Losing a pregnancy is distressing. Losing more than one can leave couples exhausted, anxious and searching for answers - and often facing well-meaning but conflicting advice. Recurrent miscarriage, also called recurrent pregnancy loss, affects around 1 to 2 percent of couples trying to conceive. A careful evaluation finds a treatable cause in some of them. Even when no cause is found, which happens in about half of couples, the chance of a successful next pregnancy is good, and most go on to have a baby.
It is also important to say clearly what does not cause miscarriage. Working, climbing stairs, travelling, having intercourse, lifting a child, eating papaya or pineapple in normal amounts, or feeling stressed does not cause a pregnancy to be lost. Many women carry unnecessary guilt, sometimes reinforced by family members. A miscarriage is not the mother’s fault.
When is it called recurrent miscarriage?
Current guidance from ESHRE (2017, updated 2022) and the RCOG (2023) recommends evaluation after two or more pregnancy losses, rather than waiting for three as was done in the past. The losses do not need to be consecutive. Earlier testing is especially reasonable if you are over 35, have had difficulty conceiving, or have had a loss in the second trimester.
Known causes
- Chromosomal problems in the pregnancy: the most common cause of any single miscarriage, and more frequent as the mother’s age rises
- Antiphospholipid syndrome (APS or APLA): an autoimmune condition that makes the blood more likely to clot and affects the placenta
- Uterine abnormalities: a septum (a wall dividing the uterus), fibroids distorting the cavity, scar tissue or polyps
- A balanced chromosomal rearrangement in one parent, which can lead to unbalanced chromosomes in the pregnancy
- Hormonal and metabolic factors: uncontrolled diabetes, thyroid disease and PCOS
- Cervical weakness, mainly relevant to losses in the second trimester
- Lifestyle factors: smoking, heavy alcohol use, and obesity raise the risk
Tests that are recommended
International guidelines recommend a focused set of tests, chosen for their ability to change treatment:
- Antiphospholipid antibodies: lupus anticoagulant, anticardiolipin antibodies and anti-beta-2-glycoprotein-I, repeated after 12 weeks to confirm a positive result
- A pelvic ultrasound, ideally 3D, to look at the shape of the uterine cavity; hysteroscopy or MRI may follow if an abnormality is suspected
- Thyroid tests: TSH and TPO antibodies
- Blood sugar (HbA1c) and, where relevant, tests for PCOS
- Genetic testing of pregnancy tissue from a future loss, which helps explain why that loss happened
- Parental chromosome tests (karyotype) in selected couples, for example when tissue testing shows an unbalanced rearrangement
If you miscarry again, ask whether the pregnancy tissue can be sent for chromosomal testing. If the loss was caused by a chromosomal problem in that pregnancy, it is reassuring in one sense - it points to chance rather than an ongoing problem in the mother - and it can spare further unnecessary tests. The male partner’s health also matters: smoking, alcohol and obesity in men have been linked to poorer pregnancy outcomes, and a general health check is reasonable.
Pre-natal sex determination is prohibited under the PCPNDT Act. The sex of the baby is not detected or disclosed at any scan.
Tests that are usually not useful
Many couples are offered long lists of expensive tests. Some are not supported by evidence, and abnormal results can lead to treatments that do not help and may carry risks.
- Natural killer (NK) cell testing and HLA typing
- Routine testing for inherited thrombophilias, such as MTHFR, in women without a personal or family history of clots
- Routine sperm DNA fragmentation testing is still debated and is not universally recommended
- Immunotherapy, intravenous immunoglobulin and intralipid infusions are not recommended outside research settings
If you are prescribed injections, steroids or immune treatments for recurrent miscarriage, ask what the evidence for them is in your situation. A second opinion is always reasonable before starting a treatment that has not been shown to improve live birth rates.
Treatment depends on the cause
- Antiphospholipid syndrome: low-dose aspirin and heparin injections during pregnancy, which improve the chance of a live birth
- Uterine septum or fibroids distorting the cavity: correction by hysteroscopic surgery may be advised
- Thyroid disease and diabetes: good control before conception
- Women who bleed in early pregnancy with a history of miscarriage: vaginal progesterone may be advised, based on large trials such as PRISM
- Second-trimester loss linked to the cervix: cervical length scans, and a cervical stitch (cerclage) when indicated
- Parental chromosome rearrangement: genetic counselling, including discussion of testing options in future pregnancies
When no cause is found
Unexplained recurrent miscarriage is frustrating, but it is not a hopeless diagnosis. Studies consistently show that supportive care in the next pregnancy - early scans, easy access to the team, and reassurance - is associated with good outcomes. Most couples with unexplained losses have a successful pregnancy in the future.
- An early scan at around 6 to 7 weeks, and regular scans in the first trimester
- A named team to contact with bleeding or worries
- Folic acid, a healthy weight, and stopping smoking
- Emotional support - counselling for both partners if needed
Grief after miscarriage is real, and it can be harder after several losses. Anxiety in the next pregnancy is common, and it is normal to find the first weeks difficult. Taking time before trying again is a personal decision; medically, there is usually no need to wait more than one normal cycle unless tests or treatment are planned. Talk openly with your partner and your doctor, and ask for support when you need it.
When to see a doctor
If you have had two or more miscarriages, a dedicated consultation before trying again is worthwhile. Bring all previous scan reports, blood tests and discharge summaries. In the next pregnancy, contact the team as soon as your test is positive. At Divine Women’s Hospital, Gota, Dr. Devang Patel offers evaluation of recurrent pregnancy loss and close monitoring in early pregnancy, with emergency care available 24 × 7.
Related care: Recurrent pregnancy loss evaluation and care
More patient guides
- The NT scan at 11–14 weeks: what it checks and how to prepare
- High blood pressure in pregnancy: the warning signs you should not wait on
- Expecting twins? Why “do they share a placenta?” is the first question
- NIPT or NT scan: which test do you need, and can one replace the other?
- Pregnancy after 35: fertility, risks and how to plan a healthy pregnancy
This guide is general information for patients and does not replace a consultation with your own doctor.