Experiencing a pregnancy loss is incredibly challenging. Many couples receive the news unexpectedly, often during a routine prenatal check-up. This loss frequently leads to feelings of helplessness, self-doubt, and profound sadness. A stable partnership and a supportive social environment are crucial to providing comfort and aiding in the grieving process.
After coping with this situation, questions often arise about the causes and, more importantly, what can be done to prevent a pregnancy loss in future pregnancies.
Here, we explain what you can do to minimize the risk of another pregnancy loss and discuss your chances of a successful pregnancy.
Whether you have experienced one or multiple pregnancy losses makes a significant difference regarding causes, examinations, and prospects. Therefore, we will address these two cases separately.
Based on a comprehensive study, scientists have developed a tool that allows you to calculate the chance of a successful pregnancy based on your age and previous pregnancies. While this tool may not consider your individual situation, it can still serve as a general guideline.
Choose here before continuing:
You experienced a single pregnancy loss?
You did nothing wrong!
Usually, the cause is a random, uncontrollable genetic anomaly of the embryo.
Check general factors for a successful pregnancy.
In individual cases, certain examinations may be useful.
Your chances of having a baby are usually very good.
How common is a pregnancy loss?
In reality, many couples experience a single pregnancy loss, and it is estimated to affect about 10-20% of all couples.
Approximately every 5th couple experiences a pregnancy loss.
The question of why and whether you did something wrong arises for almost all couples affected by a pregnancy loss.
Most common questions
It is of utmost importance to us that you understand: You did nothing wrong!
In most cases, a single pregnancy loss is a sporadic event, meaning it is a random occurrence, especially when it happens before the 12th week of pregnancy. Often, a genetic anomaly in the embryo is the cause, and in most instances, it leads to a pregnancy loss within the first 12 weeks of pregnancy. You had no control over this genetic anomaly! The risk of such genetic changes primarily depends on your age.
Genetics, a factor that cannot be influenced!
As you may already know, age plays a crucial role in fertility. With increasing age, not only do the chances of getting pregnant decrease, but unfortunately, the likelihood of maintaining a pregnancy also reduces. This is because with each passing year, the probability of genetic anomalies in your oocytes and, consequently, the embryo increases. The fertility of the male partner is also influenced by age. Regardless of age, diagnostics can be valuable to identify, understand, and successfully address your individual risk factors for pregnancy loss.
Should I undergo specific diagnostics after a pregnancy loss?
It's crucial to understand that a single pregnancy loss is generally a random event, often linked to an uncontrollable genetic anomaly in the embryo. Therefore, a specific pregnancy loss diagnostics is typically not recommended after one pregnancy loss. If you've experienced a late pregnancy loss, meaning after the 12th week of pregnancy, we recommend seeking individualized advice from your gynecologist. However, this by no means suggests that after an early pregnancy loss, one should not assess general risk factors. On the contrary, we strongly recommend taking a moment to consider: Is there something that may have been overlooked so far and can be adjusted?
Are there tests that I should still undergo?
Even though, as explained, a specific pregnancy loss diagnostics is not recommended after the first pregnancy loss, certain tests may still be advisable on a case-by-case basis.
The length of the menstrual cycle can vary significantly from person to person and is influenced by many factors, including stress and nutrition. Some women have a very regular cycle with the same number of days each month, while others may experience fluctuations from month to month. Such variations can be normal and typically do not cause concern.
A menstrual cycle length of 25-35 days is considered normal. This is calculated from the first day of your period to the first day of your next period. However, if you notice significant deviations in your cycle, it is recommended to discuss this with your gynecologist. Various factors could be responsible, including spotting and a potential shortening of the cycle, which may indicate a condition known as luteal phase deficiency. This condition can often be treated with the hormone progesterone.
The thyroid is a crucial organ that regulates many functions through hormones. Issues with thyroid function can increase the risk of pregnancy loss. If you experience persistent fatigue, feel weak and exhausted, have gained weight, noticed increased sensitivity to cold, dry skin and hair, intensified hair loss, and frequent constipation, it is recommended to have your thyroid function checked through a blood test. Hypothyroidism, which is not uncommon in women, can specifically play a role as a risk factor for pregnancy loss.
Abnormalities in glucose metabolism, such as insulin resistance, can decrease your chances of a successful pregnancy and elevate the risk of pregnancy loss. With insulin resistance, your cells no longer respond as effectively to insulin as they should. If you observe irregular cycles lasting longer than 35 days and are overweight, it may be advisable to check the so-called HOMA index. This index is determined by measuring your fasting blood sugar and insulin levels. Many women with an elevated HOMA index struggle with weight loss, but there are support options available to assist you.
What else can I do? Factors for a successful pregnancy
When you plan having a child, it is important to check your vaccination status...
Impfstatus
Bevor du deinen Kinderwunsch umsetzt, ist es wichtig, deinen Impfstatus zu überprüfen. Ein aktueller Impfschutz kann nicht nur dich, sondern auch dein Baby vor möglichen Risiken schützen. Dein Impfstatus sollte anhand deines Impfbuchs (Impfpasses) bei deiner Frauenärztin überprüft werden. Wenn du kein Impfbuch hast, sollte eines für dich angelegt werden.
Folic acid is a crucial vitamin when it comes to conception...
Folsäure
Folsäure ist ein entscheidendes Vitamin, wenn es um den Kinderwunsch geht. Es unterstützt die Entwicklung deines Babys im Mutterleib und verringert das Risiko von bestimmten Fehlbildungen. Wenn Du schwanger werden möchtest, solltest du mindestens 4 Wochen vor dem Eintritt einer Schwangerschaft mit der täglichen Einnahme von Folsäure beginnen (1x täglich, oral, Dosis 400 ug*).
*400 ug entspricht der Standarddosis, eine höhere Dosis kann notwendig sein, wenn bei dir in einer vorangegangenen Schwangerschaft kindliche Fehlbildungen aufgetreten sind aber auch, wenn du bestimmte Krankheiten hast. Besprich das am besten nochmals mit deiner betreuenden Frauenärztin.
While scientific evidence on whether specific diets enhance fertility is not conclusive...
Ernährung & Vitamine
Ob eine bestimmte Ernährungsweise deine Fruchtbarkeit erhöht, ist wissenschaftlich nicht gesichert. Dennoch wird eine ausgewogene Ernährung mit einem hohen Anteil an Gemüse, Obst, Vollkornprodukten und Ballaststoffen sowie mäßig Fisch und wenig Fleisch empfohlen. Es gibt Hinweise darauf, dass solch eine Ernährung auch einen positiven Einfluss auf die Qualität der Spermien haben kann.
A healthy BMI (Body Mass Index) can reduce the risk of miscarriage...
Gewicht
Ein gesunder BMI (Body-Mass-Index) kann das Risiko von Fehlgeburten reduzieren. Übergewicht und Untergewicht erhöhen das Risiko für Schwangerschaftskomplikationen. Der BMI stellt das Verhältnis von Körpergewicht zu Körpergröße dar und wird folgendermaßen berechnet:
BMI = Körpergewicht in Kilogramm/ (Körpergröße in Metern)2
Auf den BMI nehmen viele Faktoren wie Ernährung, körperliche Aktivität, Stress und genetische Veranlagung Einfluss. Wenn Du einen ungesunden BMI hast, ist die Umstellung auf eine gesunde Lebensweise, die eine ausgewogene Ernährung und regelmäßige körperliche Aktivität beinhaltet, ein wichtiger Schritt. Zusätzlich können hormonelle Störungen wie Schilddrüsenerkrankungen und Störungen im Zuckerstoffwechsel wie Insulinresistenz eine Rolle spielen und sollten daher untersucht werden.
Regular physical activity has a positive impact on your fertility.
Sport
Regelmäßige körperliche Aktivität wirkt sich positiv auf deinen Kinderwunsch aus. Sie unterstützt nicht nur dabei, ein gesundes Gewicht zu erreichen oder zu halten, was den Hormonhaushalt reguliert, sondern trägt auch dazu bei, Stress abzubauen.
Smoking during pregnancy increases the risk of miscarriage and significantly harms your unborn baby.
Rauchen
Rauchen während der Schwangerschaft erhöht das Risiko für eine Fehlgeburt und schadet deinem ungeborenen Baby erheblich.
Wenn du rauchst, raucht dein Baby auch.
Wenn du das Rauchen nicht aufgeben kannst, empfehlen wir dir eine Beratung bereits vor einer Schwangerschaft.
Alcohol consumption during pregnancy can lead to severe damage to your unborn child.
Alkohol
Alkoholkonsum während der Schwangerschaft kann zu schweren Schäden deines ungeborenen Kindes führen. Deshalb ist es während der Schwangerschaft äußerst wichtig, komplett auf Alkohol zu verzichten.
Es gibt keinen sichere Menge Alkohol während der Schwangerschaft, daher sollte während dieser Zeit komplett auf Alkohol verzichtet werden.
Wenn es dir schwerfällt, auf Alkohol zu verzichten, empfehlen wir dir, dies bereits vor einer Schwangerschaft mit deiner Frauenärztin zu besprechen.
Whether caffeine is a risk factor for pregnancy loss is not conclusively proven
Koffein
Ob Koffein ein Risikofaktor für Fehlgeburten darstellt, ist nicht abschließend bewiesen. Daher sollte eine übermäßige Einnahme unbedingt vermieden werden. Meist wird eine Beschränkung des Koffeinkonsums auf maximal etwa 200 Milligramm pro Tag in der Schwangerschaft empfohlen. Es ist wichtig zu wissen, dass nicht nur Kaffee, sondern auch Tee und Schokolade Koffein enthalten können. Auch wenn der Gehalt von Koffein in den verschiedenen Getränken variiert, kann dir dieser Rechner helfen, deinen Koffeinkonsum abzuschätzen: https://www.tommys.org/pregnancy-information/calculators-tools-resources/check-your-caffeine-intake-pregnancy
There is no clear evidence that psychological factors such as stress alone...
Koffein
Ob Koffein ein Risikofaktor für Fehlgeburten darstellt, ist nicht abschließend bewiesen. Daher sollte eine übermäßige Einnahme unbedingt vermieden werden. Meist wird eine Beschränkung des Koffeinkonsums auf maximal etwa 200 Milligramm pro Tag in der Schwangerschaft empfohlen. Es ist wichtig zu wissen, dass nicht nur Kaffee, sondern auch Tee und Schokolade Koffein enthalten können.
Auch wenn der Gehalt von Koffein in den verschiedenen Getränken variiert, kann dir dieser Rechner helfen, deinen Koffeinkonsum abzuschätzen: Koffein-Kalkulator
What are my chances of a successful pregnancy after a pregnancy loss?
If it was your first pregnancy loss, your chances of a successful pregnancy are still very good, especially depending on your age.
Your chances of having a baby are still very good!
The risk of another pregnancy loss increases only minimally after a previous pregnancy loss. You can see that we emphasize the number of your pregnancy losses, which plays a significant role in the recurrence risk. We will discuss this again in the chapter on reccurent pregnancy losses.
Probability of a successful pregnancy after a single pregnancy loss:
You can calculate the chance of a successful pregnancy here. Although this calculator does not take your individual situation into account, it can still serve as a reference.
Have you experienced multiple pregnancy losses?
Experiencing multiple pregnancy losses can be very challenging, and allowing for individual grief is important.
Modifiable and non-modifiable risk factors are distinguished.
Seek assistance from specialists. Comprehensive pregnancy loss diagnostics is recommended after 2, at the latest 3, pregnancy losses.
Effective therapies exist to reduce the risk of pregnancy loss.
Depending on your individual situation, your chances of having a baby are often still good.
How many couples are affected by recurrent pregnancy loss?
Depending on the applied definition, an estimated 2-5% of all couples trying to conceive are affected by recurrent pregnancy loss. Some medical guidelines define recurrent pregnancy loss as 2 or more losses, while others use a threshold of 3 or more losses. In absolute numbers, this affects a significant number of couples. It's important to know that you are not alone.
Grieving, Coping, and Mental Health After Multiple Pregnancy Losses
Experiencing a pregnancy loss can lead to profound grief. It is advisable to allow yourself to go through your individual grieving process. Compassionate communication with trusted individuals, a supportive partnership, and a healthy social environment can provide assistance. However, it may also be beneficial to speak with an external person or your doctor.
If grief transitions into tormenting feelings of guilt, obsessive rumination, lack of motivation, sleep disturbances, and social withdrawal, seeking professional help is advisable. Scientific studies have unequivocally shown that recurrent pregnancy losses can pose mental health risks such as depression, anxiety disorders, and post-traumatic stress disorders for both women and their partners. If you or your partner requires support, we strongly recommend discussing this with your doctor to establish contact with specialized professionals.
What are the causes of recurrent pregnancy losses?
The causes of recurrent pregnancy losses are described as multifactorial, meaning that many factors can play a causal role. Risk factors are distinguished between modifiable and non-modifiable factors.
Your age plays a significant role here as well. The older you are, the higher the likelihood of a genetic anomaly in the embryo. This is because with each passing year, the probability of genetic abnormalities in your oocytes increases. The effects of age on male fertility and sperm quality are not as well-researched, but there are indications that age may also play a role in these aspects.
With each pregnancy loss, the risk of another pregnancy loss in a subsequent pregnancy increases. This is because an increasing number of pregnancy losses makes the presence of underlying risk factors more likely in your case.
Various risk factors from the following categories play a role:
Overweight and underweight, smoking, alcohol consumption.
This includes congenital abnormalities of the uterus such as a septum, as well as acquired anomalies like fibroids (myomas) and adhesions.
Abnormalities in the number and structure of chromosomes, which carry genetic information.
These involve abnormalities in thyroid function, the corpus luteum, and metabolism.
This includes antiphospholipid antibodies (a group of autoimmune antibodies) and other coagulation disorders.
Various autoimmune conditions play a role here, such as thyroid antibodies, celiac disease, chronic inflammation of the uterine mucosa, and abnormalities in other immunological markers.
When to do a special pregnancy loss diagnostics?
When to undergo special pregnancy loss investigations or diagnostics varies among different guidelines. Some guidelines recommend diagnostics after two, while others recommend it after three pregnancy losses. There is also no uniform consensus regarding whether the pregnancy losses must be consecutive or if they can be interrupted by a successful pregnancy.
A pregnancy loss diagnostics can be conducted after two or three pregnancy losses.
The nature of the pregnancy losses may also play a role in this decision. For instance, after two late pregnancy losses, we strongly recommend comprehensive diagnostic testing.
Ultimately, it is always an individual decision. However, we believe that a well-informed decision can only be made when various options are known. Therefore, it is crucial for us to provide you with comprehensive information so that you can make well-informed decisions.
How does specialized pregnancy loss diagnostics work?
Specialized pregnancy loss diagnostics involve three main areas:
Capture of your individual medical history in a comprehensive doctor's consultation
In this step, the goal is to gather precise information about your medical history and the specific course of your pregnancies. This is referred to as anamnesis. It is crucial to capture and understand your situation as accurately as possible. We are aware that discussing pregnancy losses can be distressing, making a sensitive approach crucial.
Diagnostics
During the doctor's consultation, a discussion will take place to determine which examinations are necessary in your individual case to identify the causes of the pregnancy losses. These examinations can cover various areas, including:
Anatomy: Examination of the uterus, ultrasound, and/or hysteroscopy
Genetics: Chromosome analysis, blood tests
Hormones: Analysis of various hormones, such as thyroid hormones and menstrual cycle hormones, as well as blood sugar metabolism, blood tests
Blood clotting: Examination of antiphospholipid antibodies and possibly other parameters of blood clotting, blood tests
Immunology: Analysis of various immunological markers in the uterine mucosa (endometrium) and blood, endometrial biopsy and/or blood tests
Discussion of findings and therapy planning in a comprehensive doctor's consultation
The results of various examinations will be thoroughly discussed with you, explaining their implications for you and your desire for a child. You will receive information about therapy options that can help reduce the risk of recurrent pregnancy loss. Please note that the path to achieving a pregnancy is not black and white, so any potential treatment plan is always based on your individual medical history and situation.
What treatment options are available?
Experiencing recurrent pregnancy losses can diminish the hope of a successful pregnancy for many couples. It is crucial to know that there are effective treatments that can reduce the risk of pregnancy loss. The respective treatment options are usually individually tailored to your situation, so here we can only mention general possibilities.
Ensure to maintain a healthy body weight, improve your dietary habits, and incorporate regular exercise into your daily routine. Nutritional counseling can be helpful, and in some cases, medication options may provide supportive effects.
Lebensstilfaktoren
Achte darauf, ein gesundes Körpergewicht zu halten, verbessere deine Ernährungsgewohnheiten, und integriere regelmäßige Bewegung in deinen Alltag. Eine Ernährungsberatung kann hilfreich sein, und in manchen Fällen können auch medikamentöse Optionen unterstützend wirken. Rauchen solltest du unbedingt beenden, und den Alkoholkonsum vor einer Schwangerschaft reduzieren. Spätestens mit einem positiven Schwangerschaftstest solltest du komplett auf den Genuss alkoholischer Getränke verzichten.
Rauchen und Alkoholkonsum während der Schwangerschaft sollten strikt vermieden werden!
Surgical therapy options are available in this area. For instance, fibroids, a uterine septum, and adhesions can be surgically removed.
Anatomie
hier bestehen operative Therapieoptionen, beispielsweise können Muskelknoten, eine Trennwand und Verwachsungen operativ entfernt werden.
Eine umfassende Expertise in operativen Verfahren ist unerlässlich, da Verletzungen an der Gebärmutter unbedingt vermieden werden müssen.
We cannot alter genetic information; however, there are potential therapeutic options within the scope of assisted reproductive techniques (IVF/ICSI therapy),...
Genetik
Wir können die genetische Information nicht ändern, es bestehen jedoch mögliche Therapieoptionen im Rahmen einer künstlichen Therapie (IVF/ICSI-Therapie), welche individuell mit dir besprochen werden sollten.
If your thyroid function is impaired, we can treat it with medication. The hormone progesterone can assist in luteal phase deficiency, but also...
Hormone
Hormone: Wenn deine Schilddrüsenfunktion gestört ist, können wir dies mit Medikamenten behandeln. Das Hormon Progesteron kann bei Gelbkörperschwäche helfen, aber auch wenn eine Blutung in der Frühschwangerschaft auftritt oder keine Ursachen für die wiederholten Fehlgeburten gefunden wurden. Für die Normalisierung des Zuckerstoffwechsels stehen sowohl Medikamente als auch Änderungen in deiner Ernährung und Bewegung zur Verfügung.
Progesteron kann als Medikament verwendet werden, insbesondere wenn sich eine Blutung in der Schwangerschaft ereignet!
If antiphospholipid antibodies are detected in you on two occasions, we recommend treatment with acetylsalicylic acid....
Blutgerinnung
Wenn bei dir zweimal Antiphospholipid-Antikörper nachgewiesen werden, empfehlen wir eine Therapie mit Acetylsalicylsäure (ASS, Aspirin) in Kombination mit einer Injektion eines niedermolekularen Heparins unter die Haut.
Heparine verringern das Risiko einer Fehlgeburt nicht, es sei denn, es liegt ein Antiphospholipid-Syndrom vor!
If you have thyroid antibodies, we pay special attention to the proper functioning of your thyroid. A gluten-free diet can help with celiac disease....
Immunologie
Wenn du Schilddrüsen-Antikörper hast, achten wir besonders auf die richtige Funktion deiner Schilddrüse. Bei Zöliakie kann eine glutenfreie Diät helfen. Eine chronische Entzündung der Gebärmutterschleimhaut kann mit Antibiotika erfolgreich behandelt werden. Wenn weitere immunologische Auffälligkeiten vorliegen, können wir individuelle Behandlungsoptionen wie Prednisolon oder lipidhaltige Infusionen in Betracht ziehen.
Das Immunsystem spielt eine wichtige Rolle für eine erfolgreiche Schwangerschaft!
How are the chances of a successful pregnancy after multiple pregnancy losses?
The chances of a successful pregnancy after multiple pregnancy losses depend on various factors and cannot be converted into an absolute probability. We understand that you are looking for a clear assessment, but the reality is complex.
An important factor is whether we identified a treatable risk factor in the comprehensive pregnancy loss diagnostics. Your age and the number of previous pregnancy losses are also crucial factors influencing the chances.
To give you a rough idea: If you're, for example, 30 years old and have had 3 pregnancy losses, the probability of a successful pregnancy is approximately 73%. However, if you've experienced 5 pregnancy losses, the likelihood decreases to about 56%. For a 45-year-old with 3 pregnancy losses, the probability drops to only 23%.
You can calculate the chance of a successful pregnancy here. Although this calculator does not consider your individual situation, it can still serve as an estimate.
We are here to accompany you on this journey and provide the best possible support.
Frequently asked questions
As there are various causes for recurrent pregnancy losses, we recommend undergoing diagnostics that truly consider all factors and your individual situation, and are guided by physicians with extensive experience in supporting couples with infertility.
We develop Fertia Diagnostics specifically for you, enabling optimal pregnancy loss diagnostics. Fertia Diagnostics was created by experienced fertility experts, offering a straightforward, fast, and focused examination for couples facing challenges in getting pregnant or who have experienced recurent pregnancy losses. We adhere to recognized medical guidelines while simultaneously tailoring the investigation to your personal situation. At Fertia Diagnostics, you will be personally guided by highly qualified experts in reproductive medicine.
There is no evidence that stress alone can cause pregnancy loss. If you experienced significant stress, it was most likely not the reason for the pregnancy loss.
However, stress and psychological strains can lead to behaviors that negatively impact your fertility and indirectly increase the risk of pregnancy loss, such as smoking, alcohol consumption, and an unhealthy diet.
Chronic stress can affect various bodily functions, including hormonal balance and the immune system. It is advisable to reduce stress before and during pregnancy. This may be challenging, but finding ways to cope with stress and utilizing relaxation techniques is important.
The immune system plays a crucial role in fertility and the development of a healthy pregnancy. The developing embryo is immunologically only half related to the mother, as about 50% of its genes come from the paternal side. In recent years, many studies have highlighted abnormalities in various immune markers in women with pregnancy losses. Current medical guidelines usually recommend only testing for antiphospholipid antibodies, which are specific autoantibodies against the body's own tissues. Other relevant autoimmune antibodies include thyroid antibodies and antibodies associated with celiac disease. However, in individual cases, it may be reasonable to consider additional immunological investigations.
Blood-thinning medications such as low-molecular-weight heparins (e.g., Clexane®, Fragmin P®), administered by subcutaneous injection, or acetylsalicylic acid (ASA, Aspirin®) in tablet form fall into this category. If antiphospholipid antibodies have been detected twice in your case, and you have experienced recurrent pregnancy losses, the combination treatment of acetylsalicylic acid with an injection of low-molecular-weight heparin under the skin may reduce the risk of another miscarriage. If these specific antibodies are not present in your case, according to current knowledge, neither heparins nor ASA are effective in reducing the risk of pregnancy loss. However, if you have a coagulation disorder, treatment may still be beneficial to protect your health during pregnancy.
This question is frequently asked in our consultations. Unfortunately, assisted reproduction through IVF or ICSI therapy does not lower the risk of pregnancy loss. If you do not have difficulty getting pregnant, IVF therapy is generally not helpful in reducing the risk of pregnancy loss.
Our answer is quite clear: No! In most cases, there is no reason for this. Lying down or even bed rest does not reduce the risk of pregnancy loss. Prolonged lying down could actually increase health risks for you. In the case of bleeding during pregnancy, we recommend taking it easy but not strict bed rest.
Even after a comprehensive pregnancy loss diagnostics, in about 50% of cases, no causative factor can be identified. For many couples, this is a very frustrating and disappointing message. It is even more important to be accompanied by experienced physicians who develop individual treatment options with you. Even if no causes are found, various treatment options are available.
After a pregnancy loss, many couples fear it happening again. This is understandable, as it was a very profound and painful experience. From our experience, many couples find it relieving when comprehensive diagnostics have been conducted, uncovering and treating possible risk factors. A consultation with experienced physicians can also help understand your situation and chances better. Many couples report that a better understanding of the causes and treatment options has helped them look more optimistically and less anxiously toward the next pregnancy.
If you feel that your worries and fears are overwhelming, do not hesitate to discuss this openly with your gynecologist. In such cases, seeking professional psychological support should be considered.
If the grief response turns into tormenting feelings of guilt, depression, compulsive rumination, lack of motivation, sleep disturbances, and social withdrawal, we recommend discussing this with your gynecologist and considering the possibility of professional psychological help. A supportive partnership and an intact social environment can also be helpful and are described in studies as protective factors. It is proven that recurrent pregnancy losses increase mental health risks for depression, anxiety disorders, and even post-traumatic stress disorders. This can affect both partners, so a counseling option tailored to couples can also be considered.
