Recurrent Miscarriage Management

Recurrent miscarriage is defined as three or more consecutive pregnancy losses before 24 weeks. Some specialists investigate after two losses, particularly in older women or where specific risk factors are identified. It affects approximately 1% of couples.

Identifiable causes include chromosomal abnormalities in the embryo or parents, uterine abnormalities (septum, fibroids, polyps, Asherman's syndrome), antiphospholipid syndrome (a clotting disorder), and thyroid disease. In up to 50% of cases, no cause is found despite thorough investigation.

A comprehensive work-up includes karyotyping of both partners, uterine assessment (hysteroscopy, 3D ultrasound, or MRI), antiphospholipid antibodies and other clotting tests, thyroid function, and NK cell testing in selected cases.

Treatment is cause-specific: antiphospholipid syndrome is managed with aspirin and low-molecular-weight heparin; uterine abnormalities are corrected surgically; thyroid disease is treated medically; chromosomal issues may prompt consideration of PGT with IVF. Progesterone supplementation in early pregnancy also reduces miscarriage risk in some women.

Even without a found cause and without treatment, approximately 65u201370% of couples with recurrent miscarriage achieve a successful pregnancy. With treatment for identifiable causes, outcomes are significantly better. Emotional support and specialist monitoring throughout subsequent pregnancies is an important part of care.