Experiencing a miscarriage is emotionally devastating. When it happens repeatedly – defined as two or more consecutive pregnancy losses – it is classified as recurrent miscarriage (also called recurrent pregnancy loss). This affects approximately 1–2% of couples trying to conceive and warrants thorough investigation and specialised care.
Recurrent miscarriage care with Dr. Arun Muthuvel in Chennai
Dr. Arun Muthuvel is an MCh-qualified reproductive medicine and surgery specialist in Chennai who investigates recurrent pregnancy loss systematically and treats what is found, while being clear that no cause is identified in around half of couples.
That uncertainty is difficult, but it is not hopeless. Most couples with unexplained recurrent miscarriage go on to have a successful pregnancy with supportive care alone. Dr. Arun Muthuvel avoids unproven immune therapies and focuses on the tests and treatments that change outcomes.
Common Causes
Chromosomal Abnormalities
The most common cause of miscarriage is chromosomal abnormality in the embryo. As women age, the likelihood of eggs having chromosomal errors increases, which is why recurrent miscarriage becomes more common after 35. Rarely, one partner may carry a balanced chromosomal translocation that increases the risk of abnormal embryos.
Uterine Abnormalities
Structural problems with the uterus can interfere with implantation or pregnancy maintenance. These include a uterine septum (a wall dividing the uterine cavity), fibroids (especially submucosal fibroids that distort the cavity), uterine adhesions (Asherman’s syndrome), and cervical insufficiency.
Thrombophilia and Antiphospholipid Syndrome
Blood clotting disorders can compromise blood flow to the developing placenta, leading to pregnancy loss. Antiphospholipid syndrome (APS) is the most well-established treatable cause of recurrent miscarriage and is found in approximately 15% of women with recurrent loss.
Hormonal Factors
Uncontrolled diabetes, thyroid disorders, and PCOS can all increase miscarriage risk. Ensuring these conditions are well-managed before and during pregnancy is essential.
Diagnostic Workup
- Karyotyping of both partners to check for chromosomal translocations
- Pelvic ultrasound or hysteroscopy to assess uterine anatomy
- Blood tests for antiphospholipid antibodies and thrombophilia screening
- Thyroid function tests and blood sugar assessment
- Hormonal evaluation including progesterone levels
Treatment Options
- Progesterone supplementation: Evidence supports the use of progesterone in early pregnancy for women with a history of recurrent miscarriage.
- Blood thinners: Low-dose aspirin and heparin for women with antiphospholipid syndrome can significantly reduce miscarriage rates.
- Surgical correction: Removal of uterine septum, fibroids, or adhesions when they are contributing to pregnancy loss.
- IVF with PGT-A: Preimplantation genetic testing allows screening of embryos for chromosomal abnormalities before transfer, selecting only genetically normal embryos.
- Optimising underlying conditions: Strict control of diabetes, thyroid levels, and weight before attempting pregnancy.
The Outlook
What Counts as Recurrent Miscarriage
Recurrent pregnancy loss is generally defined as two or more consecutive pregnancy losses before 24 weeks. Investigation after two losses is now standard practice in most guidelines, particularly when the woman is over 35 or has other risk factors.
The Investigations That Matter
| Cause | Approximate share | Key tests |
|---|---|---|
| Chromosomal abnormality in the pregnancy | 50 to 60 percent of single losses | Tissue testing of the miscarriage where possible |
| Parental chromosome rearrangement | 2 to 5 percent | Karyotype of both partners |
| Uterine abnormality | 10 to 15 percent | 3D ultrasound, hysteroscopy |
| Antiphospholipid syndrome | 5 to 15 percent | Lupus anticoagulant, anticardiolipin, anti-beta-2 glycoprotein, repeated after 12 weeks |
| Endocrine: thyroid, diabetes, prolactin | Variable | TSH, thyroid antibodies, HbA1c, prolactin |
| Male factor including DNA fragmentation | Contributory | Semen analysis, DNA fragmentation index |
| Unexplained | Around 50 percent | Diagnosis of exclusion after the above |
Treatments With Real Evidence
- Antiphospholipid syndrome: low-dose aspirin with heparin substantially improves live birth rates and is the best-established treatment in this field
- Uterine septum, polyps or adhesions: hysteroscopic correction
- Thyroid disease: treatment of overt hypothyroidism, with levothyroxine considered for subclinical disease with antibodies
- Diabetes and prolactin disorders: optimisation before conception
- Parental translocation: genetic counselling, with IVF and embryo testing as an option
- Progesterone: vaginal progesterone benefits women with early pregnancy bleeding and three or more previous losses
- Lifestyle: stopping smoking, limiting alcohol and caffeine, and achieving a healthy weight
Treatments not supported by good evidence include intravenous immunoglobulin, intralipid, steroids and heparin in women without antiphospholipid syndrome. Dr. Arun Muthuvel will explain why these are not recommended routinely. Where the male partner’s DNA integrity is a concern, see our guide to sperm DNA fragmentation testing, and hysteroscopy for uterine assessment.
Supportive Care and Prognosis
Close early pregnancy monitoring with reassurance scans, sometimes called tender loving care, is associated with better outcomes in unexplained recurrent loss. After three losses with no cause found, the chance of a successful next pregnancy remains around 60 to 70 percent, and higher in younger women.
Frequently Asked Questions
How many miscarriages before investigation?
Two consecutive losses justify investigation in current practice, and sooner if the woman is over 35 or there are other risk factors.
Will we find a cause?
In about half of couples, yes. The remainder are classed as unexplained, and this group still has a good chance of a successful next pregnancy with supportive care.
Does IVF prevent miscarriage?
Not by itself. IVF with genetic testing of embryos can reduce the loss rate where chromosomal abnormality is the cause, but it does not help in every situation and is not a routine answer.
Is stress a cause of miscarriage?
Ordinary stress is not a proven cause of pregnancy loss. This is important, because women frequently blame themselves for something they did not cause.
Why consult Dr. Arun Muthuvel for recurrent miscarriage in Chennai?
He follows a structured, guideline-based investigation, treats the causes that respond to treatment, and does not offer unproven immune therapies that add cost without benefit.
The Bottom Line
Recurrent miscarriage deserves systematic investigation after two losses, and the treatable causes respond well when they are found. Dr. Arun Muthuvel provides evidence-based recurrent pregnancy loss care in Chennai, including supportive early pregnancy monitoring when no cause is identified.
This article provides general medical information and does not replace individual diagnosis or treatment advice. Outcomes vary with age, diagnosis, test results and clinical circumstances.