Recurrent Miscarriage
Experiencing a miscarriage can be emotionally and physically difficult. When pregnancy loss happens more than once, the uncertainty can become even harder to manage. Many couples begin asking the same questions: Why does this keep happening? Is there an underlying problem? Can anything be done before trying again?
Recurrent miscarriage is a medical condition that deserves careful evaluation rather than guesswork. Current guidance from the American Society for Reproductive Medicine (ASRM) defines recurrent pregnancy loss as the spontaneous loss of two or more pregnancies, excluding confirmed molar or ectopic pregnancies. Importantly, the losses do not necessarily have to occur consecutively.
The causes of recurrent miscarriage can range from chromosomal abnormalities and uterine conditions to certain hormonal, metabolic, autoimmune, and genetic factors. In some couples, however, testing does not identify a definite explanation. That does not mean there is no possibility of a successful future pregnancy.
If you have experienced two or more pregnancy losses, speaking with a fertility or reproductive-medicine specialist can help determine whether further investigation is appropriate and which tests are actually relevant to your situation.
What Is Recurrent Miscarriage?
Recurrent miscarriage refers to repeated spontaneous pregnancy loss. The 2026 ASRM committee opinion uses two or more pregnancy losses as the definition of recurrent pregnancy loss. This represents an important point for patients: you do not necessarily need to experience three miscarriages before discussing an evaluation with a specialist.
A miscarriage is different from infertility. Infertility generally involves difficulty achieving pregnancy, whereas recurrent miscarriage involves achieving pregnancy but experiencing repeated loss.
The distinction matters because the evaluation is different. A specialist may investigate chromosome-related causes, the uterine cavity, certain autoimmune conditions, thyroid function, metabolic health, and other factors depending on your individual history.
It is also important to understand that every miscarriage is not caused by something a woman did or did not do. Many early miscarriages occur because an embryo has an abnormal number of chromosomes. ASRM notes that approximately 50%–60% of first-trimester miscarriages are associated with embryonic aneuploidy, with the likelihood strongly influenced by maternal age.
Therefore, recurrent miscarriage should not automatically be interpreted as evidence that the uterus, lifestyle, or fertility is necessarily the problem.
Common Causes of Recurrent Miscarriage
There is no single cause of recurrent miscarriage. Several possible factors may need to be considered, and more than one factor can sometimes coexist.
1. Chromosomal Abnormalities
Chromosomal abnormalities are among the most important causes of early pregnancy loss.
During the formation of an egg or sperm, chromosomes can sometimes be distributed incorrectly. After fertilization, the resulting embryo may have an extra or missing chromosome. Many such embryos cannot develop normally, leading to miscarriage.
This type of chromosomal problem is often random rather than inherited. Maternal age is also strongly associated with the frequency of embryo aneuploidy.
For couples experiencing recurrent miscarriage, testing pregnancy tissue after a miscarriage may provide useful information about whether chromosomal abnormalities were involved. The updated ASRM guidance recommends chromosome evaluation of miscarriage tissue when feasible and supports array-based testing.
2. Genetic Factors in Either Partner
In a smaller proportion of couples with recurrent miscarriage, one partner may carry a balanced chromosomal rearrangement.
A person with a balanced translocation, for example, may have no obvious health problems because the genetic material is present but rearranged. During reproduction, however, an embryo may inherit an unbalanced chromosome arrangement, potentially resulting in miscarriage.
Parental chromosome testing is not necessarily required for everyone. Current ASRM guidance particularly considers parental karyotyping when miscarriage testing identifies an unbalanced structural chromosome abnormality or when miscarriage chromosome testing is unavailable.
A fertility specialist or genetic counselor can help determine when this type of testing makes sense.
3. Uterine or Structural Abnormalities
The shape and internal structure of the uterus can sometimes contribute to recurrent miscarriage.
Potential findings may include:
- Uterine septum
- Endometrial polyps
- Submucosal fibroids
- Intrauterine adhesions
- Retained pregnancy tissue
- Other abnormalities affecting the uterine cavity
Not every uterine abnormality causes miscarriage, and finding an abnormality does not automatically prove that it caused a previous loss.
Nevertheless, current ASRM guidance recommends offering uterine cavity evaluation as part of the assessment of recurrent pregnancy loss. Depending on the situation, evaluation may involve hysterosalpingography (HSG), saline sonography, or hysteroscopy.
4. Antiphospholipid Syndrome
Antiphospholipid syndrome (APS) is an autoimmune condition associated with abnormal blood clotting and pregnancy complications.
For selected patients with recurrent miscarriage, testing may include:
- Lupus anticoagulant
- Anticardiolipin antibodies
- Anti-beta-2 glycoprotein I antibodies
However, APS testing should be guided by clinical circumstances rather than performed indiscriminately. ASRM specifically discusses testing when clinical criteria suggest APS, including certain patterns of pregnancy loss or a personal history of thrombosis.
If APS is diagnosed, treatment during pregnancy may include low-dose aspirin and heparin under medical supervision.
5. Thyroid Disorders
Thyroid dysfunction can affect reproductive health and pregnancy.
Because thyroid problems may be treatable, thyroid assessment can be relevant during a recurrent miscarriage evaluation. ASRM recommends measuring thyroid-stimulating hormone (TSH) in patients with recurrent pregnancy loss, particularly when there has been a euploid miscarriage or miscarriage tissue has not been tested.
The appropriate interpretation of thyroid results depends on the laboratory range, pregnancy status, symptoms, and medical history. Treatment should therefore be individualized rather than based on a single number without clinical context.
6. Diabetes and Metabolic Factors
Poorly controlled diabetes can affect pregnancy outcomes.
For patients with recurrent miscarriage, ASRM recommends considering HbA1c testing when diabetes risk factors are present, such as elevated body mass index, family history, older maternal age, or a history of gestational diabetes.
Optimizing blood glucose before conception is an important part of preconception care when diabetes is present.
7. Prolactin and Other Hormonal Factors
Hormonal factors can occasionally be relevant, particularly when symptoms suggest an endocrine disorder.
For example, elevated prolactin may be considered when there are symptoms such as irregular or absent ovulation or unexpected milk production outside breastfeeding.
However, not every hormone test is useful for every person with recurrent miscarriage. A specialist can determine which investigations are appropriate based on symptoms and reproductive history.
8. Male Reproductive Factors
Pregnancy loss is not solely a female reproductive issue.
Research has associated paternal age, metabolic health, and sperm DNA fragmentation with miscarriage risk. ASRM states that sperm DNA fragmentation testing may be considered in otherwise unexplained recurrent pregnancy loss or when recurrent pregnancy loss occurs alongside infertility, although more research is needed to establish which treatments improve outcomes.
This is one reason a comprehensive evaluation may involve both partners.
9. Lifestyle and Environmental Factors
Lifestyle does not explain every case of recurrent miscarriage, but certain exposures can influence reproductive health.
Smoking and secondhand smoke exposure are associated with miscarriage risk, and smoking cessation is recommended as part of preconception care. ASRM also recommends healthy lifestyle measures, folic acid supplementation, and avoidance of toxic exposures around conception.
It is important, however, not to turn lifestyle advice into blame. A miscarriage is rarely something that can simply be attributed to one food, stressful day, physical activity, or ordinary daily routine.
When Should You See a Specialist for Recurrent Miscarriage?
One of the most important questions after repeated pregnancy loss is when to seek professional help.
With the current ASRM definition, recurrent miscarriage can be evaluated after two pregnancy losses. You do not necessarily need to wait for a third miscarriage before talking with a fertility specialist or reproductive endocrinologist.
Consider scheduling a specialist consultation if:
- You have experienced two or more pregnancy losses.
- You have had a miscarriage after a previous successful pregnancy.
- Pregnancy tissue testing showed a chromosomal abnormality.
- You have a known genetic condition or family history of chromosome problems.
- You have irregular menstrual cycles or symptoms suggesting a hormonal disorder.
- You have thyroid disease, diabetes, autoimmune disease, or another significant medical condition.
- You have known uterine fibroids, polyps, adhesions, or a uterine abnormality.
- You have experienced infertility as well as pregnancy loss.
- You have concerns about sperm health or male reproductive factors.
- You want preconception counseling before trying again.
Seeking help after two losses does not mean that extensive testing will automatically be necessary. The purpose is to determine what information is useful for your particular situation.
What Happens During a Recurrent Miscarriage Evaluation?
A specialist usually begins with your history rather than immediately ordering every possible test.
Your consultation may cover:
- Your age and reproductive history
- Number and timing of previous pregnancies
- Gestational age at each loss
- Ultrasound findings
- Whether fetal cardiac activity was previously detected
- Pregnancy tissue testing, if available
- Previous fertility treatments
- Menstrual cycle patterns
- Previous surgeries
- Medical and medication history
- Family history
- Thyroid or metabolic conditions
- Autoimmune or clotting history
- Lifestyle and environmental exposures
- Fertility history of your partner
This detailed history helps determine which investigations are likely to provide useful information.
Current ESHRE guidance similarly emphasizes individualized assessment based on factors such as age, fertility history, pregnancy history, family history, previous investigations, and previous treatment.
Tests Your Specialist May Consider
Testing for recurrent miscarriage should be targeted rather than a collection of every available reproductive test.
Depending on your history, a specialist may consider:
Pregnancy Tissue Chromosome Testing
Chromosome analysis of miscarriage tissue can help determine whether aneuploidy contributed to the loss. ASRM’s updated guidance recommends this when feasible and places it early in the evaluation process.
Uterine Cavity Assessment
HSG, saline sonography, or hysteroscopy may be used to examine the uterine cavity and identify structural problems.
Blood Tests
Depending on the circumstances, testing may include TSH, HbA1c, prolactin, or antiphospholipid antibodies.
Genetic Testing
Parental karyotyping or genetic counseling may be appropriate in selected cases, particularly when pregnancy tissue testing identifies an unbalanced chromosome rearrangement.
Male Evaluation
In selected cases, reproductive urology assessment or sperm DNA fragmentation testing may be considered.
The exact combination of tests should be individualized.
Tests That Are Not Routinely Recommended
The search for an explanation after recurrent miscarriage can understandably become overwhelming. More testing does not always mean better care.
The updated ASRM guidance does not recommend routine testing for inherited thrombophilias in recurrent pregnancy loss. It also does not recommend routine immune testing or treatments based on immune theories, NK-cell testing, endometrial receptivity testing, microbiome testing, or routine ovarian-reserve testing for this purpose.
This distinction matters because some commercially promoted tests and treatments have limited evidence behind them.
A specialist should explain why a particular test is being recommended and what would change depending on the result.
Can Recurrent Miscarriage Be Treated?
Treatment depends entirely on the cause.
If an underlying condition is identified, addressing it may improve reproductive care. Examples include:
- Treating overt thyroid disease
- Improving control of diabetes
- Treating antiphospholipid syndrome when diagnostic criteria are met
- Addressing certain uterine abnormalities
- Providing genetic counseling for a known chromosome rearrangement
- Managing relevant hormonal disorders
- Optimizing health before conception
For unexplained recurrent miscarriage, the situation can be more difficult because there may not be a specific treatment to correct.
ASRM emphasizes that evidence-based counseling is important because many patients with unexplained recurrent pregnancy loss can subsequently achieve a live birth without a specific intervention. Its 2026 guidance cites successful subsequent pregnancy attempts in approximately 50%–80% of patients with unexplained recurrent pregnancy loss.
That statistic should not be interpreted as an individual prediction. Age, medical history, chromosome findings, number and timing of losses, and other factors all influence an individual’s circumstances.
Is IVF Always Needed After Recurrent Miscarriage?
No. Recurrent miscarriage does not automatically mean that IVF is required.
For some couples, spontaneous conception with appropriate preconception and pregnancy care may be reasonable. For others, IVF may become part of the discussion because of additional infertility, a known genetic issue, diminished reproductive potential, or other factors.
Preimplantation genetic testing for aneuploidy (PGT-A) may also be discussed in certain circumstances, but it should not be presented as a universal solution for recurrent pregnancy loss. ASRM notes that PGT-A has not been shown to reduce time to successful pregnancy or increase live birth rates compared with expectant management for patients with recurrent pregnancy loss.
The right approach depends on the cause, age, fertility status, previous test results, and personal preferences.
Preparing for Your Next Pregnancy
After recurrent miscarriage, preparation for another pregnancy can feel both hopeful and frightening.
A preconception appointment can help you review:
- Previous pregnancy records.
- Results of miscarriage tissue testing, if available.
- Uterine imaging.
- Thyroid and metabolic health.
- Current medications.
- Genetic considerations.
- Lifestyle factors.
- Prenatal vitamin and folic acid use.
- A plan for early pregnancy monitoring.
Avoiding tobacco and secondhand smoke, taking appropriate folic acid, managing existing medical conditions, and reviewing medications with a healthcare professional are sensible parts of preconception care.
You should also discuss when to contact your care team after a positive pregnancy test. Some patients benefit from an individualized early-pregnancy monitoring plan, particularly when anxiety is high after previous losses.
The Emotional Impact Matters Too
The physical side of recurrent miscarriage is only one part of the experience.
Repeated pregnancy loss can bring grief, anxiety, frustration, guilt, and uncertainty about trying again. Patients may also feel isolated when friends or family members do not understand why another pregnancy can feel frightening rather than simply exciting.
ASRM specifically identifies psychological support as an important component of recurrent pregnancy-loss care.
Counseling or support from a mental-health professional experienced in pregnancy loss can be useful. Partners may also process grief differently, so open communication can be important.
Most importantly, experiencing miscarriage does not mean you failed.
Why Seeing a Specialist Can Help
A specialist consultation can bring structure to what may otherwise feel like an endless search for answers.
Instead of ordering every possible test, a reproductive specialist can review your history and determine which causes are plausible, which investigations are evidence-based, and which treatments may actually be appropriate.
This is especially relevant because recurrent miscarriage can remain unexplained even after appropriate investigation. Current guidelines emphasize evidence-based care and caution against unproven treatments that may add cost, side effects, or unnecessary stress without demonstrated benefit.
The goal of evaluation is not simply to find a diagnosis. It is to understand your individual risk factors, identify treatable conditions when present, and develop a sensible plan for future pregnancy.
Final Thoughts
Recurrent miscarriage can leave couples searching for explanations at a time when they are already dealing with significant emotional pain. While repeated pregnancy loss can have several possible causes, many early miscarriages are associated with chromosome abnormalities that occur during embryo development.
The good news is that recurrent pregnancy loss can be evaluated systematically. Current guidance supports beginning an evaluation after two pregnancy losses, with testing tailored to the individual rather than relying on indiscriminate investigations.
If you have experienced recurrent miscarriage, consider discussing your history with a fertility specialist or reproductive-medicine specialist before attempting another pregnancy. A thorough review can help identify potential causes, clarify which tests are worthwhile, and establish a personalized preconception and pregnancy-care plan.
Even when no specific cause is found, specialist care can provide evidence-based guidance and emotional support while you consider your next steps.
Learn recurrent miscarriage causes, recommended tests, treatment options, and when to see a fertility specialist for personalized pregnancy-loss care and guidance.
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