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Home › Conditions › Recurrent miscarriage
CONDITIONS · RECURRENT MISCARRIAGE
After two losses, you deserve a proper search for a cause.
We are sorry for what brought you here. Recurrent miscarriage means losing two or more pregnancies, and it can be investigated properly, with a short list of tests that change what happens next.
- Tested after 2 losses
- Both partners checked
- Only tests that change the plan
- Care planned for the next pregnancy
- Embryo chromosomes — The most common cause, usually random
- Womb cavity — Septum, fibroid, polyp or scarring
- Blood — Antiphospholipid antibodies
- Hormones — Thyroid and blood sugar
Urgent: same-day care
Bleeding heavily or in severe pain right now?
- Heavy bleeding (soaking a pad every hour), feeling dizzy or faint, severe pain in the tummy or shoulder, or a fever with pain need same-day care. Call 108 or go to the nearest emergency department now, then call us on +91 89399 94244.
01What counts as recurrent miscarriage?
Recurrent miscarriage, or recurrent pregnancy loss, means losing two or more pregnancies before 24 weeks.
The European guideline (ESHRE, 2023) uses two losses. The UK guideline (RCOG, 2023) still uses three, but allows a full workup after two. We investigate after two, especially if you are over 35, a heartbeat had been seen, or a loss came after the first trimester. You do not need to wait for a third.
02Why do miscarriages keep happening?
The most common cause of an early miscarriage is a random chromosome error in the embryo, which becomes more frequent as the woman gets older.
These errors happen when the egg or sperm forms, or at fertilisation. They are not inherited and not caused by anything you did. Work, exercise, lifting, travel or a stressful week do not cause miscarriage. This also means a run of losses can happen by chance, with nothing wrong in either of you.
03Which tests are worth doing after two miscarriages?
The tests worth doing look for causes that can be treated: antiphospholipid antibodies, thyroid, blood sugar, the shape of the womb, chromosomes and the sperm.
Antiphospholipid antibodies are tested twice, some weeks apart, because one positive result is not enough. A scan checks the womb cavity, with hysteroscopy if something looks wrong. Karyotypes of both partners look for a balanced translocation, especially when the pregnancy tissue could not be tested. He has a semen analysis, with a sperm DNA test in selected couples.
KaryotypingHysteroscopySperm DNA fragmentation04Which tests and treatments are we cautious about?
We do not order immune tests, clotting panels or add-on tests for every couple, because most have weak evidence and do not change treatment.
Couples who have lost pregnancies will understandably try anything, and this area attracts many unproven tests. Immune testing is reserved for a specific subgroup, not applied to everyone. If you are handed a long list of tests after two losses, ask of each one: what would we do differently depending on the result?
Honest note
The UK guideline for recurrent miscarriage (RCOG, 2023) does not support routine testing of natural killer (NK) cells, and the UK fertility regulator (HFEA) does not rate immune treatments such as steroids and IVIG as improving the chance of a baby in IVF. (What the evidence says)
05What is the treatment for recurrent miscarriage?
Treatment follows the cause, where one is found, and many causes can be corrected before the next pregnancy.
Antiphospholipid syndrome is treated with low-dose aspirin and heparin, started early in the next pregnancy. Thyroid and blood sugar are corrected before you conceive. A septum, polyp, scarring or a fibroid inside the cavity can often be treated by hysteroscopy. A balanced translocation leads to genetic counselling, with embryo testing (PGT-SR) as one option.
06All our tests are normal. What now?
Normal tests are the most common result of a full workup, and many couples with unexplained recurrent loss go on to have a baby.
What changes is the care around the next pregnancy: an early pregnancy test, an early scan, planned reviews and a named person to call. Progesterone may be added if there is bleeding in early pregnancy. Close supportive care in early pregnancy is one of the few things linked with better outcomes in unexplained loss. Ask for it.
Does this sound like you?
Any one of these is reason enough to ask for a proper workup.
- We have lost two pregnancies
- We saw a heartbeat, then lost the pregnancy
- We were told to 'just try again'
- I'm over 35 and have had two losses
- More than one chemical pregnancy
- Tests elsewhere were normal, and it keeps happening
What we do, in order.
- 1
Listen to each loss
When it happened, what the scan showed, and whether tissue was tested.
- 2
Test both of you
Antiphospholipid antibodies twice, thyroid, blood sugar, a scan of the womb, chromosomes and a semen analysis.
- 3
Correct what is found
Hysteroscopy for the cavity, treatment for thyroid or sugar, a medicine plan for antiphospholipid syndrome.
- 4
Plan the next pregnancy
Early test, early scan, planned reviews, and someone who knows your history. [CONFIRM: who scans and until which week]
- 5
IVF only with a reason
IVF with PGT-SR for a translocation, or for another fertility problem. Not as a general upgrade.
Your first visit
1
Talk
Each loss in order: the week, the scan, any tissue results. Both partners, unhurried.
2
Test
Only the tests that can change the plan, for both of you.
3
Plan
What was found, what it means, and what we will do before and during the next pregnancy.
4
Treat
Correct the cause if there is one. Close early care either way.
Questions patients ask
Still unsure? Ask us on WhatsApp — a real person replies.
After how many miscarriages should we be tested?
Two losses is a reasonable point to ask for a full workup. You do not need to wait for a third, especially if you are over 35, a heartbeat had been seen, or a loss came after the first trimester.
What are the main causes of recurrent miscarriage?
The most common cause is a random chromosome error in the embryo. Treatable causes include antiphospholipid syndrome, a problem in the womb cavity, uncontrolled thyroid disease or diabetes, and a balanced translocation in either partner. Often no cause is found.
Did I do something to cause the miscarriage?
No. Work, exercise, lifting, travel, stress and ordinary daily life do not cause miscarriage. The most common cause is decided before you even know you are pregnant.
Should my husband be tested too?
Yes, the male partner is part of every recurrent miscarriage workup. He has a semen analysis, a karyotype where indicated, and a sperm DNA test in selected couples.
Does a chemical pregnancy count as a miscarriage?
Yes, the European guideline (ESHRE, 2023) counts a chemical pregnancy, a positive test that ends before a scan can see it, as a pregnancy loss. Two or more are worth discussing with a specialist. Our guide covers the bleeding and recovery.
Will aspirin prevent another miscarriage?
Low-dose aspirin, with heparin, helps when antiphospholipid syndrome has been confirmed by blood tests. For other couples it is not a general remedy, so take it only on your doctor's advice.
Will IVF stop us from miscarrying?
Not by itself. IVF helps with recurrent miscarriage only when there is a separate reason, such as a balanced translocation where embryo testing is planned, or another fertility problem.
Can autoimmune disease cause miscarriage?
Antiphospholipid syndrome is the autoimmune condition most clearly linked with recurrent miscarriage, and it is treatable. Other autoimmune conditions such as lupus or thyroid disease should be stable, with your physician's input, before you try again.
In their words, not ours.
Geetha M.
· Google
She prescribes only the very necessary investigations and medications, maintaining high standards and ethics.
JOURNAL
Chemical pregnancy: what to expect
Bleeding, timing and recovery after a very early loss.
TESTKaryotyping
Looks for a balanced translocation in either partner.
TREATMENTTREATMENT · Only with a reason, such as embryo testing for a translocation.
Only with a reason, such as embryo testing for a translocation.
CONDITIONRecurrent implantation failure
Good embryos, no positive test: a different problem.
Tell us what happened. We'll start there.
You can write as much or as little as you like. A real person from Dr Vani's team replies on WhatsApp, usually within minutes during clinic hours (Mon to Sat, 9am to 5pm. Sunday closed.).
Chat on WhatsAppCall +91 89399 94244
Sex selection is prohibited in India under the PCPNDT Act, 1994 and the ART Act, 2021.