Unlocking the Mystery of Recurrent Miscarriage

A pregnancy that ends before 20 weeks is called a miscarriage. Most miscarriages happen before the end of the first trimester (before 12 weeks). Many occur before a woman even knows she is pregnant. In the past, a woman who miscarried several times might never know why it happened. Today, more and more women are finding out the causes of their recurrent miscarriages.

Recurrent miscarriage is defined as as 3 or more consecutive pregnancy losses in the first trimester or early second trimester.

Miscarriages are not uncommon. It is estimated that every woman has a 15% to 20% chance of having a pregnancy end in miscarriage.

For women who have had one miscarriage, their chances of carrying the next pregnancy to full term remain about the same as if they had never had one. The chance of miscarrying again after 2 miscarriages increases with each loss. The risk for recurrent miscarriage increases with age. Women 40 years or older with previous recurring miscarriages have a much higher risk compared to younger women.


There are many different reasons for miscarriage, including fetal chromosomal defects, hormonal problems or abnormalities of the uterus. Doctors typically do not begin testing and treatment until after 3 successive miscarriages, or after a second miscarriage if the woman is older than 35, because much of the testing and treatment is controversial, and the reasons that treatments work are not well understood.

It is likely that a woman who suffers recurrent miscarriages will go on to have a healthy baby. A healthy lifestyle, folic acid supplementation, smoking cessation, weight control, and reducing alcohol and caffeine can increase a woman's chance of having a healthy and successful pregnancy. Informative and sympathetic counseling appears to play an important role in these patients' success.

Ask your doctor about the following possible causes of miscarriage.

Genetic factors

Problems with the genes or chromosomes of the fetus are the most common causes of miscarriage with first pregnancy losses. These are usually not problems inherited from parents, but occur spontaneously, by chance, in the embryo. They are less commonly the cause for women with recurrent miscarriage.

Anatomical factors

Uterine abnormalities are associated with both first and second trimester pregnancy losses. Congenital abnormalities include double uterus or uterine septum. Other abnormalities include uterine polyps, fibroids and scar tissue inside the uterine cavity.

Cervical incompetence

Incompetent cervix complicates about 1% of pregnancies. Women with an incompetent cervix often have rapid miscarriages, commonly occurring around 20 weeks.  This condition can be successfully treated with a stitch to help hold the cervix closed.

Industrial solvents

Exposure to certain solvents, either by the pregnant woman or her partner, sometimes may cause miscarriage. Some chemicals that may be linked to miscarriages include anesthetic gases (nitrous oxide), pesticides, formaldehyde, benzene, ethylene oxide, arsenic, lead, mercury, and cadmium. Couples should discuss any chemicals in the workplace with their doctor.

Endocrine factors

By doing a biopsy of the lining of the uterus, doctors can test for a luteal phase defect, which means that the body secretes too little progesterone during the luteal phase of the menstrual cycle. This is thought to be a factor in some cases of recurrent miscarriage. The relationship between luteal phase defect and recurrent pregnancy loss remains a subject of controversy, however, according to the American College of Obstetricians and Gynecologists. There is no conclusive data that treating a woman with progesterone or fertility medication is effective against recurrent pregnancy loss.

Maternal endocrine disorders such as uncontrolled diabetes or severe thyroid abnormalities have also been linked to miscarriage.

Environmental factors

Smoking, excessive alcohol consumption and illegal drug use are causes of recurrent miscarriage. Women should not smoke and also should avoid alcohol and drugs during pregnancy.


Immunology is the study of how the body recognizes something foreign or different and makes antibodies to protect itself. An immune problem called antiphospholipid syndrome is the cause for recurrent miscarriages in 3% to 15 % of women. it is recommended that women with recurrent miscarriages be tested for lupus anticoagulant and anticardiolipin antibodies (cardiolipins are a type of phospholipids).

A woman with antiphospholipid antibodies and lupus-like anticoagulant can be treated with low-dose aspirin and heparin. This therapy can increase blood flow to the placenta by inhibiting the tendency for clotting.


What is a miscarriage?

Miscarriage is usually defined as an early pregnancy loss. Miscarriage is also called spontaneous abortion. Types of miscarriage include the following:

  • Threatened. Spotting or bleeding in the first trimester may or may not mean a miscarriage will occur. About 10% to 20% of women will miscarry in the first trimester. The woman is monitored for further bleeding. Ultrasound exams  are usually done to monitor growth of the fetus and to monitor fetal heartbeat.

  • Complete. The fetus, placenta, and other tissues are passed with bleeding

  • Incomplete. Only a part of the tissues are passed; some remain in the uterus. There may be heavy vaginal bleeding.

  • Missed abortion. The embryo or fetus dies, but is not passed out of the uterus. Sometimes, dark brown spotting occurs, but there is no fetal heartbeat or growth.

  • Septic. Miscarriage that becomes infected, the mother develops fever and may have bleeding and discharge with a foul odor; Abdominal pain is common. This is a serious condition and can result in shock and organ failure if not treated. Antibiotics and dilation and curettage (D & C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.

  • Recurrent. 2 or more miscarriages.

What is an incompetent cervix?

Fetal loss in the second trimester may occur when the cervix is weak and opens too early. This is called incompetent cervix. In some cases of incompetent cervix, a health care provider can help prevent pregnancy loss by suturing the cervix closed until delivery, called a cerclage.

How is miscarriage diagnosed?

The most common signs of miscarriage are vaginal spotting or bleeding, passing of tissue, and cramping. Ultrasound is usually used to diagnose miscarriage. If the fetus is no longer in the uterus, or there is no longer a fetal heartbeat, miscarriage is diagnosed. Other tests that may be used include pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG). No increase in this hormone level or a decrease can indicate that the pregnancy is not growing.

Treatment for miscarriage

Treatment for miscarriage in early pregnancy includes a procedure to remove the fetus and other tissues if they have not all been naturally passed. The procedure is called a surgical evacuation of the uterus, or a dilation and curettage (D&C). Anesthesia is used as the procedure can be painful to the mother. The cervical opening is dilated (opened) and either suction or an instrument called a curette is used to remove all the pregnancy tissues inside the uterus. These tissues may be sent to the lab for culture or testing for genetic or chromosomal abnormalities. However, not all miscarriages require a D&C. An early miscarriage may also be treated with expectant management or the drug misoprostol.

Later pregnancy loss may need a different procedure using hormones such as prostaglandin or Pitocin to cause the uterus to contract and push out the fetus and tissues.

Pregnancy loss does not usually cause other serious medical problems, unless an infection is present, or unless a missed abortion occurred in which the fetus and other tissues are not passed. A serious complication with a late miscarriage is disseminated intravascular coagulation (DIC), a severe blood clotting problem. This is more likely if there is a long time (usually a month or more) until the fetus and other tissues are passed.

Douglas T. Carrell, Ph.D., H.C.L.D.

Doug Carrell received his Ph.D. degree in reproductive physiology from the University of Utah in 1995, after receiving a M.S. degree in cellular and developmental biology from Brigham Young University. Dr. Carrell has worked in the area of research and treatment of human infertility for 30 years. Dr. Carrell is ... Read More


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  • Endocrinology
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  • Pediatric and adolescent gynecology services

Our highly trained reproductive endocrinology specialists are experts in both the treatment and research of infertility and our clinic consistently boasts one of the highest success rates in the nation.

Neighborhood Health Center Locations:

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Salt Lake City, Utah 84108-1237
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26 South Main
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1743 W. Redstone Center Drive, #115
Park City, Utah 84098
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5126 W. Daybreak Parkway
South Jordan, 84095
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