Recurrent miscarriage: tests and treatments
After a miscarriage, most people want to know what might have caused it. Without a clear reason, it can be very hard to face another pregnancy, not knowing if there is something that can be done to prevent another loss.
If you have had two or more miscarriages, that need to find out more is even stronger. Having investigations into the possible cause or causes of your miscarriages may provide answers and perhaps treatment, as well as support and information.
My biggest thought with each loss is – what have I done so wrong to deserve this!
Tests
If you have had three early miscarriages, you should be offered some tests to see if there is an underlying reason or reasons for your losses. However, you might be offered tests after two early miscarriages, for example:
- if you are in your late 30s or older, or
- if it has taken you a long time to conceive, whether or not you needed fertility treatment, or
- if your doctor thinks your miscarriages might have an underlying cause.
You should also be offered some tests after one second trimester loss, that is if your baby died after the first three months of pregnancy. You’ll find information about second trimester loss (late miscarriage) here and more detail about tests after second trimester loss here.
What tests
Tests for recurrent miscarriage should always follow reputable research and evidence-based guidelines, unless they are part of clinical research. For that reason, we recommend the patient information provided by the UK’s Royal College of Obstetricians and Gynaecologists (RCOG).
This information is distilled from the RCOG clinical guideline on recurrent miscarriage, which contains the evidence behind their recommendations.
If you are not based in the UK, you might prefer to read the European guideline on recurrent pregnancy loss, published by ESHRE in January 2023. This guideline differs from current UK practice and we write about it here.
I’m having some tests after two miscarriages. I know it may be a step forward but it’s really hard and I’m very anxious.
Answers – or not
It’s important to know that having tests does not necessarily mean that a cause or causes will be found. About half of the couples who have investigations don’t come out with any clear reason for their miscarriages.
This can be very frustrating, but it is also positive news because it means that there is a good chance of the next pregnancy being successful, without any treatment at all.
All the tests came back as normal. My husband was relieved as it showed that there was no obvious problem. But I was disappointed as I really wanted an answer: ‘Here’s what’s wrong. Take this magic tablet’.
If a problem is identified, there may still be a good chance of having a successful pregnancy. This will depend on what is found and whether there is any treatment to reduce the risk next time. For example:
- Some miscarriages are caused by chance (e.g. a chromosome abnormality in the baby) and cannot be predicted or prevented. Fortunately, they are not very likely to happen again.
- Some causes of miscarriage cannot be treated because as there is no way of changing the basic problem (e.g. a problem with the parents’ chromosomes), but parents may be advised to consider other options (like using donor eggs or sperm).
Treatments
If you are found to have a problem which has a clear treatment plan, that can be very positive news. Even so, your doctor should warn you that treatments don’t always work – especially if a pregnancy miscarries for a different reason from the one being treated. In this case, you may be encouraged to try the treatment again in another pregnancy.
Sometimes treatments are sometimes offered in the hope that they may help. These might include treatments being carefully researched or others where there is no clear evidence one way or another.
Again, the RCOG patient information lists the key investigations that may be offered.
On the next page, we talk about the emotional impact of recurrent miscarriage.
