Recurrent pregnancy loss: causes, tests and treatment

What counts, and what is found

Recurrent pregnancy loss is usually defined as two or three consecutive losses. Many Indian practices investigate after two, particularly if the woman is over 35 or there is another reason.

Causes that are identified: antiphospholipid syndrome and other clotting problems; uterine structural issues such as a septum, fibroids, polyps or adhesions; chromosomal rearrangements in one partner; thyroid disease and poorly controlled diabetes; and — importantly in India — genital tuberculosis, which is a real and treatable cause of loss and tubal damage.

Age is a major factor in itself: the proportion of eggs with chromosomal errors rises through the thirties and forties, and that alone explains many repeated losses.

In around half of couples no cause is found. That is frustrating and it is not the same as no hope — the majority in that group go on to a successful pregnancy.

The standard tests

Blood tests for antiphospholipid antibodies (usually repeated twice, weeks apart), thyroid function, blood sugar and HbA1c, prolactin, and a full blood count.

Imaging of the uterus: a pelvic ultrasound, and often a hysteroscopy or 3D scan to look for a septum, fibroids, polyps or adhesions.

Chromosome analysis (karyotype) of both partners, and where available, testing of the pregnancy tissue after a loss — which frequently gives the clearest answer of all.

Screening for tuberculosis where the picture suggests it, and vitamin D and other deficiencies as your doctor advises.

Ask for the results in writing and for what each one means. Couples in this situation accumulate reports and rarely get them explained together.

Treatments that have evidence

For antiphospholipid syndrome: low-dose aspirin plus heparin injections in pregnancy, which substantially improves outcomes. This is the clearest treatable cause there is.

For thyroid disease and diabetes: correction before and during pregnancy.

For a uterine septum or adhesions: hysteroscopic surgery, where indicated.

For genital tuberculosis: a full anti-tuberculosis course.

For chromosomal rearrangements: genetic counselling, and IVF with preimplantation testing in some situations.

Progesterone support is used in specific circumstances — particularly women with recurrent loss and early-pregnancy bleeding — and your obstetrician will advise whether it applies to you.

Be sceptical of expensive packages of unproven immune treatments, intralipids and steroid regimens sold for unexplained recurrent loss. Ask what the evidence is and what a trial showed.

When to see a doctor

Go to hospital immediately for: bleeding that soaks a pad an hour or more, severe or one-sided abdominal pain, dizziness or fainting, shoulder-tip pain, fever with chills, or foul-smelling discharge. A positive pregnancy test with one-sided pain and bleeding needs assessment the same hour — an ectopic pregnancy is life-threatening. Call 108 if you cannot travel quickly.

Seek referral for investigation after two or three consecutive losses, or earlier if you are over 35, have irregular cycles, a known uterine problem, a family history of clotting disorders, or a loss after the first trimester.

Grief after a pregnancy loss is real grief, at any number of weeks. If you are struggling — persistent low mood, hopelessness, panic, an inability to function, or any thought of harming yourself — that deserves help rather than endurance. Tele-MANAS on 14416 is free, confidential and answers round the clock in Indian languages.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: What are our chances after three losses? — Better than most couples expect. Even with unexplained recurrent loss, a majority go on to a live birth, and the odds improve when a treatable cause is found.

Q: Should we do IVF? — Not automatically. IVF does not fix most causes of recurrent loss, and it helps in specific situations such as chromosomal rearrangements with embryo testing. Get the cause investigated first.

Q: My reports are all normal. — That is the commonest outcome and it is genuinely hopeful. Supportive care in the next pregnancy — early scans, close follow-up — is what most units offer, and it works.

Q: Is it my wife's problem alone? — No. Chromosome testing involves both partners, and male factors including sperm DNA damage are part of the picture. Investigation should cover both.