A miscarriage is defined as any unplanned pregnancy loss occurring before the 20th week of pregnancy and is a relatively common event, affecting nearly 15% of all pregnancies. However, when miscarriages happen repeatedly — defined as three consecutive losses in the first trimester or two losses with one in the first trimester and another in the second trimester — it may indicate an underlying medical condition, such as immunological issues. Women who experience recurrent miscarriages should seek advice from a specialist to address these underlying causes and help prevent further losses.
Multiple miscarriages, along with implantation failures and low ovarian reserve, are a sign of an underlying immunological issue, which can make conceiving and carrying a pregnancy to term difficult. Because even subclinical immunological problems can contribute to recurrent losses, many patients come to us with recurrent miscarriages, unaware that they even have an autoimmune condition.
Fortunately, with proper diagnosis and treatment, achieving a successful pregnancy is possible, but it's essential to identify the issue and take proactive measures to manage it. Diagnosing and treating immune-related miscarriages requires specialized expertise that many reproductive endocrinologists (REIs) may not have. If you’ve experienced multiple miscarriages, it’s crucial to consult a specialist. At the Center for Human Reproduction, we bring over 30 years of experience in treating immune-related infertility and miscarriages, offering a deep understanding of the underlying causes and the most effective treatments.
Pregnancies that are confirmed only by a blood test (hCG) are considered "chemical pregnancies" because the gestation is confirmed through chemical means instead of ultrasound visualization of the fetus. "Clinical pregnancy" refers to a pregnancy that has reached a stage where the gestation can be seen on ultrasound. Miscarriages refer to losses of pregnancies that reached this "clinical" stage, past the chemical stage.
In life outside of fertility treatment settings, most women do not know they had chemical pregnancies since most women do not take a pregnancy test so early in their pregnancy. During infertility treatments, however, we do diagnose these very early pregnancy losses routinely because every treatment cycle is followed up with a very early pregnancy test. Honest fertility programs do not consider chemical pregnancies as part of their IVF success rate statistics. Those statistics should exclusively include clinical pregnancies.
The miscarriage of a clinical pregnancy can take place either before or after the ultrasound shows a fetal heart rate. In a normally progressing pregnancy, a fetal heart should be present sometime between approximately 5.5 and 6 weeks from the first day of the last menstrual period. If a pregnancy stops growing before the fetal heart or if no heart is seen by the expected time (which is usually a sign of an abnormal pregnancy), then the pregnancy is generally considered to be a "blighted ovum" or missed abortion. Whether a pregnancy loss occurs before or after fetal heart activity is quite important because the timing of the miscarriage can provide a hint at the underlying cause.