The myth that ordinary life activities cause pregnancy loss is one of the most persistent and most damaging beliefs surrounding miscarriage, and it leaves women carrying a burden of guilt that is entirely undeserved.
How Common Is It?
A single miscarriage is very common — it affects approximately 15–20% of recognised pregnancies. The large majority are caused by random chromosomal errors in the embryo and do not predict future losses.
Recurrent miscarriage — defined as two or more pregnancy losses — affects approximately 1–2% of couples. After two losses, thorough investigation is clearly warranted, both because the emotional toll demands it and because in many cases, a treatable cause is found.
Causes — Why Does Recurrent Miscarriage Happen?
1. Chromosomal Abnormalities in the Embryo (Most Common)
The single most frequent cause of miscarriage at any age is a random chromosomal error in the developing embryo. An embryo with the wrong number of chromosomes cannot develop into a healthy baby — the body recognises this and ends the pregnancy.
This risk rises significantly with maternal age — because egg quality declines and chromosomal errors become more frequent after 35.
2. Uterine Structural Problems
The shape or interior of the uterus may prevent a pregnancy from implanting or developing:
- Uterine septum: A tissue partition dividing the cavity — one of the most surgically correctable causes. After surgery, outcomes improve dramatically.
- Submucosal fibroids: Growing into the cavity, blocking implantation.
- Uterine polyps: Benign growths inside the uterus.
- Asherman's syndrome: Scar tissue from previous surgery or D&C procedures.
3. Antiphospholipid Syndrome (APS)
A blood-clotting disorder in which the body produces antibodies (anticardiolipin antibodies, lupus anticoagulant) that cause clotting in the small blood vessels of the placenta. This is one of the most important treatable causes of recurrent miscarriage. Treatment with low-dose aspirin and low molecular weight heparin (blood-thinning injection) is highly effective.
4. Thyroid Disease
Uncontrolled hypothyroidism or hyperthyroidism significantly raises miscarriage risk. Correcting thyroid levels to the optimal range substantially reduces this risk.
5. Parental Chromosomal Rearrangements
In 2–4% of couples with recurrent miscarriage, one partner carries a "balanced translocation" — a rearrangement of chromosomal material that is harmless to the carrier but produces unbalanced embryos. Identified through a blood karyotype test. IVF with PGT is an excellent solution for these couples.
6. Hormonal Factors
- Elevated prolactin — treatable with medication
- Poorly controlled diabetes
- PCOS-related hormonal environment
7. Unexplained (Around 50% of Cases)
Even after thorough investigation, no clear cause is identified in approximately half of all recurrent miscarriage cases. This is deeply frustrating for couples.
However — the reassuring data is this: even without a specific cause identified, approximately 60–70% of couples go on to have a successful pregnancy with supportive care and close monitoring.
Investigations — What Should Be Done?
Blood Tests
- Antiphospholipid antibodies — lupus anticoagulant and anticardiolipin antibodies (ideally tested twice, 12 weeks apart)
- TSH and Prolactin
- Fasting blood glucose
- Full thrombophilia (clotting) screen
Uterine Assessment
- 3D ultrasound or saline infusion sonography (SIS) — detailed view of the uterine cavity
- Hysteroscopy — direct visualisation and treatment if needed
Genetic Testing
- Parental karyotype (both partners) — chromosomal structure
- Testing of miscarried tissue (products of conception) — if available, this can confirm whether chromosomal abnormality was the cause
Partner
- Semen analysis plus sperm DNA fragmentation (DFI) — high DFI is an increasingly recognised contributor to recurrent miscarriage
Treatment — By Cause
| Cause | Treatment |
|---|---|
| Antiphospholipid syndrome | Low-dose aspirin + heparin injection — started before conception |
| Uterine septum | Hysteroscopic septoplasty — straightforward surgery, excellent results |
| Fibroids or polyps | Hysteroscopic removal |
| Thyroid disease | Levothyroxine — normalise TSH |
| Parental chromosomal translocation | IVF with PGT-A or PGT-SR — select only balanced/normal embryos |
| High prolactin | Cabergoline — very effective |
| Unexplained | Progesterone support + close early pregnancy monitoring |
After Two Losses, Investigation Is Worth It
In many cases a treatable cause is found — and even when none is, most couples go on to have a successful pregnancy with the right support and monitoring. Consult Dr. Dipesh Sorathiya at Khushhi IVF, Thaltej, Ahmedabad.
Book an Appointment Learn About the ClinicWhat About Unexplained Recurrent Miscarriage?
For couples where no cause is found, evidence supports:
Progesterone support in early pregnancy: The PROMISE and PRISM clinical trials showed that vaginal progesterone given from before 6 weeks of pregnancy reduces miscarriage risk in women who have had previous losses — particularly those who experience early pregnancy bleeding. This is now incorporated into standard practice at many centres.
Close early monitoring: Frequent early scans and blood tests provide reassurance during the most anxious phase — and detect any issues early.
Tender Loving Care (TLC) protocol: Studies have shown that structured emotional support, regular clinic contact, and attentive monitoring in early pregnancy genuinely improve outcomes even without a specific medical intervention. The psychological environment matters.
The Emotional Reality — It Deserves as Much Attention as the Medical
Recurrent miscarriage brings grief, anxiety, depression, and very often puts enormous strain on relationships. All of these are real, valid, and deserve attention — not just the medical workup.
- Seek counselling from a fertility-aware therapist or counsellor
- Connect with support groups — other couples who have been through this
- Communicate with your partner — shared grief is easier to carry than separate silence
- Allow yourself to grieve each loss — don't suppress it
There is no timeline for grief. But there is also real reason for hope.
Frequently Asked Questions
Should investigations begin after two miscarriages or three?
Most specialists now recommend beginning investigations after two losses, particularly if the woman is over 35. The emotional burden and the real possibility of a treatable cause both justify earlier investigation.
Does stress cause miscarriage?
Everyday stress does not cause miscarriage. Please let go of this guilt. Extreme, chronic, sustained stress may affect hormonal balance over time, but an anxious day or a difficult week does not cause pregnancy loss.
What are the chances of a successful pregnancy after recurrent miscarriage?
Even after three losses, the majority of couples ultimately achieve a successful pregnancy. Finding and treating an underlying cause improves these odds significantly. For unexplained cases, approximately 60–70% of subsequent pregnancies succeed.
Does IVF with PGT help recurrent miscarriage?
For couples where chromosomal issues are suspected — particularly older women or those with a chromosomal rearrangement — IVF with PGT-A dramatically reduces miscarriage rates by transferring only chromosomally normal embryos.
How soon can we try again after a miscarriage?
Physically, many doctors advise waiting for one normal period before trying again. Emotionally, give yourselves the time you need. There is no medical benefit to rushing — and grieving properly before the next attempt is genuinely important.
Khushhi IVF 5th Floor, Soham Pristine, Off Sindhubhavan Road, Thaltej, Ahmedabad, Gujarat 380054, India.
