Recurrent Miscarriage: Understanding Why & What Can Help
Losing a pregnancy is devastating. Losing multiple pregnancies is its own particular grief, one that accumulates with each loss and leaves you wondering what's happening in your body.
If you've experienced recurrent miscarriage, typically defined as two or more pregnancy losses, you're looking for answers. Why does this keep happening? What can be done? Is there hope?
The answers exist, though they're not always straightforward. And there is hope, along with real interventions that can help. We've supported many women through this experience, and many of them are now mothers.
What Is Recurrent Miscarriage?
Recurrent pregnancy loss, or RPL, is defined as two or more pregnancy losses. It affects about 1-2% of couples trying to conceive.
First, it helps to understand that miscarriage in general is common. About 10-20% of known pregnancies end in miscarriage, and the number is higher when you include very early losses. Most miscarriages are caused by chromosomal abnormalities in the embryo that are random and unlikely to recur.
But when miscarriage happens repeatedly, something else may be contributing. In these cases, there's often an identifiable cause or factor that can be addressed.
What Causes Recurrent Pregnancy Loss?
Several factors can contribute to recurrent miscarriage. Understanding which factors are relevant to your situation guides treatment.
Chromosomal and Genetic Factors
Even with recurrent loss, chromosomal abnormalities in the embryo remain a common cause. Research published in Fertility and Sterility found that 50-60% of first-trimester miscarriages involve chromosomal abnormalities. The risk of chromosomally abnormal eggs increases with age, which is why miscarriage rates are higher for women over 35 and significantly higher over 40.
In some cases, one partner carries a balanced chromosomal translocation, meaning their chromosomes are rearranged in a way that doesn't affect them but can cause problems in embryos. This can be identified through karyotype testing of both partners.
Uterine Abnormalities
Structural issues with the uterus can interfere with implantation or the ability to maintain a pregnancy. These include a septate uterus (a wall of tissue dividing the uterine cavity), fibroids (especially those that distort the cavity), polyps, and adhesions from previous surgeries or infections.
A study in Human Reproduction found that uterine abnormalities are present in approximately 10-15% of women with recurrent pregnancy loss. Many of these can be corrected surgically, often improving pregnancy outcomes.
Hormonal Factors
Adequate progesterone is essential for maintaining early pregnancy. Some women don't produce enough progesterone in the luteal phase, or their progesterone drops too early.
Thyroid dysfunction, even when subclinical, is associated with increased miscarriage risk. Research in the Journal of Clinical Endocrinology and Metabolism found that women with TSH levels above 2.5 had higher rates of pregnancy loss. Uncontrolled diabetes and other metabolic issues can also contribute.
Blood Clotting Disorders
Certain conditions cause the blood to clot more easily, which can affect blood flow to the developing placenta. Antiphospholipid syndrome (APS) is the most common, involving antibodies that increase clotting risk. Research shows that APS is found in approximately 15% of women with recurrent pregnancy loss.
Other inherited clotting disorders like Factor V Leiden can also play a role. These conditions are treatable, often with low-dose aspirin and/or blood thinners during pregnancy.
Immune Factors
The relationship between the immune system and pregnancy is complex. Some degree of immune modulation is necessary for the body to accept an embryo, which is genetically different from the mother. When this process doesn't happen properly, the immune system may respond in ways that interfere with implantation or early pregnancy development.
Elevated natural killer cells and other immune markers have been associated with recurrent loss in some studies, though this area remains an active area of research and testing approaches vary.
Inflammation
Chronic inflammation can affect the uterine environment and early pregnancy development. Research in the American Journal of Reproductive Immunology has found elevated inflammatory markers in women with recurrent pregnancy loss. Inflammation can come from many sources: digestive issues, autoimmune conditions, chronic infections, or lifestyle factors.
Unexplained Recurrent Pregnancy Loss
In about 50% of recurrent miscarriage cases, no clear cause is identified through standard testing. This is frustrating, but it doesn't mean nothing can be done. Research published in Human Reproduction found that women with unexplained recurrent loss who received supportive care in early pregnancy had success rates of 75% in subsequent pregnancies.
What Testing Should I Get After Recurrent Miscarriage?
If you've had two or more miscarriages, a thorough evaluation is warranted. This typically includes:
Karyotype testing for both partners
Assessment of uterine anatomy through ultrasound, sonohysterogram, or hysteroscopy
Hormonal evaluation including thyroid function and progesterone levels
Testing for antiphospholipid antibodies
Screening for clotting disorders
Sometimes additional immune testing
Not all of these tests will be relevant for everyone, and your doctor should tailor the workup to your specific history.
How We Support Women with Recurrent Miscarriage
At Fifth Avenue Fertility Wellness, we support women with recurrent pregnancy loss by addressing factors that testing often misses and optimizing conditions for a healthy pregnancy.
Supporting Egg Quality
Even when chromosomal testing of the parents is normal, egg quality affects embryo development. The same factors that influence egg quality in general apply here: inflammation, oxidative stress, mitochondrial function, hormonal environment. Supporting egg quality during the 90-day development window can improve the chances of a chromosomally normal embryo. For more, see our article on how to improve egg quality.
Reducing Inflammation
Chronic inflammation can affect the uterine environment and early pregnancy development. Many women with recurrent loss have underlying inflammatory conditions, digestive issues, or dietary patterns that contribute to systemic inflammation. Reducing inflammation through acupuncture, diet, and lifestyle can support implantation and early pregnancy.
Improving Uterine Blood Flow
Adequate blood flow to the uterus is essential for implantation and placental development. Research published in the Journal of Endocrinological Investigation found that acupuncture increases uterine artery blood flow, which supports early pregnancy.
Hormonal Balance
We work on hormonal balance throughout the cycle, supporting ovulation, progesterone production in the luteal phase, and the hormonal environment of early pregnancy. Chinese herbs can be particularly helpful here, though they're typically stopped once pregnancy is confirmed.
Nervous System Regulation
Pregnancy loss is traumatic. By the time a woman has experienced multiple losses, her nervous system is often in a state of heightened vigilance. This chronic stress affects hormonal function, immune regulation, and overall health.
We work on nervous system regulation through acupuncture and supportive care. Research in Fertility and Sterility has shown that stress reduction interventions improve pregnancy outcomes in women with recurrent loss. Many women tell us that feeling calm and supported during their next pregnancy made a significant difference.
Immune Support
While the immune aspects of recurrent loss are complex, acupuncture has documented effects on immune function. Research published in Evidence-Based Complementary and Alternative Medicine has shown that acupuncture can help modulate inflammatory and immune responses.
How to Prepare for Pregnancy After Miscarriage
For women with recurrent loss, we often recommend a period of preparation before the next pregnancy attempt. Three months allows time to address inflammation, support egg quality, regulate the nervous system, and optimize overall health.
During pregnancy, we continue with weekly acupuncture through the first trimester and often beyond. Treatment focuses on supporting implantation, maintaining hormonal balance, promoting blood flow to the uterus, and keeping the nervous system regulated. Many women find this ongoing support helps them feel less anxious during a vulnerable time.
We work alongside your reproductive endocrinologist or OB, complementing whatever medical interventions are recommended.
What This Looks Like in Practice
A woman came to us at 38 after three miscarriages. Two had occurred in the first trimester, one in the second at 16 weeks. Testing had revealed slightly elevated antiphospholipid antibodies, and she was planning to take baby aspirin and blood thinners in her next pregnancy. But she wanted to do more.
When we talked, her history revealed chronic stress and poor sleep that predated her losses. She worked in television, with unpredictable hours and constant deadlines. She had digestive issues she'd lived with for years: bloating, irregular bowel movements, food sensitivities she'd never fully sorted out. Her cycles were regular but she had significant PMS and breast tenderness, suggesting hormonal imbalance.
Beyond the physical symptoms, she was exhausted from the grief and fear. Each loss had taken something from her. She was afraid to hope again, but she wasn't ready to give up.
We worked together for three months before she tried to conceive again. We focused on her nervous system first, acknowledging the accumulated weight of her losses and the chronic stress underneath. Acupuncture twice weekly initially, then weekly as she stabilized. Chinese herbs to support hormonal balance. Dietary changes to reduce inflammation and support her digestion.
By the time she conceived, she was sleeping better than she had in years. Her PMS had resolved. Her digestion had improved significantly. She described feeling calmer and more grounded than she'd felt in a long time. She said she finally felt like she was taking care of herself, not just managing her symptoms.
We continued weekly acupuncture through her first trimester. She took the aspirin and blood thinners her doctor prescribed. The pregnancy progressed normally.
She delivered a healthy baby at 39.
We can't say which intervention made the difference. The blood thinners addressed her clotting factor. The preparation addressed her inflammation, her hormones, her nervous system. Most likely, all of it mattered. She felt strongly that the work on her overall health was essential to her outcome.
Read stories from women we've worked with →
The Emotional Dimension
We want to acknowledge that recurrent miscarriage is not just a medical problem. It's an emotional and often traumatic experience that affects how you feel about your body, your identity, and your future.
Many women with recurrent loss feel scared, grief-stricken, and uncertain about whether their bodies can carry a pregnancy. These feelings are valid and understandable. And they're also part of what needs attention.
We hold space for the grief and fear that come with this experience. We understand that trying again after loss takes courage. And we believe that addressing the emotional and nervous system aspects of recurrent miscarriage is as important as addressing the physical factors.
Your Next Step
If you've experienced recurrent pregnancy loss and want support for your next pregnancy, we can help. We'll look at your history, your overall health, and what might be addressed to improve your chances. Whether you're still seeking answers or ready to try again, we'll create a plan tailored to your situation.
Learn more about our Fertility & Health path or contact us at 212.432.1110 or info@fafwellness.com.