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Recurrent Miscarriage

Recurrent pregnancy loss (RPL) is defined as having two or more miscarriages. This affects about 1% of women and can be physically and emotionally difficult. Women who have had three or more first trimester losses, two or more second trimester losses, or at least one intra-uterine fetal death after 24 weeks are candidates for further evaluation to investigate the cause of recurrent miscarriage.

Even if no cause is found, most women with recurrent pregnancy loss will have a successful pregnancy with appropriate treatment. In the case of recurrent miscarriage, we work closely with the Maternal-Fetal Medicine Specialists at the Perinatal Assessment Center at Waukesha Memorial Hospital to provide you with the most comprehensive care.

As a team, we will work collaboratively to help you determine the risks, benefits, emotions, and cost of these evaluations.

Causes of Recurrent Miscarriage

There are numerous possible causes of repeated miscarriage. Some of these causes include genetic disorders, problems with the reproductive organs such as a septate uterus or uterine adhesions, or various medical conditions. Diabetes, antiphospholipid syndrome (APS), blood clotting disorders and polycystic ovarian syndrome (PCOS) can all increase the risk for recurrent miscarriage. In about 50-70% of women with recurrent pregnancy loss, no causes can be identified.

Evaluation for Recurrent Miscarriage

The evaluation for recurrent miscarriage includes a pelvic exam, a pelvic ultrasound along with blood work to evaluate for auto-immune disorders. A karyotype can also be performed to assess for chromosomal abnormalities in you or your partner. Other tests that may be recommended include an HSG, hysteroscopy or a sonohystogram. 

Treatment Options for Recurrent Miscarriage

Treatments for recurrent pregnancy loss depend on whether a cause was identified during the evaluation. If the cause was found to be genetic, your provider may discuss proceeding with IVF with pre-implantation genetic testing (PGT) to select for chromosomally normal embryos. For problems with reproductive organs or uterine adhesions, corrective surgery is often helpful. For auto-immune disorders, using blood thinners or other medications can decrease your risk for miscarriage.

We often use low-dose aspirin and supplemental progesterone to help optimize your chances of having a healthy pregnancy.

Coping with Recurrent Miscarriage

Losing a pregnancy is very emotional, especially if it has happened multiple times. You may blame yourself or feel guilty for this happening. Miscarriages are almost always caused by something completely out of your control, so it is important not to blame yourself. Nevertheless, it is completely normal to feel discouraged, disappointed, and emotional. You and your partner may process your grief differently.

Be sure to reach out to those you love and trust for support. You can always discuss any concerns with your healthcare provider or a counselor.


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