Recurrent miscarriage: Why does it keep happening and What can you do?

If you are reading this after a second, third, or fourth miscarriage, we want to say this first: we are deeply sorry for your losses. Miscarriage is one of the most painful experiences a person can go through — and recurrent pregnancy loss compounds that grief in ways that are hard to put into words. This guide is written with that in mind. You are not alone. You are not to blame. And in most cases, there are answers and there is hope.

• 1 in 5 pregnancies end in miscarriage.
  
  
• 1 in 100 couples experience 3 or more miscarriages.
  
  
• 50 to 75 percent have a successful pregnancy after recurrent pregnancy loss.
  
  
• More than 50 percent of RPL cases have an identifiable cause.

One miscarriage is heartbreaking. Two miscarriages leave you shaken and questioning. Three or more — and the medical community officially calls it Recurrent Pregnancy Loss (RPL) — can feel devastating, isolating, and utterly bewildering. Why does this keep happening? Is something fundamentally wrong? Will it ever work?

The first and most important thing to understand is that recurrent miscarriage is a medical condition with identifiable causes in over half of all cases, and with proper investigation and targeted treatment, the majority of couples go on to have a successful pregnancy. This guide takes you through everything: what counts as recurrent miscarriage, why it happens, what tests should be done, what treatments work, and how to protect your emotional wellbeing throughout the process.

What is recurrent miscarriage?

Recurrent Pregnancy Loss is defined as two or more pregnancy losses before 20 weeks of gestation. Some organisations define it as two losses, while others use three. In practice, most fertility specialists begin investigation after two miscarriages.

Types included:
Clinical miscarriage, biochemical pregnancy loss, missed miscarriage, molar pregnancy.
Ectopic pregnancy is not counted but still requires evaluation.

A single miscarriage is common and usually due to a random chromosomal error. Recurrent miscarriage suggests a pattern and needs investigation.

How many miscarriages before investigation?

• Two consecutive miscarriages: seek evaluation immediately.
  
  
• Two non-consecutive losses: discussion with doctor.
  
  
• One miscarriage with age above 35: consider assessment.
  
  
• Three or more miscarriages: full investigation required.

Waiting for a third miscarriage is no longer considered appropriate.

The 10 most common causes

• Chromosomal abnormalities in embryos – This is the most common cause. Errors in egg or sperm chromosomes result in embryos that cannot develop properly.
  
  

• Antiphospholipid Syndrome – An immune condition causing blood clots in placental vessels. It is highly treatable with aspirin and heparin.
  
  

• Uterine structural abnormalities – Includes septum, fibroids, polyps, and adhesions. Many are correctable with surgery.
  
  

• Parental chromosomal abnormalities – Balanced translocations in one partner can lead to abnormal embryos.
  
  

• Elevated immune response – May cause immune rejection of the embryo. Treatment is still evolving.
  
  

• Thyroid dysfunction – Even mild thyroid imbalance increases miscarriage risk. Easily treatable.
  
  

• Polycystic ovary syndrome – Hormonal imbalance affects egg quality and implantation.
  
  

• Thrombophilias – Inherited clotting disorders affecting placental blood flow.
  
  

• Sperm DNA fragmentation – Damaged sperm DNA can lead to poor embryo development.
  
  

• Unexplained RPL – No cause found in 40 to 50 percent of cases, but success rates remain high.

The complete diagnostic process