Pregnancy can be a time of hope and anticipation, which is why pregnancy loss can be devastating. Spontaneous abortion, or miscarriage, is the loss of pregnancy less than 20 weeks into gestation. And it is common: Up to one in four pregnancies end in miscarriage. However, having more than one miscarriage is less common.

Some people may experience more than one miscarriage before they have a child, while others may have a first child without complications but then experience multiple miscarriages when attempting to have a second child. This unique fertility issue is called recurrent pregnancy loss (RPL).

RPL is defined as having two or more pregnancy losses. It is far less common than a singular miscarriage:

• Less than one in 20 pregnant people will have two miscarriages in a row.
• About one in 100 pregnant people will have three or more miscarriages in a row.

Causes of RPL

In about half of RPL cases, the cause is unknown. In the other half, some common causes include:

• Fetal chromosome errors. The risk of sporadic errors in chromosomes increases with female age.
• Parental genetics. One parent may have a balanced translocation, which is a chromosomal rearrangement that leads to an abnormal chromosomal makeup in the fetus.
• Issues with the anatomy of the person carrying the pregnancy. This includes uterine fibroids, polyps, scarring or abnormality of the uterus, such as a uterine septum. Infection can also cause inflammation of the uterus, which can be associated with RPL.
• Hormonal disorders. This includes inadequate production of the hormone progesterone, which supports a healthy environment in the uterus.
• Autoimmune issues. This includes antiphospholipid antibody syndrome, a disorder where the abnormalities in the immune system lead to formation of blood clots.

Treatment and Success

Treatment for RPL depends on the underlying cause. If the cause is unknown, hormonal support may help people carry a pregnancy to term. Studies show that people with RPL have a high likelihood of having a baby if they seek treatment from a specialist. In one study, among people with a history of RPL who were seen for a consultation at a clinic like the Northwestern Medicine Recurrent Pregnancy Loss Clinic, about two thirds had at least one baby within 5 years of their initial consultation.

Psychological Support

Miscarriage can be mentally and emotionally difficult for individuals and couples, and RPL is even more distressing. Psychological therapy is a vital part of RPL treatment, which may include:

• Identifying anxiety and depressive symptoms
• Evidence-based interventions to help cope and deal with treatment-related stressors
• Strategies to process emotions related to RPL and effectively communicate with partners, family and friends
• Grief counseling

“If you have experienced more than one miscarriage, you should consider seeing a recurrent pregnancy loss specialist,” says Dr. Bernardi. “There are many evaluation and treatment options available that may be able to help you become a parent.”