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Recurrent Pregnancy Loss: Causes, Tests, and When to See a Specialist
Experiencing a miscarriage can be emotionally difficult. When pregnancy loss happens more than once, it is natural to wonder why it keeps happening and whether something can be done before trying again.
Recurrent pregnancy loss (RPL) is generally defined as two or more pregnancy losses. Current guidance recommends that an evaluation can begin after two losses rather than waiting for a third.
The important point is that recurrent pregnancy loss does not always mean there is a serious or untreatable problem. In many cases, no single cause is identified, and many women go on to have a successful pregnancy.
What Is Recurrent Pregnancy Loss?
Recurrent pregnancy loss refers to having two or more pregnancy losses. The exact definition can vary slightly between clinical guidelines, but current American Society for Reproductive Medicine (ASRM) guidance considers two or more spontaneous pregnancy losses as recurrent pregnancy loss.
A single miscarriage is relatively common and often happens because of a random chromosomal problem in the developing embryo. Repeated losses, however, may justify a more detailed evaluation to look for factors that could be contributing.
This evaluation is not about finding someone to blame. In many cases, the cause is outside a woman’s control.
What Can Cause Recurrent Pregnancy Loss?
There can be several possible causes, and sometimes more than one factor may be involved.
1. Genetic or Chromosomal Factors
Chromosomal abnormalities are an important cause of early pregnancy loss. They often happen randomly when the embryo develops with an abnormal number of chromosomes.
The likelihood of chromosomal abnormalities also increases with maternal age. Current ASRM guidance notes that chromosomal abnormalities account for a substantial proportion of first-trimester miscarriages.
Testing pregnancy tissue after a miscarriage may sometimes help determine whether a chromosomal abnormality was involved.
2. Uterine or Structural Problems
The shape and condition of the uterus can sometimes affect the ability of a pregnancy to develop normally.
Possible factors include:
- Certain congenital uterine abnormalities
- Uterine septum
- Fibroids that affect the uterine cavity
- Endometrial polyps
- Intrauterine adhesions or scar tissue
Depending on your history, your doctor may recommend imaging of the uterus or, in selected cases, hysteroscopy to assess the uterine cavity. The 2026 ASRM guidance recommends uterine cavity evaluation as part of the assessment of recurrent pregnancy loss.
3. Hormonal and Metabolic Conditions
Certain medical conditions may be associated with recurrent pregnancy loss and may need to be assessed depending on your symptoms and medical history.
These can include:
- Thyroid disorders
- Diabetes or poorly controlled blood sugar
- Prolactin abnormalities in selected patients
- Other hormonal or metabolic problems
Not every woman with recurrent pregnancy loss needs every hormone or metabolic test. Testing should be guided by the individual’s history and clinical findings.
4. Antiphospholipid Syndrome
Antiphospholipid syndrome (APS) is an autoimmune condition associated with pregnancy complications, including recurrent pregnancy loss in some women.
Specific blood tests may be recommended when the clinical history suggests APS. Routine testing for every possible immune or blood-clotting disorder is not recommended. Current ASRM guidance specifically advises against routine inherited thrombophilia testing as part of recurrent pregnancy loss evaluation.
5. Sometimes, No Clear Cause Is Found
This can be one of the most frustrating parts of recurrent pregnancy loss.
Even after appropriate evaluation, a definite cause may not be identified. That does not mean there is nothing that can be done or that a future pregnancy cannot be successful.
Current evidence indicates that many patients with unexplained recurrent pregnancy loss subsequently have a successful pregnancy, even without a specific treatment for an identified cause.
When Should You Seek an Evaluation?
If you have experienced two or more pregnancy losses, it is reasonable to discuss recurrent pregnancy loss evaluation with your gynecologist or fertility specialist.
You should also discuss your history with your doctor if you have:
- Previous miscarriages along with difficulty conceiving
- A known uterine abnormality
- Irregular periods or suspected hormonal problems
- Thyroid disease or diabetes
- A personal history suggestive of blood-clotting or autoimmune problems
- A previous pregnancy affected by significant complications
Your doctor will consider the number and timing of pregnancy losses, previous pregnancies, age, medical history, examination findings and fertility history before deciding which investigations are appropriate.
What Tests May Be Recommended?
There is no single test that can explain every miscarriage. Evaluation is usually individualized.
Medical and Pregnancy History
Your doctor may review:
- Details of previous pregnancies
- Timing of each pregnancy loss
- Ultrasound findings
- Previous pregnancy tissue testing, if available
- Menstrual history
- Medical conditions and medications
- Previous fertility treatment
- Family history
A physical and pelvic examination may also be appropriate.
Blood Tests
Depending on your history, testing may include evaluation for conditions such as:
- Thyroid abnormalities
- Diabetes or abnormal blood sugar
- Antiphospholipid syndrome
- Certain genetic factors
- Prolactin abnormalities when symptoms suggest they may be relevant
The exact tests should be selected rather than ordering a large panel of investigations without a clear reason.
Uterine Imaging
Your doctor may recommend an investigation to look at the uterus and uterine cavity.
Depending on the situation, this may include ultrasound, saline sonography, HSG (hysterosalpingogram) or hysteroscopy. Current ASRM guidance includes uterine cavity evaluation in the assessment of recurrent pregnancy loss.
HSG can also provide information about the shape of the uterine cavity and whether the fallopian tubes are open. Dr. Harpreet Kaur’s female infertility services include HSG, ultrasound imaging and diagnostic/operative laparoscopy and hysteroscopy when clinically appropriate.
Genetic Evaluation
Genetic testing may be considered for the pregnancy tissue after a miscarriage. In some circumstances, testing of both partners may also be discussed.
The purpose is to understand whether a chromosomal factor may have contributed to the pregnancy loss and to help guide further evaluation.
Can Recurrent Pregnancy Loss Be Treated?
Treatment depends on the cause.
For example, if an identifiable uterine abnormality is contributing to pregnancy loss, treatment may be considered. If a thyroid or metabolic problem is identified, appropriate medical management may be recommended. If antiphospholipid syndrome is diagnosed, specific treatment may be appropriate under medical supervision.
However, it is important not to assume that every miscarriage requires medication or that extensive testing will always find an explanation.
Current ASRM guidance cautions against several tests and treatments that have not been shown to provide benefit for routine recurrent pregnancy loss care, including routine inherited thrombophilia testing and routine immune testing.
Can You Have a Successful Pregnancy After Recurrent Pregnancy Loss?
Yes. Many women with recurrent pregnancy loss go on to have a successful pregnancy.
Even when no specific cause is identified, the outlook can still be encouraging. ACOG notes that most women with unexplained repeated miscarriages go on to have successful pregnancies.
Your doctor may recommend a preconception consultation before you try again. This provides an opportunity to review previous pregnancy losses, manage existing medical conditions, discuss medications and supplements, and decide whether any further testing is appropriate.
Emotional Support Matters Too
Pregnancy loss is not only a physical experience. Repeated loss can bring grief, anxiety, frustration and fear about trying again.
It is important to remember that a miscarriage is not necessarily caused by something you did or failed to do. Random chromosomal abnormalities are a common reason for early pregnancy loss.
If pregnancy loss is affecting your emotional well-being, consider speaking with your doctor, counselor or a pregnancy-loss support service. Emotional support is an important part of care alongside medical evaluation.
When Should You See a Fertility or Pregnancy Specialist?
Consider seeking specialist evaluation if you have experienced two or more pregnancy losses, particularly if you are planning another pregnancy.
A specialist can help determine:
- Whether further investigations are appropriate
- Whether a uterine or hormonal factor needs attention
- Whether genetic evaluation may be useful
- Whether an underlying medical condition needs management
- What steps can be taken before another pregnancy
- How your next pregnancy can be monitored based on your individual history
The goal is not simply to order more tests. It is to understand your history, identify factors that can be addressed, and create an appropriate plan for your next pregnancy.
Frequently Asked Questions
No. Recurrent pregnancy loss and infertility are different reproductive conditions. With recurrent pregnancy loss, conception has occurred but pregnancies have ended in loss. ASRM considers RPL a distinct condition requiring its own evaluation.
Not necessarily. ACOG recommends evaluation after two miscarriages, and current ASRM guidance also defines recurrent pregnancy loss as two or more pregnancy losses.
No. Uterine problems are one possible cause, but recurrent pregnancy loss can have genetic, medical or other contributing factors. In some cases, no definite cause is found.
Healthy habits are important when planning pregnancy, but they cannot prevent every miscarriage. Avoiding smoking, limiting harmful exposures, managing medical conditions and preparing for pregnancy can support overall reproductive health.
Schedule a preconception consultation with your gynecologist or fertility specialist. Bring your previous pregnancy records, ultrasound reports and any test results you have. This can help your doctor decide whether additional evaluation is needed before your next pregnancy.
A Final Word
Recurrent pregnancy loss can leave you with many unanswered questions, but having two or more miscarriages does not mean that a successful pregnancy is impossible.
A careful evaluation can help identify conditions that may be treatable and can also prevent unnecessary tests or treatments when no clear cause is present. Most importantly, your care should be individualized according to your pregnancy history, medical background and future plans.
If you have experienced recurrent pregnancy loss, speaking with a gynecologist or fertility specialist can help you understand what may have happened and what steps may be appropriate before trying again.