Two Miscarriages in a Row: Getting a Diagnosis and Options

A miscarriage is defined as the loss of a pregnancy within the first 20 weeks. According to both the American Pregnancy Association (APA), approximately 10 to 25% of all clinically recognized pregnancies will result in a miscarriage. However, if you’ve experienced two miscarriages in a row, you may understandably worry about both your chances of conceiving and your ability to carry a pregnancy to term. While enduring a miscarriage can be an upsetting and frustrating feeling of loss, there is support and medical options available.

Do Two Miscarriages in a Row Constitute a Recurrent Pregnancy Loss Diagnosis?

Historically, Recurrent Pregnancy Loss (RPL) was defined as three or more pregnancy losses. In 2013, the American Society of Reproductive Medicine (ASRM) updated the definition of RPL to, “two or more failed pregnancies”. If you’ve had two miscarriages in a row, this means that you would be considered someone who has experienced RPL. Pregnancy losses within the first trimester can  be caused by a variety of factors including, autoimmune issues, endocrine issues, and uterine anomalies. However, the most common cause of a first trimester miscarriage is a chromosomal abnormality in the embryo. The risk of miscarriage can also increase with the number of previous pregnancy losses. This is why if you’ve experienced two miscarriages in a row, seeing a reproductive endocrinologist sooner rather than later can hopefully shed some light on what may be causing the issue.

What Testing is Done for Recurrent Pregnancy Loss?

There are several tests that can be done to gain insight into what has caused the two miscarriages in a row. For example, if your doctor suspects that there may be a concern with your uterus, he or she can perform a test called a Hysterosalpingogram (HSG). This is like an x-ray of your uterus to see if it’s misshapen at all, which might be problematic for a pregnancy.

There are also several kinds of blood work and tests that your doctor can order. They can look at your hormone levels, such as your progesterone levels, see if you have any protein deficiencies and order a thyroid panel.

If you are under the care of a doctor and a D&C is necessary, there is  a test that can be ordered called Products Of Conception (POC) testing. POC testing is done on tissue from the lost pregnancy and evaluates the chromosomes to help provide insight into what has caused the miscarriage. This can provide helpful information to couples regarding if there might be an increased risk for having another miscarriage in the future due to a chromosomal abnormality, and it can provide some closure for the couple if a cause for the miscarriage is identified.

Options for Two Miscarriages in a Row

After a fertility work-up has been completed and test results are in, your reproductive endocrinologist may have an idea of what caused  two miscarriages in a row. If there is a specific diagnosis, perhaps that can be properly treated and addressed. If fertility treatment is recommended or the doctor feels the pregnancy losses may have been  due to a genetic abnormality, in vitro fertilization (IVF) with Preimplantation Genetic Testing for Aneuploidy (PGT-A, formerly known as PGS) might be recommended. PGT-A can increase your chances of having a healthy baby and decrease your chances of a miscarriage by selecting chromosomally normal embryos.

If your doctor determines that there may be an implantation problem,  he or she may consider a test called Endometrial Receptivity Analysis (ERA).  ERA can determine your personalized implantation window. This way, your doctor will know the ideal time to transfer the embryo to give it the best chance of implanting in the uterus, thus giving you the best chances of achieving a pregnancy.

There is a lot to process and while you and your doctor discuss possible causes of your pregnancy losses and options for fertility treatment. It is important to remember that there are many women who have experienced a miscarriage who can lend support. Resolve: the National Infertility Association has support groups all over the United States that you can attend and online resources if you prefer something more private.

Experiencing a miscarriage can be emotionally and physically taxing.  But with the help of reproductive technology you and your fertility doctor will work out the best next steps to achieve a healthy, ongoing pregnancy and move one step closer to becoming a parent.