Recurrent Pregnancy Loss

Recurrent pregnancy loss means two or more consecutive losses before the pregnancy reaches viability. It is far more common than people realise, and most couples who experience it will eventually have a child.

Any single miscarriage is most often caused by a chromosomal error in that particular pregnancy. Those errors happen at random when the egg and sperm combine, they rise with the age of the egg, and they do not repeat as a pattern. When losses repeat, the question changes: there may be a factor present in every pregnancy instead of chance striking twice.

Investigation finds a contributing factor in some couples and not in others, and no cause is identified in a substantial proportion. That result is disappointing to receive and it carries better news than it sounds like, because couples in whom nothing is found still have a good chance of a successful next pregnancy.

One thing needs saying plainly. Nothing you did caused this. Not working, not exercising, not travelling, not lifting, not a stressful month, not an argument and not something you ate. Couples routinely trace back through the weeks looking for the mistake, and there is no mistake to find.

Evaluation is offered after the second loss and looks at both partners.

Your doctor starts with a detailed account of each pregnancy: how many weeks each reached, whether a heartbeat had been seen, whether the loss was sudden or found at a scan, and what any tissue examination showed. That history is the most informative part of the whole workup, because early losses and losses after a heartbeat point in different directions and the pattern narrows what is worth looking for.

They will examine you and look at the shape and lining of the uterine cavity with a scan, since a structural difference in the cavity can be present without any symptom. They look for a clotting tendency of the kind that affects the placenta, which is confirmed on repeat testing twelve weeks apart instead of on a single result. Thyroid function and glucose control are checked, and a chromosome analysis of both partners is considered where the pattern or the family history suggests it.

Expect them to ask about weight, smoking, alcohol and your cycle, and about your menstrual and obstetric history in full. Bring any scan reports and discharge summaries from previous pregnancies to the first appointment, since they save weeks.

Physically, a single loss means bleeding for one to two weeks, and the next period usually arrives in four to six weeks. Where a procedure was needed, the bleeding settles sooner. Ordinary activity resumes within days.

Emotionally, recovery follows no timetable and does not move in a straight line. Grief after a pregnancy loss is a normal response and it is often felt very differently by each partner, which can be isolating at the point where you most need each other. Anniversaries and other people's pregnancies bring it back months later. Support is worth asking for, and where low mood, anxiety or sleeplessness persist for weeks, tell your doctor.

The investigations themselves take six to eight weeks to complete, and some are deliberately repeated twelve weeks apart before they can be interpreted, so a full answer takes a few months.

One normal cycle before trying again is the usual advice, largely so that dating the next pregnancy is straightforward. There is generally no medical reason for a long wait, and where a specific finding needs treating first, your doctor will tell you and say how long that takes.