experiencing a miscarriage is one of the most profound losses a person can face. Experiencing it multiple times can leave couples feeling devastated, confused, and hopeless. If you have experienced two or more consecutive pregnancy losses, you may be dealing with Recurrent Pregnancy Loss (RPL).
RPL affects approximately 1–2% of couples trying to conceive. But here’s what couples need to hear: in most cases, there is a cause — and there is a path forward.
At PSFC OMR, Chennai, we approach recurrent miscarriage with deep compassion and clinical rigour, leaving no diagnostic stone unturned.
What Is Recurrent Miscarriage?
Recurrent Pregnancy Loss (RPL) is clinically defined as two or more consecutive pregnancy losses before 20 weeks of gestation. Some specialists use three losses as the threshold; more progressive centres investigate after two, especially in women over 35.
Common Causes of Recurrent Miscarriage
1. Chromosomal Abnormalities (Most Common)
In approximately 50–60% of miscarriage cases, the embryo carries chromosomal abnormalities — too many or too few chromosomes. This risk increases with maternal age. If every miscarriage involves a different chromosomally abnormal embryo, the cause is typically random genetic error rather than a structural problem with the parents.
2. Uterine Structural Abnormalities
Conditions such as a septate uterus (a partition dividing the uterine cavity), fibroids (especially submucosal), polyps, or intrauterine adhesions (Asherman’s syndrome) can prevent proper implantation or disrupt blood supply to the developing embryo.
3. Antiphospholipid Syndrome (APS)
APS is an autoimmune condition where the body produces antibodies that cause blood clots in placental vessels, leading to repeated pregnancy loss. It is one of the most important and treatable causes of RPL.
4. Hormonal & Metabolic Imbalances
- Thyroid disorders (both hypo- and hyperthyroidism)
- Uncontrolled diabetes
- Elevated prolactin
- Luteal phase defect (insufficient progesterone)
5. Inherited Thrombophilia
Inherited clotting disorders (e.g., Factor V Leiden, prothrombin gene mutation, MTHFR variants) can increase clotting in placental vessels, leading to repeated pregnancy loss.
6. Parental Chromosomal Rearrangements
In approximately 3–5% of RPL couples, one parent carries a chromosomal rearrangement (balanced translocation) that, when passed on, causes chromosomally unbalanced embryos.
7. Sperm DNA Fragmentation
High sperm DNA fragmentation — not detected in standard semen analysis — is increasingly recognised as a contributing factor in recurrent miscarriage, particularly in first-trimester losses.
8. Unexplained RPL
In approximately 50% of RPL cases, even after thorough investigation, no clear cause is identified. This is frustrating but does not mean the prognosis is poor — many couples in this category go on to have successful pregnancies with supportive care.
Diagnostic Tests for Recurrent Miscarriage
| Test | What It Evaluates |
| Parental karyotyping (blood chromosome test) | Identifies balanced translocations in either parent |
| Hysteroscopy / 3D Ultrasound / MRI | Detects uterine structural abnormalities |
| Antiphospholipid antibody panel | Diagnoses antiphospholipid syndrome (APS) |
| Thrombophilia panel | Identifies inherited clotting disorders |
| Thyroid function tests + TPO antibodies | Detects thyroid-related causes |
| Prolactin, HbA1c, fasting insulin | Screens for metabolic / hormonal causes |
| Sperm DNA fragmentation test | Assesses paternal contribution |
| PGT-A (in IVF setting) | Screens embryos for chromosomal abnormalities |
Treatment Options
1. Antiphospholipid Syndrome
Low-dose aspirin + low molecular weight heparin (LMWH) during pregnancy. This combination has a proven track record and dramatically improves live birth rates in APS.
2. Uterine Abnormalities
Hysteroscopic septum resection, fibroid removal (myomectomy), or polypectomy can restore the uterine cavity to normal. Success rates after surgical correction are excellent.
3. Thyroid & Hormonal Treatment
Optimising TSH to below 2.5 mIU/L before conception, normalising prolactin, and progesterone supplementation in the luteal phase are all effective interventions.
4. Parental Chromosomal Rearrangements
IVF with PGT-SR (preimplantation genetic testing for structural rearrangements) can select chromosomally balanced embryos, significantly reducing the risk of further losses.
5. Unexplained RPL: Supportive Care
For unexplained RPL, evidence-based supportive care includes: progesterone supplementation, low-dose aspirin, vitamin D optimisation, and close early pregnancy monitoring. Psychological support is equally important.
Emotional Support Matters
Recurrent miscarriage takes an enormous emotional toll. At PSFC OMR, Chennai, we offer integrated psychological support alongside clinical care — because healing the heart is as important as finding the medical answer.
Conclusion
Recurrent miscarriage is not a dead end. Most couples who seek a thorough evaluation will find answers — and with the right treatment, most will eventually bring home a healthy baby.
Every loss is a story that deserves to be understood. And every couple who keeps trying deserves a team that never stops looking for answers.
FAQs
How many miscarriages before seeking specialist evaluation?
Most guidelines recommend investigation after 2 consecutive miscarriages. If you are over 35, seek evaluation earlier — even after a first loss.
