What is recurrent miscarriage?

One miscarriage is devastating. Two can feel like the ground has shifted. By three, many women are carrying something heavier than grief: the fear that it will happen again, and the question nobody seems to be answering. Why?

If that is where you are, here is what the term means, what can be looked at, and what you are entitled to ask.

What does recurrent miscarriage mean?

Recurrent miscarriage, also called recurrent pregnancy loss, describes more than one pregnancy loss. The exact definition varies. European guidelines use two or more losses. Other guidelines use three consecutive losses, which is why, in Australia, standard care often waits for a third loss before investigation is offered.

I believe one is one too many to go without answers, and two losses is a very reasonable point to start asking questions.

How common is it?

A single miscarriage is common, affecting around one in four known pregnancies. Recurrent miscarriage is much less common: around 1 to 2 percent of couples experience three or more consecutive losses, and up to around 5 percent experience two.

That matters, because it means recurrent loss is not simply "bad luck repeating". It is a pattern worth looking at.

What can be investigated?

What is appropriate depends on your history, so it's important to work with a health practitioner who specialises in recurrent loss. These are the areas most often considered, for both partners:

• Antiphospholipid antibodies, which are linked to recurrent loss and clotting in early pregnancy.
• Thyroid function, including thyroid antibodies, not just TSH on its own.
• The shape of the uterus, usually with a detailed ultrasound, to look for differences such as a septum.
• Chromosome testing of the pregnancy tissue, where it is available, which can show whether a chromosomal difference was present and what kind.
• Chromosome testing of both partners (karyotyping), in some situations, to look for an inherited variant.
• Sperm DNA fragmentation, which is not part of a standard semen analysis and is increasingly discussed in recurrent loss.

Some areas, such as natural killer cells, the reproductive microbiome and nutrigenomic factors, are still evolving in the research. They may be worth a conversation with a clinician who specialises in recurrent loss.

Half of the fertility equation involves him. Investigation is not complete until both partners have been considered.

What if nothing is found?

For many couples, investigations do not find a single clear cause. That can be its own kind of hard. You wanted an answer, and "unexplained" can feel like being sent home again.

Two things are worth knowing. "Unexplained" often means "not yet fully investigated", so it is fair to ask whether anything has been missed. And even when no cause is found, many women with recurrent loss go on to have a successful pregnancy. Supportive care in the next pregnancy, including early scans and emotional support, genuinely matters.

What recurrent loss does to you

Recurrent loss is cumulative. Each loss carries the grief of the one before. Many women describe no longer trusting their body, dreading every scan, and finding a positive test brings fear before joy. Partners often grieve quietly, without anywhere to put it.

None of that means you are not coping. It means you have been through something that deserves care, not just a plan to try again.

Questions to take to your next appointment

• "Given my history, what investigations would you recommend now, rather than after another loss?"
• "Has antiphospholipid syndrome been tested for?"
• "Can we look at a full thyroid panel, including antibodies?"
• "Should my partner have any testing, including sperm DNA fragmentation?"
• "If I have another loss, can the pregnancy tissue be tested?"

These are reasonable, evidence-informed questions. You are not asking for too much.

Common questions

What is recurrent miscarriage?

Recurrent miscarriage, also called recurrent pregnancy loss, usually means two or more pregnancy losses. Some guidelines use three consecutive losses as the definition, which is why many women in Australia are not offered investigation until after a third loss.

How common is recurrent miscarriage?

Around 1 to 2 percent of couples trying to conceive experience three or more consecutive losses, and up to around 5 percent experience two. It is far less common than a single miscarriage, which affects around one in four known pregnancies.

What tests are done for recurrent miscarriage?

Investigations may include testing for antiphospholipid antibodies, thyroid function and antibodies, an ultrasound or other imaging of the uterus, chromosome testing of the pregnancy tissue where available, and chromosome testing (karyotyping) of both partners in some cases. Sperm DNA fragmentation testing is sometimes discussed for the male partner. What is appropriate depends on your history.

Can recurrent miscarriage be treated?

Sometimes a specific cause is found and can be managed, for example antiphospholipid syndrome or a uterine difference. Often no single cause is found. Even then, many women with recurrent loss go on to have a successful pregnancy, and supportive care during the next pregnancy matters.

This article is for education only and does not replace individual medical advice, diagnosis or treatment. Every person's situation is different. Please speak with your healthcare professional about what is right for you.