When I evaluate a couple, I look for antiphospholipid syndrome (APLA), thyroid and blood sugar problems, and a septum or other shape problem in the uterus. I also look for chromosomal rearrangements in either partner. In about half of couples no cause is found. Even then, many studies report that around two in three couples have a successful next pregnancy, and supportive care in early pregnancy can make that pregnancy feel far less frightening.
How I Work With Couples After Repeated Losses
My work has two parts. The first is to find a treatable cause where one exists. The second is to look after you closely through the next pregnancy, whether or not a cause is found. I do both at Divine Women's Hospital, Gota, Ahmedabad.
- Both partners at the first visit. Several tests, and much of the lifestyle advice, concern the man as well, so I prefer to see you together.
- Your full history first. I go through the week of each loss, every scan and any tissue reports before ordering anything, so that tests are chosen rather than ordered in bulk.
- Procedures under the same roof. If a septum or adhesions need hysteroscopic surgery, I perform it myself as a laparoscopic and hysteroscopic surgeon.
- The next pregnancy with the same doctor. Early reassurance scans and, where needed, high-risk pregnancy care continue with me, so the plan we made before conception is the one we follow afterwards.
- Language: I consult in Gujarati, Hindi or English
What Is Considered Recurrent Miscarriage?
Recurrent miscarriage is generally considered to be the loss of two or more pregnancies before 20–24 weeks. The chance of it rises with the mother's age and with each additional loss.
A single miscarriage, by contrast, is common - it happens in about 10–15% of recognised pregnancies. It is usually caused by a chance chromosomal error in that pregnancy and does not, as a rule, point to an underlying problem.
- Most losses happen before 12–13 weeks, in the first trimester.
- Losses between 13 and 24 weeks are less common and more often have a specific cause. This may be a weak cervix, infection, APLA or a problem with the uterus, so I investigate them even after a single episode.
- When to evaluate: ESHRE and other guidelines suggest evaluation after two losses, counting biochemical pregnancies (a positive test with no pregnancy ever seen on a scan). Older guidance waited for three; definitions still vary.
Recurrent Miscarriage Causes and How Often Each Is Found
Recurrent miscarriage causes fall into a few well-studied groups; the table shows roughly how often each is found and what follows when it is.
| Possible cause | How often it is involved | What I do about it |
|---|---|---|
| A chromosomal error in the pregnancy itself | Behind most single losses, and fewer with each repeat loss | Testing the pregnancy tissue helps explain the loss |
| Antiphospholipid syndrome (APLA) | About 10–15% of women with recurrent loss | Low-dose aspirin plus heparin injections in the next pregnancy |
| A uterine septum or other shape problem | About 10–15% | Hysteroscopic removal of the septum in selected women |
| A balanced translocation in one partner | About 2–5% of couples | Genetic counselling; options include prenatal testing or PGT with IVF |
| Thyroid disease, uncontrolled diabetes | Variable | Correcting them before conception and monitoring through pregnancy |
| Age, BMI, smoking, alcohol | Contributing factors | Lifestyle changes, reaching a healthy weight, giving up tobacco |
Recurrent Pregnancy Loss: What Raises the Chance of Another Loss
- The woman being 35 or older, with a steeper rise after 40.
- Three or more earlier losses.
- PCOS, thyroid disease or poorly controlled diabetes.
- A BMI below 18.5 or above 30.
- Smoking, chewing tobacco or heavy caffeine intake by either partner.
- An earlier loss after 10 weeks, or an earlier stillbirth.
Recurrent Miscarriage Testing: Scans and Blood Tests for Recurrent Pregnancy Loss
The evaluation takes one or two visits and a few blood tests, and is ideally finished before the next pregnancy. APLA tests are repeated 12 weeks apart to confirm a positive result.
- Detailed history - the week of each loss and what each scan showed.
- Antiphospholipid antibodies - lupus anticoagulant, anticardiolipin and beta-2 glycoprotein I.
- Thyroid - TSH together with thyroid antibodies.
- Blood sugar - fasting sugar or HbA1c.
- The uterine cavity - a 3D ultrasound, with hysteroscopy if a septum or adhesions are suspected.
- Chromosomes - karyotype of both partners where indicated, or chromosomal analysis of tissue from a recent loss.
- Earlier records - your previous scans and pathology reports.
If you have another loss, ask whether the pregnancy tissue can be sent for chromosomal testing - it can explain what happened.
Tests I Do Not Order Routinely, and Why
I do not routinely recommend NK cell testing, HLA typing, extensive thrombophilia panels or multiple infection screens such as TORCH. Their results do not reliably change treatment or the outcome. If your history gives a specific reason for one of these tests, we discuss it openly.
- A slightly raised homocysteine, or a single borderline antibody result, is common and usually means little on its own.
- A borderline APLA result is repeated before any long-term treatment begins, because daily heparin injections for nine months are a real commitment.
Recurrent Pregnancy Loss Treatment for the Cause We Find
- APLA - low-dose aspirin together with daily heparin injections from the positive pregnancy test has been shown to substantially improve the chance of a live birth. My APLA and lupus page explains this in more detail.
- Uterine septum - divided by hysteroscopy as a day-care procedure.
- Thyroid and diabetes - thyroid levels are brought into range before conception, and diabetes is brought under control.
- Balanced translocation - genetic counselling explains the realistic chance of a healthy pregnancy, which is often better than couples expect, and the testing options.
- Mid-trimester loss caused by a weak cervix - a cervical stitch (cerclage) at 12–14 weeks in the next pregnancy, or serial cervical length scans. See my preterm birth prevention page.
| What was found | Treatment | When it starts |
|---|---|---|
| Confirmed APLA | Low-dose aspirin plus daily heparin | Aspirin before conception; heparin from the positive test |
| Uterine septum | Hysteroscopic resection | Before trying again; usually one to two cycles allowed for healing |
| Hypothyroidism or raised TSH | Thyroxine to bring TSH into range | Before conception; dose increased once pregnant |
| Diabetes | Diet, metformin or insulin to reach the HbA1c target | Before conception |
| Balanced translocation | Genetic counselling, prenatal testing, or PGT with IVF | Before the next pregnancy |
| Earlier mid-trimester loss with a weak cervix | Cerclage, or cervical length surveillance | From 12–14 weeks |
Repeated Miscarriage Treatment When Every Test Is Normal
Unexplained recurrent loss is the most common result of a full evaluation, and it is not a dead end. Many couples go on to a successful pregnancy without any specific medicine. Studies have linked early, supportive care with easy access to scans to better outcomes.
- Vaginal progesterone, started at the first sign of pregnancy, may be offered to women who have miscarried before and now have bleeding in early pregnancy. This is based on trial evidence.
- Not supported by current evidence for unexplained loss: steroids, IVIG, and routine heparin in women who do not have APLA.
How I Look After You in the Next Pregnancy
- Call as soon as your test is positive, so that any treatment can start on time.
- First reassurance scan at about 6–7 weeks, when the heartbeat can usually be seen.
- Further scans every one to two weeks during the first trimester, if they help you.
- Before conceiving: take folic acid 400 micrograms a day (or 5 mg if I advise it) and reach a healthy weight. Stop tobacco in every form, and keep caffeine to about two cups of tea or coffee a day.
- Once you pass the week of your earlier losses, the routine schedule continues. If you have APLA or another condition, I pay extra attention to the baby's growth and your blood pressure.
Grief, Anxiety and Your Long-Term Health
The grief after a miscarriage is real at any week of pregnancy, even though people around you may not acknowledge it. Some couples take time before trying again, even when there is no medical reason to wait. Anxiety and low mood are common in both partners after repeated losses.
The support I put in place is practical: knowing exactly whom to call, scans booked ahead, time to talk openly, and referral for counselling when it would help.
APLA also raises the risk of blood clots outside pregnancy. Women with confirmed APLA need long-term follow-up and contraception that does not contain oestrogen.
My Five-Step Approach to Recurrent Loss
- Listening and historyeach earlier loss is gone through in detail: the week, the scan findings and the reports.
- Focused testsAPLA, thyroid, sugar, imaging of the uterus and chromosomal tests as indicated, without unnecessary panels.
- Results and a planthe findings explained to both of you, and a written plan for the next pregnancy agreed.
- Treatment before conceptionhysteroscopy, thyroid or sugar correction, or genetic counselling completed first where needed.
- Support in early pregnancymedicines started at the positive test and early reassurance scans booked in advance.
Bad Obstetric History: When to Book an Appointment
In India, doctors often write "bad obstetric history" (BOH) on the reports of a woman with earlier losses. Please book a visit if you have any of these:
- Two or more losses, including biochemical pregnancies.
- A loss after 10 weeks when the baby looked normal on scan.
- An earlier stillbirth or a very early preterm birth.
- Known APLA, lupus or a history of blood clots.
- A previous scan suggesting a septum or an abnormal uterine cavity.
- You are pregnant again after recurrent loss and would like early monitoring.
Bleeding, Pain or Fever: When to Come In the Same Day
- Heavy bleeding that soaks a pad in an hour, or large clots.
- Severe pain low on one side of the abdomen, or shoulder-tip pain in early pregnancy.
- Fainting, dizziness or a racing heartbeat.
- Fever or a foul-smelling discharge after a miscarriage.
- Pain or swelling in a leg, or breathlessness, particularly if you have APLA.
Labour and emergency care at Divine Women's Hospital is open 24×7. Call +91 90545 74829 and come in directly.
Miscarriage Myths and What the Evidence Says
| Myth | What the evidence says |
|---|---|
| "Stress, lifting or travel caused my miscarriage." | Everyday activity, work, intercourse and ordinary stress do not cause miscarriage. Most losses are due to chromosomal errors. |
| "After three losses, a successful pregnancy is unlikely." | Even after several unexplained losses, most couples eventually have a successful pregnancy. |
| "The more tests, the better the answers." | Popular tests such as NK cells and TORCH do not change treatment. A focused evaluation is more useful. |
| "Heparin helps every woman with recurrent miscarriage." | It clearly helps women with APLA, but it has not been shown to help unexplained loss. |
Questions Patients Ask Me About Recurrent Miscarriage
After how many miscarriages should we get tested?
Evaluation is reasonable after two losses, and sooner if a loss happened after 10 weeks or you are over 35. Older guidance used to wait for three.
Do both partners need to be tested?
Yes, for some tests - especially chromosomal tests when they are indicated. We also talk about lifestyle factors such as smoking in the male partner.
How soon can we try again?
Most couples do not need to wait longer than one normal cycle, but the key tests and any treatment should be finished before the next conception.
What is APLA, and how does it cause miscarriage?
APLA is an autoimmune condition in which antibodies make the blood more likely to clot and affect the placenta. It is confirmed by two positive tests 12 weeks apart and treated with aspirin and heparin.
Can progesterone prevent a miscarriage?
Vaginal progesterone may help women who have miscarried before and now have bleeding in a new pregnancy. It has not been shown to help every woman with recurrent loss.
Do I need a TORCH test after a miscarriage?
Not routinely. It does not explain recurrent miscarriage and is done only when there is a specific reason.
Can a septum in the uterus cause repeated miscarriages?
Yes. A septum is linked to miscarriage. It is identified on 3D ultrasound or hysteroscopy and, in selected women, can be divided as a day-care procedure.
What if all my reports are normal?
That is the most common result. It means no treatable cause was found, and with supportive care the chance of a successful next pregnancy remains good.
Should the tissue from the miscarriage be tested?
It is worth considering after a second or later loss. It can explain that particular loss and guide which further tests are needed.
Can my husband's health affect miscarriage?
Yes. A balanced translocation in the male partner is a recognised cause, and smoking, heavy alcohol use and older age in the father are linked to damage in sperm DNA. Sperm DNA fragmentation testing is not routinely recommended, and lifestyle advice applies to both partners.