Recurrent Miscarriage: A Complete UK Guide
What is recurrent miscarriage?
In the UK, recurrent miscarriage is defined as the loss of three or more pregnancies in a row. Some clinicians and guidelines also recognise two consecutive losses as worth investigating, particularly if you are over 35 or have no living children. Around one in a hundred women will experience recurrent miscarriage, and many will go on to have a successful pregnancy with the right care.
It is one of the most distressing experiences a parent can face, and it is entirely normal to feel frightened, angry, or hopeless. But there is hope: specialist clinics such as the NHS Recurrent Miscarriage Clinic and the private Tommy's clinics in London, Birmingham, and Edinburgh have helped thousands of families achieve a successful pregnancy.
What causes recurrent miscarriage?
In around half of cases, no clear cause is found. This can feel frustrating, but it also means there is nothing you have done wrong. Known causes include:
- Chromosomal problems in the embryo, which become more common with age
- Antiphospholipid syndrome (APS), a blood clotting disorder that affects around 15% of recurrent miscarriage cases
- Inherited thrombophilias, which are less commonly linked to miscarriage but may be tested for
- Uterine anomalies, such as a septate uterus or cervical weakness
- Thyroid disorders, including both under- and over-active thyroid
- Progesterone insufficiency, which is being increasingly recognised
- Lifestyle factors, such as smoking, high alcohol intake, or very low or high BMI
A 2022 Cochrane review found that low-dose aspirin plus heparin significantly improves live birth rates in women with APS, and the PRISM trial (2019) showed that progesterone supplementation can help some women with recurrent bleeding in early pregnancy.
NHS investigations and referral
Ask your GP for a referral after three consecutive first-trimester losses, or earlier if you have had a second-trimester loss or a known risk factor. You should be offered:
- Blood tests for antiphospholipid antibodies (tested twice, 12 weeks apart)
- Tests for inherited thrombophilias if there is a family history
- Thyroid function tests and a thyroid antibody check
- A karyotype test on you and your partner
- A pelvic ultrasound to look at the shape of your uterus
- A review of any tissue from previous losses
- Screening for diabetes and, in some cases, a glucose tolerance test
The NHS pathway is described in NICE guideline NG126, which you can read in full on the NICE website. Waiting times for specialist clinics vary across the country.
Private and specialist options
If you do not want to wait for an NHS appointment, or you have had two losses and want earlier help, private clinics can investigate sooner. The Tommy's National Centre for Miscarriage Research (tommys.org) runs clinics in London, Birmingham, and Edinburgh. Fees vary, and some patients are eligible for part-funded places.
Other private options include the Lister Miscarriage Clinic and the Recurrent Miscarriage Clinic at St Mary's, London. Your GP may agree to share care with a private specialist.
Treatment and support
Treatment depends on the cause. Options include:
There is no single answer to recurrent miscarriage, but with specialist care and the right information, most couples go on to have a successful pregnancy. You do not have to go through this alone.