Recurrent Miscarriage (Recurrent Pregnancy Loss): Investigation and Compassionate Care in Türkiye

What is recurrent miscarriage (recurrent pregnancy loss)?

Recurrent miscarriage, also called recurrent pregnancy loss, is the loss of two or more consecutive clinical pregnancies before the fetus can survive independently. It is uncommon — about 5 % of women experience two or more consecutive losses and roughly 1 % experience three or more — but for the couple living through it, the statistics matter far less than the grief. The losses are usually early, in the first trimester, and they deserve a proper evaluation rather than being dismissed as bad luck. Understanding the difference between repeated loss and a single, sporadic miscarriage is the first step toward the right care.

What are the chances of a successful pregnancy after recurrent loss?

The most important message for any couple facing recurrent miscarriage is that the outlook is genuinely encouraging. Even when no cause is found, around 65 % to 75 % of women go on to have a successful pregnancy without specific treatment, and women attending a dedicated specialist clinic show subsequent live-birth rates near 75 %. The chance does depend on age and the number of previous losses — a 30-year-old with two losses has roughly an 84 % chance of a successful next pregnancy, while the figure is lower at older ages — but for most couples the next pregnancy is more likely to succeed than to fail. Knowing this realistic, hopeful picture is part of the care itself.

Source: American College of Obstetricians and Gynecologists (ACOG), repeated miscarriage guidance

Two losses or three — when should you be investigated?

Guidelines differ on when to start testing, which often leaves couples confused about whether they "qualify" for an evaluation. In the United States, recurrent pregnancy loss is defined as two or more consecutive losses, while some other systems use three; in practice, many specialists — including us — begin a structured work-up after two losses, especially with increasing age. The point of an earlier evaluation is not to rush you but to avoid losing time when a treatable cause may be present. If you are anxious or older, asking for assessment after two losses is entirely reasonable.

What causes recurrent miscarriage?

Recurrent miscarriage has several recognised causes, although in about half of couples no clear reason is found even after a full work-up. The main categories are genetic and chromosomal factors, uterine and anatomical problems, clotting and immune disorders such as antiphospholipid syndrome, and hormonal conditions, with lifestyle factors adding to the risk. Each category points to different tests and, importantly, to different treatments. A structured evaluation sorts through these systematically rather than chasing one possibility at a time.

Source: American Society for Reproductive Medicine (ASRM), evaluation and treatment of recurrent pregnancy loss

Genetic and chromosomal causes

Genetic factors are a leading reason for early pregnancy loss, usually as a random chromosomal error in the embryo that is no one's fault. Less commonly, one partner carries a balanced chromosome rearrangement that does not affect their health but raises the risk of an unbalanced embryo, and such rearrangements account for a small share of recurrent loss. Testing the tissue from a miscarriage, combined with a full evaluation, identifies a likely cause in more than 90 % of cases. Where a parental rearrangement is found, we discuss the realistic options honestly, including natural conception and, in selected couples, IVF with embryo genetic testing.

Uterine and anatomical causes

Problems with the shape or lining of the uterus are among the most treatable causes of recurrent miscarriage, which is where a gynecologic surgeon adds particular value. A uterine septum, a submucosal fibroid that distorts the cavity, polyps or scar tissue (adhesions) can all interfere with a pregnancy and are often correctable with minimally invasive surgery. These are identified with three-dimensional ultrasound or hysteroscopy, and correcting them can improve live-birth rates in the right patient. Importantly, the same surgeon who finds such a problem can usually treat it.

Clotting, immune and hormonal causes

Certain medical conditions raise the risk of recurrent loss and can be treated once identified. Antiphospholipid syndrome — a clotting and immune disorder — is found in around 15 % of women with recurrent miscarriage, and when confirmed, blood-thinning treatment in a future pregnancy can improve outcomes. Hormonal conditions such as untreated thyroid disease, poorly controlled diabetes, raised prolactin and PCOS also play a role and are correctable. Lifestyle factors including smoking, significant excess weight and high alcohol or caffeine intake add measurable risk and are worth addressing before the next pregnancy.

Which tests matter — and which are not needed?

A good evaluation does a focused set of tests rather than an exhausting, expensive battery of everything. The core work-up includes blood tests for antiphospholipid syndrome and thyroid function, an assessment of the uterine cavity, and genetic testing of the parents or miscarriage tissue where appropriate. Tests with little proven value — such as routine immune "natural killer cell" panels — are generally avoided because they rarely change the plan and can cause needless worry and cost. We explain why each test is done, so you are never tested simply for the sake of it.

Source: European Society of Human Reproduction and Embryology (ESHRE), guideline on recurrent pregnancy loss

How is recurrent miscarriage treated?

Treatment for recurrent miscarriage is directed at the specific cause when one is found, which is why an accurate evaluation matters so much. A uterine septum or fibroid can be corrected surgically, antiphospholipid syndrome is treated with blood-thinning medication in pregnancy, and hormonal conditions are brought under control before conceiving. For unexplained loss, the most powerful intervention is often the simplest — close, supportive antenatal care, which in studies raised subsequent success rates to around 86 % compared with about 33 % without it. We combine cause-directed treatment with that supportive care, because both the medicine and the reassurance change outcomes.

Source: Royal College of Obstetricians and Gynaecologists (RCOG), investigation and treatment of recurrent miscarriage

Our approach to recurrent miscarriage

Our approach is built on three commitments: a structured, evidence-based work-up, treatment aimed only at causes that genuinely matter, and honest, compassionate communication throughout. We do not order tests that will not change the plan, and we do not promise outcomes we cannot deliver, because false hope is its own harm. Where a treatable cause is found we act on it; where none is found we focus on supportive care and a realistic, hopeful picture of the next pregnancy. Associate Professor Dr. Cengiz Andan reviews each couple's history personally, so the plan reflects your losses, your age and your goals rather than a generic protocol.

Correcting treatable causes with the same surgeon

One advantage of being evaluated by an experienced gynecologic surgeon is that a correctable cause can be both found and treated without fragmenting your care. A uterine septum, a submucosal fibroid, polyps or adhesions are exactly the problems where hysteroscopic or laparoscopic surgery can restore a normal cavity and improve the chance of carrying a pregnancy. When the cause is medical or genetic rather than surgical, we coordinate with hematology, genetics and the IVF team so the whole plan stays joined up. We see this continuity — one responsible specialist across diagnosis, surgery and coordination — as central to caring for couples after repeated loss.

Why does experience matter in recurrent miscarriage care?

In recurrent miscarriage, experience shows in restraint as much as in action — knowing which tests truly help, when surgery is justified, and when to reassure rather than intervene. Associate Professor Dr. Cengiz Andan brings 18 years of experience, more than 2,000 laparoscopic procedures and over 500 endometriosis surgeries, which means treatable uterine causes are recognised and corrected with care. Where surgery is needed, the complication rate is kept low, near 2 %, and the lining of the uterus is protected for a future pregnancy. Even so, we are always clear that no evaluation or treatment can guarantee a pregnancy, and that outcomes vary from couple to couple.

The emotional side: it is not your fault

The grief of repeated pregnancy loss is real, and acknowledging it is part of good medical care rather than separate from it. It is important to know that miscarriages are almost never caused by anything you did or did not do — not work, not exercise, not stress — and the guilt many women carry is misplaced. We make space for that grief, answer your questions honestly, and treat emotional support as a genuine part of the plan, since reassurance and close care measurably improve outcomes. If the weight of loss feels overwhelming, we encourage leaning on a partner, trusted people, or a counsellor alongside the medical care.

Your home country or Türkiye — what's really different?

For the planned evaluation and any surgery, the quality of recurrent-miscarriage care does not need to differ between your home country and Türkiye — the same tests, the same techniques and the same international guidelines apply. What changes is access: shorter waiting times for a full work-up and surgery, the continuity of one responsible specialist, and a lower overall cost driven by currency and operating expenses rather than by any reduction in standards. The honest summary is that you are not trading quality for price; you are trading a long wait and a higher bill for a faster, well-organized pathway.

Starting from abroad and receiving your report

International couples almost always begin the process remotely, which keeps any visit to Türkiye short and focused. After an online review of your history and results, a plan is prepared so that your time here is spent on the tests or surgery that are actually needed, rather than repeating work already done. You leave with a clear written report of your findings and any treatment, prepared in English, so you can hand it directly to your own doctor at home and continue care locally.