Recurrent Pregnancy Loss

Recurrent pregnancy loss means losing two or more pregnancies before the point at which the baby could survive, generally before 20 to 24 weeks. Some guidelines use three losses as the threshold. It affects about 1 to 2 in 100 couples trying to conceive.

Investigation finds a treatable cause in fewer than half of couples. That is frustrating, but the outlook is better than many expect: even when no cause is identified, most couples go on to have a successful pregnancy with supportive care alone. Many treatments sold for unexplained loss lack good evidence.

Symptoms

• Two or more miscarriages, which need not be consecutive
• Vaginal bleeding and cramping in early pregnancy
• A pregnancy that stops developing, found on a routine scan without symptoms
• Loss of pregnancy symptoms such as nausea and breast tenderness
• Painless opening of the cervix with loss in the second trimester in some women
• Grief, anxiety and fear about trying again

Causes and risk factors

The most common reason for any single miscarriage is a random chromosomal error in the embryo, which becomes more frequent as the mother's age rises, particularly after 35. Recognised causes of recurrent loss include antiphospholipid syndrome, a clotting-related immune condition; a balanced chromosome rearrangement in one partner, found in about 2 to 5 in 100 couples; womb shape differences such as a septum, and fibroids or scar tissue inside the cavity; poorly controlled diabetes or thyroid disease; and cervical weakness for later losses. Obesity, smoking, alcohol, high caffeine intake and damaged sperm DNA contribute. Everyday stress, exercise, sex and lifting do not cause miscarriage.

How it is diagnosed

• Antiphospholipid antibodies: Lupus anticoagulant, anticardiolipin and beta-2 glycoprotein antibodies, taken twice at least 12 weeks apart and outside pregnancy.
• Assessment of the womb: 3D transvaginal ultrasound, saline scan or hysteroscopy to look for a septum, fibroids, polyps or adhesions inside the cavity.
• Genetic testing of pregnancy tissue: Testing tissue from a loss shows whether it was chromosomally abnormal, which explains that loss and often makes further tests unnecessary.
• Parental karyotype: A blood test for both partners, usually when pregnancy tissue suggests an unbalanced rearrangement or cannot be tested.
• Thyroid function, thyroid antibodies and HbA1c: Identify thyroid disease and diabetes.
• Tests of limited value: Inherited thrombophilia screens, natural killer cell tests and HLA typing are not recommended in routine practice by major guidelines.

Treatment options

• Aspirin and heparin: Low-dose aspirin with daily heparin injections from a positive test improves live birth rates in confirmed antiphospholipid syndrome. It does not help unexplained loss.
• Hysteroscopic surgery: Division of a womb septum or removal of adhesions and polyps inside the cavity, as a short day-case procedure.
• Thyroid and diabetes control: Levothyroxine for an underactive thyroid and good glucose control before conception.
• Progesterone: Vaginal progesterone may help women with previous miscarriages who bleed in early pregnancy. Benefit outside that group is uncertain.
• Genetic counselling and PGT: For couples with a chromosome rearrangement. IVF with embryo testing is one option, though natural conception also has a good chance of success.
• Cervical stitch: For women with second trimester losses from cervical weakness, placed at about 12 to 14 weeks or guided by cervical length scans.
• Supportive care: Early reassurance scans, a named contact and psychological support in a dedicated clinic. Folic acid, a healthy weight and stopping smoking.

When it is urgent

During pregnancy, go to a local emergency or early pregnancy unit for heavy bleeding soaking a pad an hour, severe one-sided abdominal pain, shoulder-tip pain, dizziness or fainting, or fever with offensive discharge after a loss. Ectopic pregnancy and infection are emergencies and should never wait for travel.

Travelling to Türkiye for treatment

A visit between pregnancies can complete the full investigation in under a week: antibody bloods, 3D ultrasound or hysteroscopy, karyotypes and an unhurried consultation, with hysteroscopic surgery on the same trip if needed. IVF with embryo testing can also be planned as a defined course. Pregnancy care itself, including early scans, heparin injections and any cervical stitch, must be with a team near your home. Be cautious about immune therapies, such as intralipid, IVIG or steroids offered for unexplained loss, since trials have not shown benefit.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions