Losing more than one pregnancy is painful, and it is natural to want answers. Guidelines now suggest looking into it after two losses. Some tests are recommended and others are not, and many people go on to have a pregnancy that continues.
If you are reading this after a loss
We are sorry. Losing a pregnancy, at any stage, can bring deep grief, and losing more than one can feel overwhelming. Many people also feel guilt, though a pregnancy loss is very rarely caused by anything a person did, such as working, travelling, lifting, having sex or feeling stressed.
This guide explains what doctors look for after repeated losses. Read it when you feel ready, and at your own pace.
What recurrent pregnancy loss means
Pregnancy loss (also called miscarriage) means a pregnancy didn't continue before the baby could survive outside the uterus. Medical reports sometimes call it "spontaneous abortion"; this simply means a miscarriage, not a procedure.
The European Society of Human Reproduction and Embryology (ESHRE) 2022 guideline defines recurrent pregnancy loss as two or more pregnancy losses. The losses don't need to be one after another. A pregnancy confirmed by a positive pregnancy test, even if it was never seen on a scan, counts.
Good to know. Single pregnancy losses are common, and most happen because of a one-off chromosome difference in the pregnancy. After two or more losses, it is reasonable to ask for an assessment, without waiting for a third.
Tests that are usually recommended
After recurrent loss, a doctor will take a detailed history for both partners. Based on the ESHRE guideline, tests commonly recommended include:
| Test | What it looks for |
|---|---|
| Antiphospholipid antibodies | An immune condition (antiphospholipid syndrome) that can affect blood clotting and pregnancy; treatment is available if found |
| Thyroid tests (TSH and thyroid antibodies) | An underactive thyroid, or thyroid antibodies, which can be linked with pregnancy loss |
| Assessment of the uterus | Differences in shape, such as a septum, usually checked with 3D ultrasound |
| Genetic testing of pregnancy tissue | Can sometimes explain why a particular loss happened, where it is available |
| Parental karyotype (chromosome test) | In selected cases only, after a doctor assesses individual risk, for example after a previous pregnancy with a chromosome difference |
Tests that aren't routinely recommended
Some tests are widely offered but are not recommended routinely, because there isn't good evidence that they help or that treatment based on them improves outcomes. These include, for example, routine screening for inherited clotting conditions without other reasons, tests of natural killer (NK) cells, HLA testing, and ovarian reserve tests such as AMH for this purpose.
If any of these is suggested, it is reasonable to ask why, what the result would change, and what it costs.
Caution. Be cautious about treatments offered without clear evidence, especially those based on non-routine tests. Ask your doctor what the evidence is, and don't start any medicine without medical advice.
What happens if no cause is found
For many people, the tests don't find a specific cause. This is hard to hear, but it is not bad news in itself. Many people with recurrent pregnancy loss, including those with no cause found, go on to have a pregnancy that continues.
In a future pregnancy, early support can help: an early scan, a named person to contact, and being listened to. Your doctor can advise on general health steps such as folic acid (400 micrograms a day), stopping smoking and keeping alcohol low, without any suggestion of blame.
Looking after yourself and each other
Grief after pregnancy loss is real, for both partners. Partners may grieve differently, and a male partner's feelings are often overlooked. It is common to feel anxious in a new pregnancy, or to find others' pregnancy news painful.
You don't have to explain your losses to anyone. If family members ask questions, a short reply is enough; our guide to handling family questions has some ideas.
Support can help. Consider talking to a counsellor. Tele-MANAS offers free, confidential mental-health support in many Indian languages, 24x7: call 14416 or 1-800-891-4416.
When to see a doctor
- You have had two or more pregnancy losses and would like an assessment.
- You are planning another pregnancy and want to discuss early support.
- Low mood, anxiety or sleep problems last more than a couple of weeks.
In early pregnancy, call 112 or go to the nearest hospital straight away if you have heavy bleeding (soaking a pad in an hour), severe tummy pain, pain on one side or in the shoulder tip, or you feel dizzy or faint. If you ever have thoughts of harming yourself, seek help immediately.
Sources
This is general information, not medical advice. It can't account for your history. Please talk to a doctor about your own situation. Medical disclaimer
Severe pain, heavy bleeding or fainting? Call 112 or go to the nearest hospital.