Recurrent miscarriage: assessment and personalised treatment
Experiencing multiple pregnancy losses is a difficult experience, but you are not alone. At Clínica Fertia, we analyse each case in depth to identify the cause and help you achieve a successful pregnancy.
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What is recurrent miscarriage?
Recurrent miscarriage or recurrent pregnancy loss is defined as the loss of two or more pregnancies before 20 weeks, whether consecutive or not.
It is a more common condition than it seems and requires specific investigation to identify the causes.
Many patients come to us with the same question:
“Why is this happening to me?”
And most importantly: in many cases, there is an explanation and a solution.
Main causes of recurrent miscarriage
There may be multiple causes, and in many cases these are combined.
Among the most common:
Chromosomal abnormalities in the embryo
Uterine factors (malformations or abnormalities of the uterus)
Thrombophilias
Advanced maternal age
Sperm DNA fragmentation
Immunological problems
Why do recurrent miscarriages occur?
Genetic abnormalities
Embryonic chromosomal abnormalities are the most common cause of early pregnancy loss, particularly as maternal age increases.
Anatomical factors
Certain uterine malformations, polyps, fibroids or adhesions can hinder proper implantation and the development of the pregnancy.
Immunological factors
Abnormalities in the immune response may interfere with the maternal-foetal tolerance necessary for the pregnancy to progress normally.
Thrombophilias
Some coagulation disorders can affect placental development and compromise the course of pregnancy.
Endocrine factors
Thyroid problems, poorly controlled diabetes or certain hormonal disorders can affect embryonic viability.
Sperm DNA fragmentation
In some cases, male factors may also play a significant role in recurrent pregnancy loss.
Investigating recurrent miscarriage: personalised diagnosis
The investigation into recurrent miscarriage is key to identifying the cause and determining the treatment. Not all patients require the same investigation.
At Clínica Fertia, we carry out an individualised assessment to identify which factors may be behind the pregnancy losses and determine which tests are actually necessary in each case.
This may include:
- Detailed medical history
- Comprehensive gynaecological examination
- Assessment of reproductive history
- Design of a personalised diagnostic plan
- Multidisciplinary coordination where necessary
An assessment that goes beyond conventional tests
Recurrent miscarriage is usually a multifactorial condition. That is why we analyse each of the possible causes involved individually to gain a comprehensive understanding of your case.
- Genetic factors
These account for 50-60% of miscarriages. This percentage increases as the woman’s age increases. Furthermore, they are the most common cause of recurrent miscarriage. These are abnormalities in the number or arrangement of chromosomes that ultimately cause the embryo’s development to cease.
- Thrombophilias and coagulation
These may be hereditary or acquired, such as antiphospholipid syndrome, and occur in 3-4% of cases. These coagulation disorders lead to the formation of small clots that prevent the placenta from developing properly, thereby compromising the embryo’s viability.
- Immunological factors
Abnormalities in the maternal immune system can lead to an inappropriate immune response that compromises the early stages of pregnancy.
- Uterine abnormalities
Uterine malformations occur in up to 16.7% of women with recurrent miscarriage. Double, bicornuate, unicornuate, septate or hypoplastic uteri are associated with miscarriage due to reduced uterine volume, decreased myometrial distensibility and endometrial abnormalities caused by insufficient vascularisation. Submucosal or large intramural fibroids, and the presence of adhesions following previous surgery, are also causes of miscarriage.
- Endometrial receptivity and microbiome
The presence of an inappropriate microbiome or pathogens is also associated with a higher incidence of miscarriage.
- Male factor and sperm DNA fragmentation
Sperm DNA fragmentation occurs when the genetic material of the sperm cell is broken. Although fertilisation is still possible, this can disrupt embryonic development and lead to pregnancy loss
What strategies do we use to manage recurrent miscarriage?
Imaging tests
Both 3D ultrasound and hysteroscopy enable us to diagnose intrauterine conditions such as malformations, adhesions, polyps or fibroids.
Immunological tests
Testing for the presence of autoantibodies and serum immunoglobulins, complement system analysis, KIR genotyping and paternal and maternal HLA-C haplotype analysis.
Genetic testing
Genetic testing of both parents and at the embryonic level.
Endometrial pathology study
Study of endometrial NK cells and cytokines related to lymphocyte response, using the Th1/Th2 ratio; for this, we apply flow cytometry techniques using the ImMap test. Screening for the presence of plasma cells in relation to chronic inflammation, as well as an analysis of the endometrial microbiome using mass sequencing techniques via the EMMA and ALICE tests.
Understanding the cause is the first step towards achieving pregnancy.
Highly complex assisted reproduction
In cases of recurrent miscarriage, a highly complex assisted reproduction approach is required.
This enables:
- Identifying causes that are not immediately apparent
- Tailoring treatment
- Increasing the chances of a successful pregnancy
In cases where there is an embryonic genetic abnormality, low ovarian reserve or a history of multiple previous pregnancy losses, assisted reproduction techniques can help optimise the chances of achieving a successful pregnancy.
At Clínica Fertia, we have a high-complexity fertility unit specialising in these cases.
Is it possible to achieve a full-term pregnancy after several miscarriages?
Yes. Although each case must be assessed on an individual basis, many couples go on to have a full-term pregnancy after identifying and treating the factors underlying their pregnancy losses.
In some cases, we find a clear and treatable cause. In others, more advanced investigations are required, and a personalised reproductive strategy must be devised that combines various diagnostic and therapeutic tools.
At Clínica Fertia, we work with patients who have experienced multiple miscarriages, failed cycles or complex diagnoses. Our aim is to help you find answers and support you until you achieve a healthy, successful pregnancy.
Treatment for recurrent pregnancy loss
Treatment depends on the identified cause.
This may include:
- Advanced embryo selection using PGT
- Hormone treatment and metabolic management
- Immune management
- Treatment of coagulation disorders
- Surgical correction of uterine conditions
The aim is clear:
to achieve a pregnancy that progresses normally.
When you have experienced several miscarriages, you need answers
Behind every recurrent miscarriage there is a story, but also a cause that deserves to be investigated. Our aim is not only to support you, but to help you find answers and develop a personalised strategy to move forward with greater confidence.
That is why our approach is not just about treatment, but supporting you and providing clarity at every step.
Specialists in highly complex recurrent miscarriage
Recurrent miscarriage is one of the most complex conditions in reproductive medicine. In many cases, there is no single cause, but rather a combination of various genetic, immunological, anatomical and endocrine factors.
Dr Elena Puente and her team carry out a comprehensive assessment of each case, examining both maternal and embryonic factors to design a personalised diagnostic and treatment strategy.
Our aim is to help you find answers and increase your chances of achieving a successful pregnancy.
Frequently asked questions about recurrent miscarriage
What is considered a recurrent miscarriage?
The loss of two or more pregnancies, whether consecutive or not.
What are the causes of recurrent miscarriage?
These may be genetic, uterine, immunological or related to embryo quality.
What tests are carried out as part of the investigation into recurrent miscarriage?
Includes karyotyping, thrombophilia testing, immunological and metabolic testing, uterine tests and hormonal analyses.
What is a peripheral blood karyotype?
It is a genetic test that analyses the chromosomes to detect abnormalities.
Does sperm DNA fragmentation play a role in miscarriages?
Yes, it can affect embryo quality and increase the risk of miscarriage.
Is it possible to achieve pregnancy after several miscarriages?
Yes, with appropriate diagnosis and personalised treatment.
What treatment is available for recurrent pregnancy loss?
It depends on the cause, but may include assisted reproduction and specific treatments.
When should you visit a high-complexity fertility unit?
In cases of recurrent miscarriage or unclear causes.
Take the next step with a clear diagnosis
We know this journey isn’t easy, but we also know there are options.
At Clínica Fertia, we analyse your case in depth to help you achieve a successful pregnancy.