Recurrent miscarriage means losing two or more pregnancies. It can be an emotionally distressing experience, leaving you with trauma, stress, doubts, and unanswered questions.

Instead of assuming what may have gone wrong, seeking professional help can help identify possible underlying causes and the next steps.

A recurrent miscarriage evaluation allows a fertility specialist to understand your medical and pregnancy history and determine which investigations may be relevant. Depending on your individual situation, this may involve genetic testing, blood tests, uterine evaluation, or other fertility assessments.

But where do you begin, and what should you expect from the testing process?

This guide explains the possible reasons behind repeated miscarriages, the recurrent miscarriage tests doctors may recommend, available treatment approaches, and the role of male-factor evaluation. At Archish Fertility & IVF Clinic, the focus is on understanding your individual history and planning the next steps with appropriate medical guidance.

What is Recurrent Miscarriage?

Recurrent miscarriage, also known as recurrent pregnancy loss (RPL), refers to two or more pregnancy losses. It is a clinical condition that may require evaluation to understand whether an underlying factor is contributing to repeated pregnancy loss.

A miscarriage refers to the spontaneous loss of a pregnancy before the fetus can survive outside the uterus. Most early miscarriages occur because of chromosomal abnormalities in the embryo, often as a random event during embryo development. However, recurrent pregnancy loss can have several contributing factors.

These may include:

• Chromosomal or genetic abnormalities
• Uterine or structural abnormalities
• Antiphospholipid syndrome and other selected medical conditions
• Endocrine or metabolic disorders
• Certain genetic factors affecting either partner
• Male-factor abnormalities, including sperm-related factors
• In some cases, no specific cause is identified

Importantly, recurrent miscarriage does not necessarily mean that a person cannot achieve a successful pregnancy. A systematic evaluation helps determine which factors may be relevant and whether any of them can be addressed before the next pregnancy.

What are the Causes of Repeated Miscarriages?

Repeated miscarriages can have multiple causes, and more than one factor may contribute in some cases. Identifying the possible cause helps your fertility specialist decide whether further testing or treatment is needed. Some of the most common causes are:

1. Chromosomal Abnormalities: Chromosomal abnormalities are a common cause of early pregnancy loss. They can occur when an embryo develops with an abnormal number or structure of chromosomes. Many of these abnormalities occur randomly and do not indicate a problem with either parent. The likelihood of chromosomal abnormalities also increases with maternal age.

2. Uterine Abnormalities: Structural problems within the uterus can sometimes interfere with implantation or normal pregnancy development. A uterine evaluation can help identify these structural factors. These may include:

• Septate uterus
• Intrauterine adhesions or scar tissue
• Certain uterine fibroids
• Endometrial polyps
• Other congenital or acquired uterine abnormalities

3. Antiphospholipid Syndrome: Antiphospholipid syndrome (APS) is an autoimmune disorder associated with abnormal blood clotting and adverse pregnancy outcomes. It is one of the established medical conditions that may be evaluated in recurrent pregnancy loss.

4. Hormonal and Metabolic Disorders: Certain endocrine and metabolic conditions can affect pregnancy. These may include thyroid disorders and poorly controlled diabetes. Depending on your medical history, your specialist may recommend appropriate hormonal or metabolic testing.

5. Genetic Factors: In some couples, one partner may carry a balanced chromosomal rearrangement without having any symptoms. Although the parent may be healthy, the rearrangement can sometimes result in an embryo with an unbalanced chromosomal arrangement, increasing the risk of pregnancy loss.

6. Male Factors: Recurrent pregnancy loss is not always related to the female partner. Sperm quality and sperm DNA integrity may also be considered, particularly when miscarriages remain unexplained or occur alongside infertility.

7. Unexplained Recurrent Pregnancy Loss: Sometimes, even after a detailed recurrent pregnancy loss evaluation, no definitive cause is identified. This is known as unexplained recurrent pregnancy loss. It can be frustrating, but it does not mean that a future healthy pregnancy is unlikely.

What Tests are Recommended for Recurrent Miscarriages?

There is no single test for recurrent miscarriage. Hence, your fertility specialist may recommend a combination of various tests. The following table lists the most commonly recommended tests for recurrent miscarriage:

Please note: Current ASRM guidance specifically recommends offering chromosome evaluation of miscarriage tissue and uterine cavity evaluation in recurrent pregnancy loss, while other investigations are recommended only in certain circumstances. (ASRM Guidance)

Does Everyone Need All These Tests?

No. Recurrent miscarriage testing should be individualized. A fertility specialist first reviews your pregnancy history, previous reports, age, medical conditions, and any available miscarriage tissue results. This helps determine which investigations are relevant and avoids unnecessary testing.

What is the Role of Male-Factor Testing in Repeated Miscarriage?

Repeated pregnancy loss can involve factors related to either partner. While many evaluations focus on the female reproductive system, sperm health and paternal genetic factors can also play a role in recurrent pregnancy loss.

A male-factor evaluation may include:

1. Semen analysis: A semen analysis evaluates sperm concentration, motility, and morphology. It provides a basic assessment of sperm health and can identify abnormalities that may also contribute to infertility.

2. Sperm DNA fragmentation testing: Sperm may have DNA damage even when routine semen parameters appear normal. Sperm DNA fragmentation testing assesses the integrity of sperm DNA and may be considered in cases of unexplained recurrent pregnancy loss, particularly when infertility is also present.

3. Karyotyping: Parental karyotyping examines the number and structure of chromosomes in both partners. In some cases, a person may carry a balanced chromosomal rearrangement, such as a translocation, without having any noticeable health problems. However, it can increase the likelihood of producing embryos with an unbalanced chromosome arrangement, which may result in miscarriage.

Karyotyping may be considered when indicated by the couple’s reproductive history or the results of pregnancy-tissue genetic testing.

4. Review of male health factors: A fertility specialist may also review factors that can affect sperm quality, including:

• Increasing paternal age
• Smoking and tobacco exposure
• Excessive alcohol consumption
• Obesity
• Certain medications
• Medical conditions affecting fertility
• Relevant environmental or occupational exposures

What Treatments are Available for Recurrent Miscarriage?

Recurrent miscarriage treatment depends on the underlying cause. There is no single treatment that works for every person, so the next step usually depends on what the evaluation reveals.

1. Treating an identified medical condition: If testing identifies a treatable condition, managing it before or during pregnancy may help improve pregnancy outcomes. For example:

• Antiphospholipid syndrome (APS): Confirmed APS may be treated with low-dose aspirin and heparin under medical supervision.
• Thyroid disorders: Overt thyroid disease should be appropriately treated before pregnancy.
• Uncontrolled diabetes: Improving blood sugar control before conception is important.
• Hyperprolactinemia: Treatment may be considered when elevated prolactin is associated with anovulation or related symptoms.
• Uterine abnormalities: Conditions such as a uterine septum, endometrial polyps, submucosal fibroids, or significant intrauterine adhesions may be considered for surgical correction when clinically appropriate.

2. Genetic counseling: If testing identifies a chromosomal abnormality in the pregnancy or a parental chromosomal rearrangement, genetic counseling can help couples understand their reproductive options. These may include natural conception, prenatal testing, IVF with preimplantation genetic testing for structural rearrangements (PGT-SR) in selected cases, or donor gametes.

What is the Role of Progesterone in Treating Repeated Miscarriages?

Progesterone plays an important role in maintaining pregnancy. Its use in recurrent pregnancy loss depends on the clinical situation.

Current medical evidence does not support routine progesterone for every person with RPL, but vaginal progesterone may be considered in some cases, particularly when early pregnancy bleeding occurs.

Can IVF or ICSI Help After Repeated Miscarriages?

IVF may be considered when recurrent miscarriage occurs alongside infertility, a known genetic factor, or another indication for assisted reproduction. In selected couples with a parental chromosomal rearrangement, IVF with PGT-SR may help identify embryos without the specific unbalanced rearrangement.

ICSI may be recommended when there is a significant male-factor indication, particularly when sperm-related problems affect fertilization. It is not automatically required simply because a couple has experienced recurrent miscarriage.

It is also important to understand that IVF with PGT-A is not a universal treatment for recurrent miscarriage. Current ASRM guidance states that PGT-A has not consistently been shown to reduce miscarriage or improve live birth rates compared with expectant management in RPL.

What if No Cause for Repeated Miscarriage is Found?

This is more common than many people realize. When investigations do not identify a specific cause, treatment may focus on preconception optimization, appropriate pregnancy monitoring, supportive care, and shared decision-making rather than adding unproven treatments.

Many people with unexplained recurrent pregnancy loss go on to have a successful pregnancy without a specific intervention. Current ASRM guidance estimates that around 50% to 80% of patients with unexplained RPL may succeed in a subsequent pregnancy attempt.

The key is to avoid treating every miscarriage with the same protocol. Recurrent miscarriage treatment should be based on the cause, the couple’s fertility profile, and the evidence supporting each option.

When Should You Consult a Fertility Specialist After a Miscarriage?

See a fertility specialist for recurrent miscarriage after two losses. Go sooner in these cases:

• You are 35 or older and have had one loss.
• Your loss happened after 10 weeks.
• You have thyroid disease, diabetes, PCOS, or a clotting problem.
• Your periods turned very light or stopped after a D&C.

Seek emergency care for heavy bleeding, severe pain, or fever.

What Happens During a Recurrent Miscarriage Evaluation?

Repeated pregnancy loss can be difficult to process, especially when you do not have a clear explanation for why it happened. However, the right medical support can help you understand what your previous losses may mean, identify factors that require attention, and make informed decisions about what comes next.

At Archish Fertility & IVF Clinic, the aim is to help couples move forward with clarity rather than uncertainty. If you have experienced recurrent miscarriage, speaking with a fertility specialist can be an important step toward understanding your reproductive health and planning your next pregnancy.