Pregnancy Miscarriage: Why It Happens, How It Happens & What to Do NextAt a Glance

A miscarriage can leave you with many questions: Why did it happen? Could it happen again? What should you do before trying for another pregnancy?

The answer depends on when the miscarriage happened, whether it was your first or a repeated loss, and what your medical evaluation shows.

Understanding why miscarriage happens, the possible reasons for pregnancy loss, and when you may need further testing can help you plan your next steps.

A miscarriage is the loss of a pregnancy before 20 weeks of pregnancy.

Most miscarriages happen during the first trimester.

They are generally divided into:

• Early miscarriage: Pregnancy loss before 12 weeks
• Late miscarriage: Pregnancy loss between 12 and 20 weeks

The possible causes can be different in early and later pregnancy, so your doctor will consider how far the pregnancy had progressed when deciding what evaluation you need.

A miscarriage is common, and in many cases, it happens because the pregnancy was not developing normally. It is also usually not caused by something you did or did not do.

There is no single reason for every miscarriage.

In early pregnancy, chromosomal abnormalities are one of the most common causes. This means the developing pregnancy has an extra, missing or altered chromosome and cannot develop normally.

These chromosomal changes often happen randomly when the egg, sperm or early embryo is forming.

Other possible reasons for miscarriage include:

Fibroids, polyps, a uterine septum and other changes in the shape of the uterus can sometimes affect pregnancy.

Problems with the cervix can also cause pregnancy loss, particularly later in pregnancy.

Conditions such as thyroid disorders and diabetes can affect pregnancy. Some hormonal or metabolic problems may also increase the risk of pregnancy loss.

Certain infections can affect a pregnancy and may contribute to miscarriage.

Some blood-clotting conditions are linked to pregnancy loss. Antiphospholipid syndrome (APS) is one condition doctors may check for when a woman's pregnancy history suggests it.

Some miscarriages happen because of genetic abnormalities in the pregnancy.

In some cases, one of the parents may also carry a genetic change that can increase the risk of pregnancy loss.

Certain maternal medical conditions can affect pregnancy and may need to be treated or controlled before another pregnancy.

A miscarriage can happen at different stages of pregnancy. The stage at which it happens can help your doctor decide what may have caused it and which tests may be useful.

A very early miscarriage can happen before you even realise that you are pregnant.

A miscarriage at around one month may look like a delayed or heavier-than-usual period. You may have bleeding, cramps or pass blood clots.

At this stage, chromosomal problems are a common reason for pregnancy loss.

A miscarriage at around two months happens during the first trimester.

You may experience bleeding, cramps or lower back pain. However, these symptoms alone cannot confirm a miscarriage.

An ultrasound and, when needed, blood tests can help determine whether the pregnancy is developing normally.

A miscarriage at four months occurs during the second trimester.

The possible causes can be different from those of very early miscarriage. Your doctor may look at the uterus, cervix, infection, genetic factors, placental problems and certain medical conditions.

A miscarriage at five months is also a second-trimester pregnancy loss.

At this stage, your doctor may investigate problems involving the cervix, uterus, placenta, infection, genetic factors or certain maternal health conditions.

What happens next depends on whether this was your first miscarriage or whether you have had more than one.

After a miscarriage, your doctor will first make sure that the pregnancy loss is complete and that there are no complications.

Depending on your symptoms and how far along the pregnancy was, you may need an ultrasound, blood tests or other tests.

You do not necessarily need a full recurrent pregnancy loss evaluation after one miscarriage.

Many women who have one miscarriage go on to have a healthy pregnancy.

Your doctor may recommend further testing if your medical history, previous pregnancies or other findings suggest that it would be useful.

Once you have recovered, your doctor can also advise you about when it is appropriate to try for another pregnancy.

If you have had two miscarriages, it is worth discussing whether you need an evaluation for recurrent pregnancy loss (RPL).

Your doctor may review:

• Your previous pregnancy records
• Ultrasound reports
• Blood test results
• Your medical history
• Any genetic testing already done

Depending on your history, testing may look at genetic, uterine, hormonal, metabolic, immune, blood-clotting and male reproductive factors.

The aim is to find a possible reason for the repeated pregnancy losses and treat or manage anything that can be addressed before the next pregnancy.

Recurrent Pregnancy Loss: When Repeated Miscarriage Needs Investigation

Having more than one miscarriage can be a sign that something needs to be investigated.

Recurrent pregnancy loss (RPL) means repeated pregnancy losses and is also called recurrent miscarriage. The reasons can be different for different couples, which is why a detailed evaluation is important.

At EPIA, we look beyond the obvious causes and investigate the factors that may be contributing to repeated pregnancy loss.

EPIA is one of the leading and first comprehensive centres for recurrent pregnancy loss, with 40+ years of experience in reproductive medicine and recurrent pregnancy loss.

Our approach brings diagnosis and treatment together, so that the aim is not just to identify a possible cause, but to create a treatment plan based on what we find.

We start by reviewing your complete pregnancy and reproductive history, including your previous miscarriages, investigations and treatments.

Depending on your history, we investigate six key areas:

• Genetic and chromosomal factors
• Uterine and endometrial health
• Hormonal and metabolic factors
• Blood-clotting factors
• Reproductive immunology
• Male reproductive factors

This helps us look for both common and less obvious reasons behind repeated pregnancy loss.

Once the evaluation is complete, your treatment plan is based on your diagnosis and individual history.

Depending on what we find, treatment may include:

IVIGImmune regulation delivered through intravenous infusion.

LIT therapyA therapy designed to support maternal immune tolerance to the embryo.

Alpha ThymosinA course of injections used to support immune balance.

HCQUsed in selected cases to help manage autoimmune and inflammatory factors.

HeparinUsed in selected cases to support healthy blood flow to the developing placenta.

The right treatment is not the same for every woman. Your diagnosis determines your treatment plan.

EPIA brings more than four decades of experience in reproductive medicine and recurrent pregnancy loss.

Our RPL program combines fertility care, genetics, reproductive immunology and endometrial assessment under one coordinated approach.

Repeated pregnancy loss can involve more than one factor. Our approach brings different areas of investigation together rather than looking at each factor in isolation.

If you have experienced repeated pregnancy loss, you do not have to keep going through pregnancy after pregnancy without understanding what may be happening.

Get in touch with EPIA to discuss your history and find out whether a recurrent pregnancy loss evaluation could help you

Most miscarriages happen because the pregnancy is not developing normally. Sometimes, however, a clear cause cannot be found.

One miscarriage does not mean that you cannot have a healthy pregnancy in the future.

If you have had repeated miscarriages, it is important to investigate whether there is an underlying factor that may be contributing to the losses.

A proper evaluation can help identify problems that can be treated or managed and help you plan for your next pregnancy.