Repeated miscarriages or failed embryo transfers: why they happen and what can help
If you have lost more than one pregnancy, or had more than one embryo transfer that did not work, it is rarely anything you did wrong. Dr Mayur Pai explains the causes that can be checked, step by step — the womb, hormones, blood clotting, the immune system and genetics — and why there is real hope.
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Is it something I did wrong?
Losing a pregnancy is painful. Losing more than one, or seeing transfer after transfer not work, brings grief, worry and many questions, and many women quietly blame themselves. So the first thing to say is the most important: this is rarely something you did wrong.
It does not mean the door is closed, either. In most of these situations there is a reason we can look for, and once we understand it, we can make a proper plan together.
What is the difference between recurrent miscarriage and implantation failure?
People often confuse the two, but they are different problems, and knowing which one you face already tells us where to look.
- Recurrent miscarriage, also called recurrent pregnancy loss, usually means two or more pregnancy losses. A pregnancy does begin, but it is lost, and this happens more than once.
- Recurrent implantation failure is when good-quality embryos have been placed into the womb more than once, during IVF, but a pregnancy has not started.
Recurrent miscarriage is more common than people think, and neither problem means you cannot have a healthy baby. Many couples who go through this do go on to have one. If your difficulty is getting pregnant at all, see the common causes of infertility.
Why does it happen?
There is rarely just one cause, and that helps: it means there are several things we can check, and often several we can improve, one step at a time. In the second video, Dr Mayur Pai explains each check.
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The womb itself
First, we study the home itself: the uterus. We look carefully at the shape of the cavity and at the lining, where the embryo needs to settle. Sometimes there is a small polyp, a fibroid pushing into the cavity, some scar tissue, or a lining that is not building up as it should. Modern scans and a simple camera test of the inside of the womb, called hysteroscopy, let us see these clearly, and many can be treated once they are seen.
Hormones, thyroid and blood sugar
Next come the hormones, and the thyroid gland is especially important: a thyroid that is even slightly out of balance can quietly affect implantation and early pregnancy. We also check the hormones that prepare and support the lining, and blood sugar, because uncontrolled sugar matters too. These can usually be brought back into range with careful treatment.
Blood clotting and the immune system
In some women the blood tends to clot a little too easily, or the body's own defence system does not settle down the way it should to welcome a pregnancy. This is a specialised area, so we test for it thoughtfully, not blindly. Where we do find something, there are recognised ways to support the pregnancy, always under supervision.
Genetics and the embryo
A very common reason for an early loss is simply that the embryo did not have the right number of chromosomes. This happens by chance, in that particular pregnancy. It is nature's own filter and it is nobody's fault: not the work you did, not the food you ate, not the stress of a hard day. Understanding this lifts a heavy and unfair burden of guilt.
When losses keep happening, we look more closely at the genetic side. That is why we sometimes test both partners, and, when appropriate in IVF, the embryos. Such testing looks only at chromosome health; we do not carry out or offer sex determination of any kind.
What if all the tests are normal?
Even after a full, careful search, some couples have no single clear cause. Please do not lose heart if that is you: it does not mean nothing can be done. We shift our focus to giving the next attempt the most favourable conditions we can, and even when every test is normal, the outlook is genuinely reassuring.
How is it treated?
When we do find a cause, treatment is often simpler than couples fear. It may mean correcting a hormone level, managing the thyroid or blood sugar, treating a clotting problem under supervision, or occasionally a small corrective procedure, such as removing a polyp or scar tissue from inside the womb. Alongside this, close monitoring and steady emotional support in the next pregnancy make a real difference.
No one can honestly promise the outcome of any one pregnancy, but a proper evaluation turns fear of the unknown into a clear plan.
What does a plan look like in practice?
Two composite pictures, drawn from many couples rather than any one person, show how this works. A woman in her early thirties comes to us after three early losses, exhausted and blaming herself. A couple comes after two embryo transfers that did not work, and the checks show that the lining needs a small correction and the thyroid needs adjusting. In both, we investigate step by step instead of guessing, treat what we find, and plan the next step carefully. The feeling in the room changes, because now there is a plan instead of a question mark.
What should you do next?
If this has been your experience, our gentle suggestion is not to try again and again without a fresh look. Pause, ask for a proper recurrent-loss evaluation, and bring your partner. We do the right investigations, understand your situation and decide the next step together, because your plan should be yours alone.
Please look after yourselves, too. Grief after a loss is real, for both partners. Talk to each other, and to us. You deserve answers, patience and a team that walks beside you, and better days are very often ahead.
Where treatment happens
This guide is by Dr Mayur Pai, MBBS, MS (Obstetrics & Gynaecology), a fertility and laparoscopy specialist. Pai Hospital in Goa has its own operating theatre and its own IVF laboratory, so the scans, the camera test, the laboratory work and any procedure happen in one place, under one team. Free patient transport is available from across Goa and nearby areas.
Getting started
You do not have to carry this alone. Send a WhatsApp message to +91 95185 02773 with a little about your history; earlier reports help. Your first online consultation is free. Consultations are by appointment, so please call reception on +91 95459 20817 to book a time. This article is for education only and is not personal medical advice; please consult your doctor about your own situation.
Repeated miscarriages: where does IVF fit in?
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In this earlier, longer video, Dr Mayur Pai looks at a question many couples ask after more than one loss: will IVF solve it? The honest answer is that it depends on the cause. Many couples with repeated miscarriages have no trouble conceiving; the difficulty lies in keeping the pregnancy. So the first step is always a proper evaluation of both partners, not jumping straight to IVF.
Assisted reproduction has a place when getting pregnant has also become slow, when the wife's age or egg reserve means time is short, or when the evaluation finds a problem that laboratory treatment can help with. Whatever the route to pregnancy, the next one is watched closely, with early scans and support as the doctor advises. If IVF itself has not worked more than once, read what to review before trying again.
Your questions
How many miscarriages count as recurrent miscarriage?
Recurrent miscarriage usually means two or more pregnancy losses. It is more common than people think, and it does not mean you cannot have a healthy baby. It is a good reason to ask for a proper evaluation, with your partner.
Did I cause the miscarriage by working, eating something or being stressed?
Very rarely. Many early losses happen because of a chance chromosome error in that particular pregnancy, not because of anything the mother did: not the work you did, not the food you ate, not the stress of a hard day.
What is recurrent implantation failure?
It is when good-quality embryos have been placed in the womb more than once, but a pregnancy has not started. It is different from recurrent miscarriage, where a pregnancy begins but is lost.
What tests are done after repeated losses or failed transfers?
We check step by step: the shape and lining of the womb, with scans and, where needed, a camera test; the hormones, thyroid and blood sugar; blood clotting and immune factors, tested thoughtfully; and genetic factors, sometimes in both partners. Which tests you need depends on your history.
What if all the tests come back normal?
That happens for some couples, and it does not mean nothing can be done. We focus on giving the next attempt the most favourable conditions we can, with close monitoring and steady support.
Or call +91 95185 02773
This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.