Recurrent Miscarriage Causes: What Is Treatable and When to Test

By Dr. Ram Prakash, Maaeri Fertility & IVF Centre.

Recurrent miscarriage causes fall into a handful of categories, and several can be treated once found, which is the part nobody leads with. Do you know what makes recurrent loss different from one miscarriage? It is a condition with a defined workup behind it, not bad luck repeated. Being told miscarriage is common is true, and also where most couples stop getting anything useful.

How Is Recurrent Miscarriage Defined?

The two-loss threshold

Two. The ESHRE guideline on recurrent pregnancy loss sets it at two or more losses before 24 weeks. The older three-loss rule came out of caution about over-investigating. It did not come from evidence that two losses carry different biology.

How common it is

Recurrent pregnancy loss affects around 1% of couples, and because the risk climbs with each one, investigating after the second is the reasonable move rather than waiting for a third.

What Are the Most Common Recurrent Miscarriage Causes?

Chromosomal factors

Roughly half of pregnancy losses come down to chromosomal abnormalities, and in some couples the reason is that one partner carries a balanced rearrangement, a change that looks normal in them while producing unbalanced embryos. Which is why both partners get karyotyped. Where a rearrangement turns up, reported live birth rates with IVF and genetic testing sit around 30 to 35%.

Antiphospholipid syndrome

This is the most important treatable cause. The numbers run like this:

1. Between 5 and 20% of women with recurrent loss test positive for antiphospholipid antibodies
2. Untreated, live birth in that group has been around 10%
3. Low-dose aspirin with heparin is the one combination shown to raise it

The antibodies disturb blood flow where the placenta meets the uterus. Treated pregnancies still want close monitoring throughout.

Uterine anatomy

A septum, submucous fibroids and intrauterine adhesions all affect whether a pregnancy holds, though the evidence on correcting them surgically is thinner than most people expect when they are offered an operation. RCOG goes as far as saying there is not enough evidence to judge whether removing a septum prevents a future miscarriage. Hysteroscopy still remains the best way to see the cavity.

Thyroid and hormonal factors

Poorly controlled thyroid disease is associated with higher loss, but the thing to note here is that the cut-off itself is contested, with guidance having shifted the upper TSH limit from 2.5 to 4.0 mIU/L. So your result wants reading against your own history. Not one number on a range.

When nothing is found

About half of cases stay unexplained after a full workup. Frustrating. Not hopeless, though: with supportive care and early monitoring, the prognosis for a live birth sits in the region of 75%.

What Tests Are Done, and When Should You Seek Help?

When to bring the appointment forward

Investigation should start after two consecutive losses, and you should bring that forward if you have had a second-trimester loss, if either of you has a known autoimmune or chromosomal condition, or if you are over 35. Our post on preventing miscarriage in early pregnancy covers what comes after.

Test	What it looks for	Why it matters here
Karyotype, both partners	Balanced rearrangement	Changes whether genetic testing of embryos is useful
Antiphospholipid panel	LA, aCL, anti-beta2GP-I	Needs two samples 12 weeks apart to confirm
Thyroid function and anti-TPO	Subclinical hypothyroidism	Treatable before the next attempt
Hysteroscopy and pelvic ultrasound	Cavity and uterine shape	Direct view, where imaging alone can mislead

Where genetic testing fits

Where a chromosomal cause is confirmed, our guide on PGT testing and the detail on PGT for recurrent pregnancy loss explain how it fits the plan.

Frequently Asked Questions

Does recurrent miscarriage mean I cannot carry a pregnancy?

No. Most couples with recurrent loss go on to a successful pregnancy, including many who never get a diagnosis.

Is IVF with PGT the automatic next step?

It is not. Mainly it is indicated where a parental rearrangement is confirmed, and miscarriage history on its own does not point to IVF.

Can stress cause recurrent miscarriage?

No robust evidence says stress causes miscarriage biologically. Your wellbeing still matters through months of testing, which is a separate argument.

Wrapping Up

Knowing which recurrent miscarriage causes are treatable is what turns a run of losses into a plan. The NHS overview is a sound starting read, though the answers come from a workup.

This article is for general educational purposes and is not a substitute for personalised medical advice from your fertility specialist or embryologist