Miscarriage & Recurrent Miscarriage

Miscarriage is the loss of a pregnancy before the 20th week.

Spontaneous miscarriage can be a very distressing and unfortunately common occurrence for women and couples. It is thought that approximately one in three pregnancies end up in a miscarriage, and around two thirds of which occur before the pregnancy is even clinically evident.

Recurrent miscarriage

Recurrent miscarriages is defined as 3 or more consecutive pregnancy losses, which adds an additional layer of emotional and medical complexity for those navigating this difficult path. It affects about 1% of couples trying to conceive.

What is associated with an increased chance of miscarriage?

There are many risk factors associated with increased chances of miscarriage. The most well documented factors include increasing maternal age, previous miscarriages and smoking.

The most important of these is maternal age, ranging from a miscarriage rate of 15 percent in women aged under 30, to 20 percent at 35 years of age, to 40% at age 40 and 80% at age 45.

Other risk factors are chromosomally or structurally abnormal pregnancy, maternal chronic disease or thrombophilias or uterine anomalies such as septum, fibroids or intrauterine adhesions, or cervical anomalies.

Risk factors that have less consistent evidence include very high caffeine intake, high alcohol intake, maternal obesity and fever. There is also a suggestion of increase risk of miscarriages with male factors such as advancing paternal age and/or abnormal semen parameters.

Advancing gestation after the first trimester, in a chromosomally and structurally normal pregnancy, is associated with a dramatically decreased miscarriage risk (less than 1%). Women who have previously had a child are also less likely to miscarry than the general population (5% overall risk). However, it is noted that these statistics may vary depending on other factors including maternal age.

It is important to acknowledge that it may be normal for some women and couples to go through grief reactions of differing severity. More often than not, a cause of the miscarriage will not be certain or diagnosable. Some women may need reassurance after a miscarriage that they did not cause the miscarriage by anything they have done, such as sexual intercourse, heavy lifting, bump to the abdomen or stress.

The general advice is to wait two to three months after a miscarriage before trying again to conceive. However, evidence for this is not substantial. There has been more recent data to suggest no greater risks of adverse outcomes if subsequent pregnancy occurs sooner than three months after a miscarriage. A study involving more than 600 subjects published in 2014 showed that there were similar live birth, miscarriage, and other pregnancy complication rates if conception occurred sooner compared with later than three months. Therefore, it is more worthwhile to ensure these women feel emotionally and physically ready to conceive again before they recommence trying, no matter the interval of waiting.

After miscarriage, the predictive risk in future pregnancies of another miscarriage is around 14 percent after one miscarriage, and 26 percent after two miscarriages and 28 percent after three miscarriages.

What’s Involved in Fertility Assessment?

Symptoms & Diagnosis

Symptoms of a miscarriage can include vaginal spotting or bleeding, cramping or pain in the abdomen, and the passing of tissue or fluid from the vagina. Recurrent miscarriages may prompt a more thorough investigation into potential underlying causes, which can include genetic factors, anatomical issues with the uterus, hormonal imbalances, and immune system disorders.

Diagnosis typically involves a blood tests and ultrasound (sometimes more than one).

Investigations for recurrent miscarriages are usually recommended after the third miscarriage, because mathematically the observed frequency of three consecutive miscarriages is slightly higher than expected from chance alone. However, this depends on the baseline risk of miscarriages and can differ between different population groups.

Generally investigations for recurrent miscarriages may include genetic testing for both partners, testing for maternal endocrinological and thrombophilia conditions as well as more detailed investigations of the uterus looking for structural anomalies including hysteroscopy.

Treatment & Management

Treatment for miscarriage may vary based on the stage of pregnancy and the individual’s symptoms. Options include:

  • Expectant management (waiting for the miscarriage to progress naturally)
  • Medical management (using medication to expedite the process)
  • Surgical management (such as a dilation and curettage, or D&C, to remove the pregnancy tissue)

For those experiencing recurrent miscarriages, treatment focuses on addressing any underlying causes once identified. This may involve surgical correction of anatomical issues, medication for hormonal imbalances, or interventions for immune disorders.

Genetic counselling may also be recommended for couples with chromosomal concerns.

Support & Resources

Miscarriages are unfortunately a very common occurrence, but their emotional impact can be profound. It’s essential for individuals and couples to seek support, whether through counselling, support groups, or connections with others who have had similar experiences.

The causes and experiences after a miscarriage may vary for different women and couples. It can be a time of great stress and anxiety for some. Most women will benefit from a conversation with their doctor to discuss their concerns and plans before moving forward, no matter their situation.

Prevention & Future Pregnancies

While not all miscarriages can be prevented, managing risk factors, such as maintaining a healthy weight, controlling chronic conditions, and avoiding harmful substances, can improve the chances of a healthy pregnancy. For those with recurrent miscarriages, specialised care from a healthcare provider experienced in reproductive medicine can offer the best chance for a successful pregnancy.


Miscarriage and recurrent miscarriage are challenging experiences laden with emotional and physical complexities.

Understanding the causes, seeking appropriate medical care, and accessing emotional support are critical steps in healing and moving forward. With the right care and support, many can go on to achieve successful pregnancies, carrying with them the hope for the future.


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Contact us today to schedule a consultation and take the first step towards realising your parenthood goals.