Understanding When a Miscarriage May Indicate an Underlying Fertility Issue
Miscarriage is a heartbreaking reality for many women, yet it is far more common than most realize. According to the American College of Obstetricians and Gynecologists (ACOG), around 10 to 20 percent of known pregnancies end in miscarriage, with the actual number likely higher due to early pregnancy losses. While many women go on to conceive successfully, some experience multiple miscarriages, leaving them wondering if an underlying fertility issue is preventing them from carrying a pregnancy to term.
A single miscarriage, while devastating, does not necessarily indicate an ongoing reproductive problem. However, if pregnancy loss happens more than once, or if getting pregnant again becomes difficult, it may be a sign of an issue that needs medical attention. Understanding when to seek testing can provide answers and solutions.
When Is Recurrent Pregnancy Loss (RPL) a Sign of Infertility?
One miscarriage is usually an unfortunate but isolated event. It is not typically a sign of infertility, and most women can conceive again without difficulty. However, recurrent pregnancy loss (RPL) is different. Defined as two or more consecutive miscarriages before 20 weeks, it affects only about 1% of women but often signals an underlying problem.
It may be time to consult a fertility specialist if you have:
- Had two or more consecutive miscarriages
- Experienced a late miscarriage (after 12 weeks)
- Struggled to conceive for six to twelve months after a miscarriage
- A history of irregular menstrual cycles, endometriosis, or polycystic ovary syndrome (PCOS)
Finding the cause of pregnancy loss can help guide treatment and improve the chances of a successful pregnancy.
4 Causes of Recurrent Miscarriage and How to Address Them
While pregnancy loss is never easy, understanding the cause is a key step toward finding solutions. Some miscarriages result from random chromosomal issues, meaning they were never viable from the start. Others stem from persistent medical conditions that may require intervention.
#1. Genetic Causes of Recurrent Miscarriage: How Chromosomes Affect Pregnancy
A significant percentage of early miscarriages occur due to chromosomal abnormalities in the embryo. These abnormalities often happen at conception when the egg and sperm combine, leading to an incorrect number of chromosomes. While this is often random, it becomes more common with maternal age.
In some cases, one or both parents may carry a balanced translocation, meaning their chromosomes are arranged differently but function normally. When passed to an embryo, however, it can result in missing or extra genetic material, preventing normal development.
How to diagnose it:
- Karyotyping (genetic screening of both parents)
- Preimplantation genetic testing (PGT) during IVF to select chromosomally normal embryos
- Genetic analysis of previous pregnancy losses, if available
What can be done?
- If genetic abnormalities are detected, IVF with PGT can help select healthy embryos.
- If a parental chromosome issue is found, genetic counseling may provide insights into reproductive options.
#2. Uterine and Cervical Causes of Recurrent Miscarriage
The uterus provides the foundation for pregnancy. If there are structural abnormalities or weaknesses, miscarriage can occur even if conception happens successfully.
Common uterine issues that can contribute to pregnancy loss:
- Fibroids or polyps, which interfere with implantation
- A septate uterus, where a band of tissue divides the uterine cavity, making it harder for an embryo to attach
- Scar tissue (Asherman’s syndrome), which can form after miscarriage, surgery, or infection
- Endometrial lining issues, where the uterine lining is too thin to support implantation
Cervical insufficiency occurs when the cervix is too weak to stay closed, leading to a second-trimester miscarriage. This can happen without noticeable symptoms until the pregnancy is already in danger.
How to diagnose it:
- Saline ultrasound (sonohysterogram) or hysterosalpingogram (HSG) to assess the uterus
- Hysteroscopy to examine the uterine cavity with a small camera
What can be done?
- Minimally invasive surgery to remove fibroids, polyps, or correct uterine abnormalities
- Cervical cerclage (a stitch to support the cervix) for women with cervical insufficiency
- Hormonal support or endometrial therapies to improve uterine lining quality
#3. Hormonal Imbalances and Endocrine Disorders That Cause Miscarriage
Hormones regulate ovulation, implantation, and early pregnancy development. If hormone levels are off, miscarriage risk increases.
Common hormonal disorders that may contribute to miscarriage:
- Polycystic ovary syndrome (PCOS), which affects ovulation and progesterone levels
- Thyroid dysfunction (hypothyroidism or hyperthyroidism), which can disrupt pregnancy support
- Uncontrolled diabetes, which can interfere with embryo development
- Low progesterone (luteal phase defect), which may prevent the uterine lining from supporting pregnancy
How to diagnose it:
- Thyroid function tests (TSH, T3, T4)
- Progesterone level testing to assess ovulation and pregnancy support
- Glucose and insulin testing for diabetes or insulin resistance
What can be done?
- Thyroid disorders can often be corrected with medication
- PCOS-related pregnancy loss may benefit from ovulation-stimulating medications
- Progesterone supplementation may be recommended for women with repeated early pregnancy losses
#4. Immune and Blood Clotting Disorders Linked to Pregnancy Loss
The immune system plays a key role in pregnancy. If it misfires, the body may mistakenly reject or clot off a pregnancy.
Common immune and clotting disorders linked to miscarriage:
- Antiphospholipid syndrome (APS), which can cause blood clots in the placenta
- Thrombophilias, inherited conditions that make women prone to clotting-related pregnancy complications
- Elevated natural killer (NK) cells, which may attack pregnancy tissue
How to diagnose it:
- Antiphospholipid antibody testing
- Thrombophilia panel for genetic clotting disorders
- Immune testing for overactive responses
What can be done?
- Blood thinners such as low-dose aspirin or heparin may reduce clotting risks
- Steroid therapy or immune-modulating treatments may help in some autoimmune cases
Testing and Treatment Options for Recurrent Miscarriage
When multiple miscarriages occur, it is important to rule out underlying causes like uterine problems, hormonal disorders, and genetic abnormalities. While it can feel overwhelming, advances in fertility diagnostics provide several pathways to gaining clarity and developing a treatment plan. A specialist may recommend:
- Genetic screening to assess for chromosomal abnormalities
- Imaging to evaluate uterine health
- Hormonal testing to check for imbalances
- Clotting and autoimmune panels to rule out APS or related conditions
- Semen analysis to assess sperm quality
How the Parryscope® Fertility Test Helps Diagnose Recurrent Miscarriage
For women who have had multiple miscarriages, one of the biggest frustrations is not knowing why it keeps happening. Getting the right tests can feel like a slow and complicated process, often requiring multiple appointments over months. That’s one of the reasons I developed the Parryscope® Fertility Test—to provide faster, more comprehensive answers in a single visit.
The most common cause of miscarriage is abnormal DNA from the egg or sperm, but the next leading cause is uterine anatomy. If the uterus is not structured in a way that supports implantation and fetal development, miscarriage risk increases significantly. Parryscope® provides a detailed view of the uterine cavity, allowing us to identify abnormalities such as fibroids, scar tissue, or a septate uterus. These issues can often be corrected, improving the chances of a successful pregnancy.
The test also evaluates fallopian tube function, which is often overlooked when diagnosing recurrent miscarriage. If the tubes are blocked or damaged, it can lead to implantation failure or increase the risk of an ectopic pregnancy. By assessing tubal health in real-time, we can determine whether this is a contributing factor.
In addition, Parryscope® provides insight into ovarian reserve, which helps us understand egg supply. While we can’t directly measure egg quality, knowing whether a woman has diminished ovarian reserve can help predict the likelihood of chromosomal issues that could lead to miscarriage.
For those struggling with recurrent miscarriages, having all of this information at once means fewer delays in determining the next steps. Instead of waiting months for multiple tests, Parryscope® allows us to quickly identify possible causes and decide whether treatment, surgery, or assisted reproduction is the best course of action. If you’ve had multiple miscarriages and are looking for answers, this test can provide a clear and efficient way forward.
When to See a Fertility Specialist After Miscarriage
Recurrent miscarriage is not always a sign of infertility, but it is a reason to investigate further. Knowing the cause can help determine the best treatment, whether it’s lifestyle changes, medical management, or advanced reproductive options. If you’ve experienced multiple miscarriages, seeking expert guidance can provide the answers you need to move forward.
You don’t have to go through this alone. Reach out today to take the next step in your fertility journey.
