- Recurrent miscarriage is typically defined as three or more consecutive losses.
- Investigations focus on blood tests for hormonal, clotting, and genetic disorders.
- A 3D ultrasound is used to check for structural issues within the uterus.
- In about half of cases, no clear cause is found, but the prognosis is still good.
Defining Recurrent Pregnancy Loss
Recurrent pregnancy loss is a specific clinical condition that requires a thorough and systematic investigation. In the NHS, the official threshold for starting these tests is usually after a woman has experienced her third consecutive miscarriage.
However, for many women, particularly those over 35 or those who have undergone fertility treatment, waiting for a third loss can feel like an eternity. For this reason, many gynaecologists will recommend beginning the investigative process after the second loss to be proactive.
The Core Investigations
Our goal is to look for underlying causes that we can potentially treat. The investigation starts with a detailed medical history and then a series of blood tests. We screen for a clotting disorder called Antiphospholipid Syndrome (APS), which is a well-known cause of recurrent loss.
We also check your thyroid function, as an underactive thyroid can contribute to miscarriage. At the same time, we perform genetic testing on both you and your partner, called karyotyping, to see if there are any chromosomal rearrangements that could be affecting the embryo's viability.
Assessing the Uterine Environment
Alongside blood tests, it's essential to examine the uterus itself. The best tool for this is a 3D ultrasound scan, which provides a detailed view of the uterine cavity shape.
This scan helps us identify structural issues such as a uterine septum, bicornuate uterus, or large fibroids that might prevent an embryo from implanting or growing properly. If we find an issue, many can be corrected with minimally invasive hysteroscopic surgery, significantly improving your chances of carrying a pregnancy to term.
Frequently asked questions
How many miscarriages are considered 'recurrent'?
In the UK, the NHS generally defines recurrent miscarriage as three or more consecutive pregnancy losses in the first trimester. However, many private consultants, myself included, would suggest investigating after two losses, especially if you are over 35.
What are the first tests my doctor will run?
We run a series of blood tests to check for underlying conditions. This includes screening for thyroid problems, clotting disorders like Antiphospholipid Syndrome (APS), and checking parental chromosomes (karyotyping) to look for genetic rearrangements.
Can the structure of my womb cause miscarriages?
Yes, the shape of the uterus can play a role. A 3D ultrasound scan can identify issues like a uterine septum (a wall of tissue dividing the uterus) or large fibroids that might be affecting implantation. These can often be corrected with surgery.
What if all my test results come back normal?
Unfortunately, in about 50% of cases, we don't find a specific cause. While this can be frustrating, it can also be reassuring. It often means there is no major underlying barrier, and with supportive care, the chances of a successful future pregnancy are high.
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