Miscarriage

Adenomyosis can be associated with fertility challenges, and for some patients it may contribute to very early pregnancy loss (often called a chemical pregnancy). While we can’t say adenomyosis is the only—or even the most common—cause of a chemical pregnancy, it can change the uterine environment in ways that may interfere with implantation and early embryo development, including increased inflammation within the uterine muscle and altered uterine contractions.

It’s also common for adenomyosis to overlap with endometriosis, and that overlap can add additional factors that may affect implantation and early pregnancy. If you’re experiencing recurrent chemical pregnancies—especially alongside heavy bleeding, painful periods, or pelvic pain—our team can help you evaluate whether adenomyosis (and/or endometriosis) may be part of the picture and what uterus-sparing options might make sense for your goals. You can explore more on our site or reach out to schedule a consultation so we can review your history and imaging and map out next steps.

After two miscarriages, our goal is to look beyond a single “endo explanation” and map out all the factors that can affect implantation and early placental development. We start by reviewing your full history in detail (loss timing, symptoms, prior imaging, surgeries, cycle patterns, and any fertility treatments), because the pattern of your losses often guides what to test first. We typically include expertly interpreted pelvic imaging—often ultrasound and, when helpful, MRI—to look for endometriosis features (like endometriomas), adenomyosis, uterine shape issues, and other pelvic conditions that can coexist with endo.

Because endometriosis can overlap with immune, inflammatory, and hormonal drivers, we may also evaluate thyroid function and other endocrine factors, and consider autoimmune overlap when symptoms or history point that way. If your symptom picture suggests contributors outside the uterus and ovaries, we may broaden the workup to related conditions that can worsen inflammation or pelvic dysfunction, rather than stopping at a standard checklist. If you’d like, you can reach out to schedule a consultation so our team can tailor a miscarriage evaluation plan to your history and goals—and help you understand which findings are most actionable for your next steps.

Yes—endometriosis may be associated with a higher risk of miscarriage, although it does not mean miscarriage is inevitable. Many people with endometriosis conceive and go on to have healthy pregnancies, but research suggests pregnancy outcomes can be affected in some patients, especially depending on the subtype, severity, and overall inflammatory burden.

We think the connection is likely multifactorial. Endometriosis is associated with chronic inflammation and changes in the pelvic and uterine environment, which may interfere with implantation or early placental development in some cases; hormonal and immune factors may also play a role. If you’ve experienced a loss (or recurrent losses) and have known or suspected endometriosis, our team can help evaluate the full picture and discuss whether a surgical diagnosis and excision approach makes sense as part of a fertility-focused plan.

Yes—adenomyosis can affect both fertility and pregnancy. It may interfere with implantation and is associated with higher risks during pregnancy, including miscarriage and preterm birth, with diffuse adenomyosis often having a greater impact than focal disease.

The good news is that there are ways to tailor a plan based on your goals and the pattern of disease we see on imaging and evaluation. Depending on your situation, we may consider medical pretreatment, adjustments to an IVF approach, or carefully selected surgery when adenomyosis is focal and accessible. If you’re trying to conceive now or planning pregnancy, our team can help you map out next steps and coordinate a strategy that prioritizes both fertility and safety.

Yes. Focal adenomyosis can affect fertility and miscarriage risk, especially when a lesion distorts the uterine cavity or sits close enough to interfere with implantation. When the uterine lining environment or contour is disrupted, it can make it harder for an embryo to attach and may be associated with a higher risk of early pregnancy loss.

That said, not all focal adenomyosis behaves the same—smaller nodules farther from the cavity may have less impact, and the best next step depends on your imaging, symptoms, and reproductive goals. Our team can help you understand whether medical suppression, assisted reproduction, or—in carefully selected situations—fertility-sparing surgery to restore uterine shape may fit your plan, and we’ll tailor recommendations around your timeline for trying to conceive.

Diffuse adenomyosis can affect fertility by changing how the uterine muscle contracts and by altering the uterine environment where an embryo needs to implant and develop. For some patients, this can contribute to difficulty conceiving and may be associated with a higher risk of early miscarriage.

The good news is that outcomes can sometimes be improved with an individualized plan. Depending on your goals and imaging findings, our team may consider medical pretreatment to calm inflammation and reduce symptoms before attempting conception, or coordinate timing with fertility treatment such as IVF. If you’re trying to conceive or have had recurrent losses, reach out to schedule a consultation so we can review your history and tailor the next steps.

Progesterone support is commonly used after IVF, and it may be helpful for some people who have early pregnancy bleeding and a history of prior miscarriages. However, using progesterone routinely for everyone with a positive pregnancy test hasn’t consistently been shown to prevent miscarriage, so the decision is usually based on your specific history and how the pregnancy was conceived.

Low-dose (“baby”) aspirin is most clearly beneficial when recurrent loss is linked to antiphospholipid syndrome, often as part of a coordinated plan that may also include anticoagulation. For unexplained miscarriages, aspirin hasn’t reliably improved outcomes, and using it without a clear indication can add unnecessary risk or confusion. Our team can review your prior losses, labs, and fertility treatment details to recommend an approach that fits your situation—reach out to schedule a consultation if you’d like a personalized plan.

A recurrent pregnancy loss evaluation is often recommended after two consecutive first-trimester miscarriages, or after any second-trimester loss. If you’ve had a single early loss, many patients don’t need a full workup right away—but if there are additional risk factors or a complex history, we may recommend evaluating sooner.

A typical workup focuses on the most common, actionable causes. This often includes assessing the uterine cavity for issues such as a septum, fibroids, or polyps; checking labs such as antiphospholipid antibodies and thyroid function; and, in some situations, genetic testing like parental karyotypes. More extensive clotting (thrombophilia) testing is usually reserved for select cases based on your history, and our team can help tailor an evaluation plan to your specific pattern of loss and symptoms.