How Common Are Recurring Miscarriages?

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I am 39 years old, I have a 2-year-old daughter, and we have been trying for baby number two, so far unsuccessfully. I’m a generally optimistic and reasonable person, but I’ve now had two miscarriages in a row. One part of me says, “Third time will be the charm,” and the other part is starting to really worry if there is something wrong. How prevalent are recurrent miscarriages, and what are the chances of three in a row vs. a healthy pregnancy?

—Feeling a Little Eeyore

First, let me say, I’m really sorry you’re going through this. Secondary infertility isn’t discussed enough and can often be a surprise, and, of course, miscarriage is hard in any situation.

Let me start with what we know from the data. The vast majority of first-trimester miscarriages — about 90% — happen because of chromosomal abnormalities. These are random events, and they are more likely as we get older. At 39, these abnormalities are more likely than when you conceived your daughter. The hardest part about this statistic is that it means most early losses aren’t preventable.

Even adjusting for age, multiple miscarriages do make it more likely that you’ll have another. After one miscarriage, your risk of another is only slightly higher than someone who hasn’t had a loss. But after two, the picture changes a bit — the risk approximately doubles. I do not say this to scare you, but this is a point at which it may make sense to talk to your doctor.

This is true for two reasons. First, while most recurrent losses are still due to chromosomal issues, there are a small number of other possible causes that may make sense to screen for.

Antiphospholipid antibody syndrome (an autoimmune condition that affects blood clotting and can impact pregnancy)
A uterine septum (a tissue wall that partially divides the uterus)
A balanced translocation (a chromosomal rearrangement that can be passed to embryos)

These are all rare, but if detected, they would influence what you do next (and some are treatable).

The other reason to talk to a doctor is that you may ultimately want to consider IVF, and this conversation may be better started earlier.

I hope you get some answers, and I’m thinking of you.