Recurrent Miscarriages: Causes & What You Can Do About Them

Recurrent miscarriages or pregnancy loss is defined as the loss of three or more pregnancies, and it affects one to two per cent of couples, according to KK Women’s and Children’s Hospital (KKH). 

For women who have experienced recurrent miscarriages, it is a world of tears, guilt, grief, and immense anxiety.

"Will this pregnancy end all-too-early, in a miscarriage too?" "Will I be able to hold this baby in my arms, safe and whole?" These are some questions women ask themselves.

Friends and family may not know what to say to yet another miscarriage, but to the women experiencing it, it’s not just another miscarriage. The pain and grief is just as real and raw as it was the last miscarriage, and the one before.

What causes recurrent miscarriages or pregnancy loss?

According to Dr Liu Shuling, director and senior consultant of the KKIVF Centre and lead physician of the Recurrent Pregnancy Loss (RPL) Clinic at KKH, known causes of recurrent pregnancy loss are similar to causes of miscarriages such as poorly controlled medical conditions, thyroid disorders, high BMI, fibroids, placenta problems, and foetal abnormalities.

However, she acknowledges that many patients with recurrent pregnancy loss are unable to explain their losses. “More than 50 per cent of patients with three or more miscarriages will have normal results despite extensive investigations.”

One thing's for sure: just because you’ve experienced multiple miscarriages doesn’t mean that there is no hope for conceiving.

“Women with unexplained pregnancy loss still have an excellent prognosis for future pregnancy outcomes, if offered supportive care – especially in a dedicated clinic for patients who suffer from recurrent pregnancy loss, like the KKH RPL clinic,” explained Dr Liu. 

“In fact, even after three miscarriages, a patient could still have a 60 to 70 per cent chance of having a live birth in her fourth pregnancy.”

Recurrent pregnancy loss is not your fault

For many women, their journey with recurrent miscarriages is a painful and discouraging one.

They may not have any problems getting pregnant naturally, but find that their babies spontaneously stop growing at the same point of each pregnancy, over and over again.

They may start to blame themselves for the recurrent miscarriages, thinking that maybe they exercised too much, were too stressed out, ate too much “cooling” foods, or even that they had inadvertently harmed their foetus with exposure to radiation from devices.

“Many women blame themselves for the loss, but I always tell my patients that it is not their fault and that a miscarriage is not within their control,” Dr Liu says firmly.

Discovering the root cause of recurrent pregnancy loss

The best way of managing recurrent miscarriage risks is to get to the root cause of the loss, through comprehensive assessment and treatment recommendations. 

To kickstart your investigation, some places you can seek help from are the KKH Recurrent Pregnancy Loss clinic, the Reproductive Immunology Clinic at the NUH Women’s Clinic, and the Recurrent Pregnancy Loss department at SGH.

Another avenue you can turn to is Naprotechnology.

Naprotechnology, which stands for Natural Procreative Technology, has been around in Singapore for more than 30 years. Developed in the United States more than 40 years ago, it is a system of medical care that works cooperatively with the body’s natural procreative cycle, to systematically evaluate the events that occur during the course of the menstrual and ovulation cycles. 

This involves tracking the woman’s fertility cycle by charting her cervical mucus, vaginal discharge, and bleeding pattern via the Creighton Model System, a detailed system that classifies a woman’s cervical mucus using external observations (for example, clear, stretchy, lubricative, cloudy, tacky).

Dr John Hui, family physician and practitioner of Naprotechnology, shares: “Women who use the Naprotechnology programme to understand their fertility better may even discover underlying medical issues preventing pregnancy, like undiagnosed endometriosis, polycystic ovarian disease, and hormonal imbalances. Some have even been able to detect conditions like cancer of the womb, when they realised their bleeding pattern was different from their usual using these charts.”

“Addressing these medical conditions through surgery or medication can help women boost their fertility naturally.”

For women with multiple miscarriages, Naprotechnology is able to discern whether the miscarriages are due to inconsistent luteal phases, suggesting a luteal phase defect, or whether there is an underlying condition that needs to be treated.

Inconsistent luteal phases may lead to recurrent miscarriages because there is insufficient support for the womb to grow a lining rich enough to support the pregnancy – and there are some medications that you can take to boost progesterone levels, to normalise the luteal phase. 

This, Dr Hui explains, can be deduced from tracking your cycle for a period of more than three months, and recording the observable characteristics of the cervical mucus. 

“If your chart looks normal, then we’ll investigate further,” he says. “We’ve been able to pick up polyps in the womb and cysts in the ovaries, and severe cases of previously undiagnosed endometriosis. And I’m happy to share that some of the women who chose to get these conditions treated did manage to carry their next babies to term.”

Men are also part of the investigative process. “We don’t forget about the men! Whether the woman’s fertility chart looks alright or not, and even as we get the other tests for the woman done, we also send sperm samples to the lab to check the sperm quality. There are various conditions in men that contribute to infertility, and they should and can be treated as well,” says Dr Hui.

Poor quality of the sperm such as DNA defects could be a cause of recurrent miscarriages too.

Does Assisted Reproductive Technology (ART) lower the risk of miscarriage?

While modern medicine and ARTs like In-Vitro Fertilisation (IVF) and Intrauterine Insemination (IUI) have helped many women in Singapore have their babies, can it help women who have recurrent pregnancy loss?

Not exactly, says Dr Liu. 

Dispelling the view that ARTs like IVF may lower the likelihood of pregnancy loss, Dr Liu explains: “IVF pregnancies will still have a risk of miscarriage and it will not be lower than spontaneous pregnancies.”

Dr Liu cautions that IVF should only be considered if you are unable to get pregnant despite having regular, unprotected intercourse for more than 12 months; or if either husband or wife has a balanced translocation, which predisposes their pregnancies to having abnormal DNA, leading to recurrent miscarriages.

In fact, Dr Liu recommends that women with recurrent pregnancy losses should firstly undergo investigations for underlying medical conditions, and seek advice from specialists to find out if there are any factors that can be improved to increase their chance of having a healthy baby.

The ultimate goal, both doctors concur, is to help women achieve good health for optimal fertility. There will always be unknown causes for some cases of recurrent miscarriage. For the women who manage to discover the root causes of their multiple losses, the relief is immense.

“There’s certainly hope, and help available for women who wish to investigate further,” says Dr Hui encouragingly.

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