Miscarriage is unfortunately common and can be emotionally devastating.

When pregnancy loss happens repeatedly, patients naturally want to understand why.

Recurrent pregnancy loss deserves structured, evidence-based assessment while recognising that sometimes no single cause can be identified.

Why Do Miscarriages Occur?

A major cause of early miscarriage is chromosome abnormality within the embryo.

The likelihood increases with female age because chromosome errors become more common in eggs.

However, recurrent miscarriage can have other causes.

Uterine Factors

Abnormalities within the uterine cavity may contribute in selected patients.

Assessment may involve ultrasound, saline sonography or hysteroscopy depending on the circumstances.

Examples include some uterine septa, significant intracavity fibroids, polyps or adhesions.

Antiphospholipid Syndrome

Antiphospholipid syndrome is an autoimmune condition associated with recurrent pregnancy loss and other pregnancy complications.

Specific laboratory criteria and clinical history are required for diagnosis.

Genetic Factors

Occasionally, one partner carries a balanced chromosome rearrangement without having health problems themselves.

Karyotype testing may therefore be considered in appropriate recurrent-loss situations.

Thyroid and Medical Conditions

Thyroid disease and other relevant medical conditions should be identified and appropriately treated.

Testing should be targeted rather than ordering large panels of unproven investigations.

What About Sperm?

Paternal factors are increasingly being studied in recurrent pregnancy loss.

A standard semen assessment and review of male reproductive health may be appropriate.

Specialised sperm tests should be used selectively because evidence that every available test improves treatment outcomes is not established.

Is IVF the Answer?

Not necessarily.

Some couples experiencing recurrent miscarriage conceive easily but struggle to maintain pregnancy.

IVF does not automatically correct every cause of miscarriage.

For selected couples, however, IVF with embryo genetic testing may form part of a discussion, particularly where chromosome-related factors are relevant.

Be Careful With Unproven Treatments

Recurrent miscarriage is an area in which patients are frequently offered immune therapies, extensive testing and other interventions.

Before proceeding, ask whether good-quality evidence demonstrates improvement in live birth, rather than simply changes in laboratory measurements.

The Take-Home Message

Recurrent miscarriage should be approached systematically and compassionately.

Assessment may consider maternal age, pregnancy history, uterine anatomy, antiphospholipid syndrome, genetics and relevant endocrine or medical conditions.

Treatment should target identified problems rather than automatically adding multiple interventions without evidence.