Recurrent pregnancy loss

Recurrent pregnancy loss is generally defined as two or more pregnancy losses confirmed by a positive pregnancy test, not counting an ectopic or molar pregnancy. Unlike some definitions of the past, the losses do not need to happen one right after another to count, and a very early loss still counts. If this has happened to you more than once, it is reasonable to ask for an evaluation rather than being told to simply try again.

Why it is not just bad luck

A single miscarriage is common and usually is not investigated on its own, since it is often a one-off chromosomal issue in that particular pregnancy. Two or more losses are different: they are common enough to affect a meaningful share of people trying to conceive, and they raise the odds that something identifiable, and sometimes treatable, is contributing.

What gets checked

A typical evaluation looks at several areas at once, since a cause can sit in more than one place:

• Genetics, testing tissue from a loss where possible, and sometimes both partners' chromosomes.
• Uterine shape, checked with an HSG, an ultrasound, or occasionally a hysteroscopy, looking for things like a uterine septum or fibroids distorting the cavity.
• Hormonal factors, including thyroid function (TSH) and, in some cases, blood sugar regulation.
• Blood-clotting and immune factors, a group of conditions that can affect the placenta's blood supply.

When no cause is found

Moving forward

Depending on what the evaluation finds, next steps range from correcting a uterine or hormonal issue, to blood-thinning medication where a clotting factor is found, to closer monitoring in a future pregnancy, to IVF with genetic testing of embryos in specific situations. Emotional support matters here too; our mental health and support page has resources for coping with loss while continuing treatment.