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Recurrent miscarriages
I've had multiple miscarriages. What do I do now?
Any miscarriage is an extremely emotional time that comes with its own unique form of grief. Having more than one may feel unfair, overwhelming, and may impact your emotional wellbeing.
Unfortunately, there is a small percentage of women and birthing people (~1%) that will experience recurrent miscarriages.1 Typically, recurrent miscarriage refers to experiencing multiple miscarriages in a row. Traditionally, it has been described as the loss of three, or more consecutive pregnancies, however, definitions may vary.2–5 Recurrent miscarriages may occur at similar or different stages of pregnancy.6
The emotional impact
A second miscarriage is a crucial event for negatively affecting levels of anxiety and depression in women and birthing people.7,8 The grief becomes bigger and more isolating, and you may become fearful of getting pregnant again.9 This emotional burden further deteriorates with each additional miscarriage and may have an impact on physical wellbeing as well as mental health.7,8
Common feelings that arise with recurrent pregnancy loss:
Recurrent pregnancy loss may also have a negative impact on relationships. Although the emotional burden is greater in the person who has physically experienced a miscarriage, partners may also develop anxiety and depression during this time.10 Studies demonstrate that effective communication between partners and sharing the experience of miscarriage has a key role in decreasing psychological risks, such as depression.10
It may be difficult to acknowledge another pregnancy loss, and you may not feel able to talk about your experience. But engaging with someone may help you get the support you need.
After experiencing recurrent miscarriage, you may start questioning:
- Why is this happening to me?
- Will I ever have a healthy pregnancy?
- Can I cope with continuing to try for a baby?
- Is there anything to help prevent this from happening?
All these feelings are common, so don’t be afraid to ask them out loud. No one should suffer in silence, and after multiple pregnancy losses, your healthcare provider should provide you additional support to understand why this may be happening.
Intervention
For women and birthing people who experience recurrent miscarriage, it is recommended that a referral to a reproductive specialist should be offered to investigate if there are any underlying issues affecting pregnancy.4,5,6,11
If you have experienced three or more miscarriages but had a healthy pregnancy (or pregnancies) in between, you are still considered as experiencing recurrent miscarriage and can request additional support from your health care provider.6
There are certain risk factors for miscarriage in every pregnancy. However, in recurrent miscarriages, there may be underlying issues that make recurrent pregnancy loss more likely.
Tests for recurrent miscarriage
If you have been referred to a reproductive specialist, they will offer you different tests to try and determine the cause of recurrent pregnancy loss.
There are four basic tests that are used to investigate recurrent miscarriages12
- A blood test to check thyroid function
- Blood test on lupus anticoagulant
Blood test on anticardiolipin antibodies
These blood tests aim to assess for evidence of antiphospholipid antibodies. If positive, treatment with aspirin and low molecular weight heparin could help to support future pregnancies13
- Transvaginal pelvic ultrasound to identify uterine abnormalities
Genetic testing11,13
Genetic testing is offered based on individual circumstances to investigate whether there are any chromosomal abnormalities in the baby. You and your partner may also be offered testing if it has not been possible to test the pregnancy, or there is evidence to suggest an issue that could have been inherited from either biological parent.
Chromosomal abnormalities are associated with most miscarriages. However, these are mostly chance events that happen during fertilisation and cannot be predicted or prevented. If there is any evidence to suggest any inherited abnormalities, you will be referred to a geneticist who will be able to help support you through your pregnancy journey, if you wish to continue trying for a baby.
What happens if all my tests come back normal?
Although it may be very difficult to acknowledge, the causes of recurrent miscarriage will be determined in only half of cases.11 However, where no cause has been determined, 75% of couples will go on to have a successful pregnancy.11,16
Getting pregnant again
For pregnancy following recurrent pregnancy loss, your healthcare provider should facilitate specialist antenatal care.
This may include:11
- Early and more frequent ultrasound scans
- Additional psychological support and advice
- Progesterone treatment
- Any treatment where an underlying cause has been determined
The thought of getting pregnant again may feel heavy, and you may feel fearful if a cause for your previous miscarriages has not been determined. However, with the right support, most people go onto have a healthy pregnancy. Take the time to look after yourself and always speak to your healthcare provider if you require any additional advice or support.
If you have had miscarriages in the past and are experiencing bleeding within the first 16 weeks of pregnancy, talk with your healthcare provider about further examinations and possible treatment options, which in some cases can help support an ongoing pregnancy.11