Second Miscarriage: When Should You Seek the Help of a Doctor

When you’ve experienced one pregnancy loss, it can be a strain on your nerves to decide whether you want to try and get pregnant again. Having a miscarriage is not something you want to endure more than once. Unfortunately, 10 to 25% of all clinically recognized pregnancies will result in a miscarriage. But if you experience a second miscarriage, you may want to consider seeking the help of a physician. With medical intervention, you may not only be able to address any potential underlying medical issues, but you can explore several options that can help reduce the chances of additional pregnancy losses.

Second Miscarriage: How is it diagnosed and treated?

A miscarriage is defined as the loss of a pregnancy before 20 weeks gestation. Most miscarriages happen during the first trimester, which is before 14 weeks. What’s important to note is the signs and symptoms of your second miscarriage may differ from your first pregnancy loss. It can also vary depending on how far along you are in your pregnancy. Here are some signs to look out for:

• Cramping or severe pain in the abdomen and/or back
• Vaginal bleeding, spotting, or passing of blood clots
• Other fluid passing from the vagina

In any of these cases, or if you’re simply not feeling right or you’re just concerned, you should contact your doctor immediately, so they can best advise you on next steps. Once you have been informed that you have had a miscarriage, it is important to discuss next steps with your doctor. Again, your second miscarriage can be different from your first, so your doctor will advise you on whether you should be monitored or if you require additional medical intervention such as minor surgery known as dilation and curettage (D&C).

Second Miscarriage: Asking about Recurrent Pregnancy Loss (RPL)

Once your doctor has treated your second miscarriage, and you’re physically and mentally in a place where you feel comfortable in discussing future family building options, you may want to discuss a diagnosis known as Recurrent Pregnancy Loss. Recurrent Pregnancy Loss (RPL) is defined as two or more pregnancy losses by the American Society of Reproductive Medicine (ASRM).

If you’ve recently had a second miscarriage, this means that you might want to consult with a reproductive endocrinologist to look at a variety of factors including, autoimmune issues, endocrine issues, uterine anomalies and chromosomal abnormalities. The risk of miscarriage can potentially increase with the number of previous pregnancy losses. This is why if you’ve experienced a second miscarriage, seeing a specialist can help reduce your chances of any additional losses.

Second Miscarriage: Options and hope for the future

After a second miscarriage and once you’re in the care of a doctor, there are several tests they can run on you to rule out any possible medical issues that may be causing these losses. Some examples are a test called a Hysterosalpingogram (HSG), which 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 to provide an overview of your fertility, including your ovarian reserve.  Your physician may recommend tests to see if you have any protein deficiencies and order a thyroid panel.

In terms of options after a second miscarriage, your doctor may discuss assisted reproductive technology such as in vitro fertilization (IVF) plus a form of genetic testing called Preimplantation Genetic Testing for Aneuploidy, previously known as PGS. Since chromosomal abnormalities are responsible for roughly 70 percent of miscarriages, PGS can increase your chances of having a healthy baby and decrease your chances of a miscarriage by selecting chromosomally normal embryos for future embryo transfers.

If you and/or your partner have a diagnosis of a genetic condition, or have a known increased risk to have a child affected with a genetic disease, your doctor might suggest  Preimplantation Genetic Testing for Monogenic Diseases (PGT-M), formerly known as PGD.

A test called Products of Conception (POC) can help determine the cause of a miscarriage. If you’ve been going through fertility treatment or you’re already under the care of a doctor and had a pregnancy loss, POC testing may be offered.  POC testing is performed on the tissue from the lost pregnancy and evaluates the chromosomes to help provide insight into what may have caused the second miscarriage.

When you’ve endured a second pregnancy loss, things may feel bleak. However, you should take comfort not only in the options provided above but that studies show that most couples diagnosed with recurrent pregnancy loss, when diagnosed and treated, were successful in conceiving following those losses.