If you’ve ever gone through a miscarriage, then you know it’s more than just a loss. It’s not just a pregnancy that ended; it’s grief, confusion, and the loss of a baby you loved but never got to hold. When it happens more than once, it’s not just sadness, but fear. You start to wonder why your body is betraying you, if you’re doing something wrong, or if you will ever get to hold your baby.
Let’s provide some clarity and comfort by talking about recurrent miscarriages, the causes, tests, and how to cope.
What Is a Miscarriage?
Miscarriage is the loss of pregnancy before 20 weeks of gestational age, according to the World Health Organization. Different countries have slightly different timelines; for example, in Nigeria, a miscarriage is typically defined as pregnancy loss before 28 weeks.
Most miscarriages happen in the first trimester, that is, before week 12, and sadly, they are more common than people realise. Up to 1 in 4 pregnancies end in miscarriages, and they happen before the woman even knows she is pregnant.
If this pregnancy loss happens two or more times in a row (or three or more times in some countries), it is called recurrent miscarriage.
Why Do Recurrent Miscarriages Happen?
When miscarriages happen more than once, you start asking yourself questions like, “Why did this happen?” “What is wrong with my body?” “Will I ever carry a pregnancy to the end?”
Recurrent miscarriages usually happen because of underlying medical, genetic, or anatomical reasons. Some of the main causes of recurrent miscarriages are:
Chromosomal or genetic causes
This is one of the most common causes of early pregnancy losses.
Let’s take it back to science class. The egg and the sperm fertilise to form an embryo. Every embryo needs 46 chromosomes to grow properly. Sometimes, during fertilisation, the egg or sperm might carry extra chromosomes or even be missing some. If this happens, the embryo can’t develop properly, and your body sometimes decides to end the pregnancy on its own as a way of preventing some severe abnormalities that wouldn’t allow the baby to survive outside the womb.
When this keeps happening, your doctor might recommend genetic testing for you and your partner or even for the tissue of the miscarriage to check for abnormal chromosomal patterns.
Hormonal causes
During the luteal phase of your menstrual cycle, progesterone levels rise to stabilise the uterine lining (the lining of your womb) in case fertilisation occurred during your fertile window. If pregnancy occurs and your body doesn’t make enough progesterone, a condition known as luteal phase defect, it can make it harder for the fertilised egg to implant in your womb.
Some other hormonal causes that could increase the risk of miscarriages include hypo or hyperthyroidism (low or high thyroid hormone levels), uncontrolled diabetes, or even polycystic ovary syndrome (PCOS).
Uterine causes
Sometimes, the issue isn’t with the hormones or the chromosomes, but where the baby is actually trying to grow – the uterus. For example:
- Fibroids: Uterine fibroids are non-cancerous growths that can affect the shape of the womb and make it harder for a fertilised egg to implant or for the pregnancy to continue.
- Congenital uterine shapes, like a septate uterus, where a thin wall of tissue (a septum) divides the uterus either fully or partially. This can make it tricky for the embryo to attach or grow properly.
- An incompetent cervix, a condition in which the cervix opens too early, can lead to miscarriage.
Immune system factors
Your immune system is your body’s built-in protective mechanism that helps you fight bad guys like infections. However, sometimes it can be like a hero turned villain, especially in those with conditions like Systemic Lupus Erythematosus (SLE) or Antiphospholipid Syndrome (APS). These conditions can cause clots in the placenta or prevent the embryo from properly implanting in the womb, which can cause recurrent miscarriages.
They are actually treatable once they’ve been identified as the causes, with low-dose aspirin prescribed by your doctor during pregnancy.
Lifestyle and environmental factors
We can’t ignore that there are some regular habits or factors in your environment that can actually cause recurrent miscarriages. They include:
- Smoking, alcohol, or the use of recreational drugs can affect the placenta and the baby’s development.
- High caffeine intake might slightly increase the risk of miscarriage.
- Severe stress, although might not directly cause miscarriage, but can affect your hormones and overall health, which can increase the risk of miscarriage.
- Being underweight or obese can interfere with pregnancy outcomes.
- Exposure to radiation, heavy metals like lead or mercury, or certain chemicals can affect early pregnancy.
They don’t always cause miscarriages, but they can make a fragile pregnancy even more vulnerable.
Tests to Do If You Have Recurrent Miscarriages
If you have had two or more miscarriages, you need to see a doctor to get a full work-up. This would include:
- Blood tests to check for thyroid, diabetes, clotting disorders, or hormonal imbalances.
- An ultrasound scan or a hysteroscopy to check the shape and structure of your uterus.
- Genetic testing for you and your partner.
- Screening for autoimmune causes like SLE.
How to Cope Emotionally
Most people focus on just the medical treatment of miscarriages, which we acknowledge is very important, but what about the emotional aspect? Pregnancy loss is not just something you can “move on” from without taking the right steps. If you’re going through this, here are some tips that might help you cope:
- Talk about it with your partner, friend, family, or a mental health therapist. Keeping it inside by yourself can make the grief heavier.
- Join a support group. Hearing stories from other women who have had similar experiences would make you feel less alone. If you don’t know where to find one, you can join an anonymous support group on the Fertitude app.
- Give your body, your heart, and your mind time to grieve and heal.
- Be kind to yourself. You’re not a failure because you had a miscarriage. Treat yourself with some compassion.
Final Thoughts
If miscarriages keep happening, there might just be a reason. Don’t carry the burden alone. Speak to a doctor to get a proper evaluation so that you can get the help you need.
References
Recurrent Pregnancy Loss – StatPearls – NCBI Bookshelf
Recurrent pregnancy loss: Evaluation and discussion of the causes and their management
Recurrent Pregnancy Loss – Gynecology and Obstetrics – MSD Manual Professional Edition
