Recurrent Pregnancy Loss: Causes, Testing, and When to Seek Help
If you've experienced more than one pregnancy loss, please know this first: what you're feeling is valid, you are not alone, and in the large majority of cases, a loss is not something you caused or could have prevented. Recurrent pregnancy loss is one of the most painful experiences a person or couple can go through, and it can feel isolating in a way that's hard to put into words. It's also a recognized medical condition — one that can often be evaluated, sometimes explained, and in many cases followed by a successful pregnancy. This article walks through what recurrent pregnancy loss means, what can cause it, what an evaluation involves, and when it makes sense to see a specialist.
What Is Recurrent Pregnancy Loss?
Recurrent pregnancy loss (RPL), sometimes called recurrent miscarriage, is generally defined as the loss of two or more pregnancies. In its updated 2026 guidance — the first major update in over a decade — the American Society for Reproductive Medicine (ASRM) describes RPL as two or more spontaneous pregnancy losses before 22 weeks, not counting confirmed ectopic (tubal) or molar pregnancies.
A few important points come out of that updated definition:
-
You don't have to wait for a third loss. Older guidance often referenced three losses; current guidance recognizes that evaluation is reasonable after two.
-
The losses don't have to be consecutive. Two losses count even if a healthy pregnancy occurred in between.
-
Very early losses count too. This includes early losses confirmed by a blood or urine pregnancy test, even before anything is visible on an ultrasound.
If any of this describes your experience, you may be a candidate for evaluation — and you don't have to navigate that decision alone.
First, Some Reassurance
Miscarriage is far more common than most people realize, in part because it's so rarely talked about. Roughly one in eight recognized pregnancies ends in loss, and the true number is higher when you count very early losses. Recurrent loss — two or more — affects a smaller group, but that group is still large, and you are in good company even when it feels otherwise.
Two things are worth holding onto:
First, most individual miscarriages happen because of a random chromosomal error in that particular embryo — something that occurs by chance at conception and isn't caused by stress, exercise, work, past choices, or anything you did or didn't do. This becomes more common as we age, which is one reason age influences miscarriage risk.
Second, and just as important: even after recurrent losses, the majority of patients go on to have a successful pregnancy — especially with appropriate evaluation and support. A history of loss is painful, but it is not a verdict.
What Causes Recurrent Pregnancy Loss?
RPL can have several causes, and sometimes more than one factor is involved. The main categories include:
Chromosomal and genetic factors. The single most common reason for any given miscarriage is a chromosomal abnormality in the embryo. In a smaller number of couples, one partner carries a "balanced" chromosomal rearrangement — they're healthy themselves, but it can raise the chance of an embryo receiving the wrong amount of genetic material.
Uterine (anatomic) factors. The shape or condition of the uterus can play a role. Examples include a uterine septum (a band of tissue dividing the cavity), scar tissue (adhesions), fibroids, or polyps. Many of these are treatable.
Hormonal and metabolic factors. Conditions such as thyroid dysfunction and poorly controlled diabetes can contribute to loss, as can certain other hormonal imbalances. These are typically checked with simple blood work.
Antiphospholipid syndrome (APS). This is an autoimmune condition that affects blood clotting and is one of the few well-established, treatable immune-related causes of recurrent loss. It's identified through specific blood tests.
Lifestyle and health factors. Smoking, heavy alcohol or caffeine use, and obesity can each contribute, which is why preconception health is part of the picture.
Unexplained loss. Even after a thorough evaluation, roughly half of couples won't find a clear-cut cause. This is understandably frustrating — but "unexplained" is not the same as "hopeless." Many people with unexplained RPL still go on to have healthy pregnancies.
When Should You See a Fertility Specialist?
Consider reaching out to a reproductive specialist (a reproductive endocrinologist) if:
-
You've had two or more pregnancy losses, consecutive or not
-
You've had a single loss and you're older, or you already know you have a risk factor such as a thyroid condition, an autoimmune disorder, or a known uterine issue
-
You're feeling anxious about trying again and want answers and a plan
You do not need a referral to feel entitled to answers, and you don't have to wait until a certain number of losses to ask for help. Seeking evaluation is a reasonable, proactive step — not an overreaction.
What Does an Evaluation Involve?
A recurrent pregnancy loss workup is designed to look for the treatable causes above. It's usually a combination of the following, and it typically evaluates both partners:
Chromosome testing of pregnancy tissue. Current guidance places new emphasis on genetically testing the tissue from a miscarriage, when possible, using modern array-based methods. Learning whether a loss was due to a chromosomal abnormality can meaningfully shape what testing and treatment come next.
Parental chromosome testing. A blood test for each partner can check for the balanced rearrangements mentioned earlier.
Evaluation of the uterus. Imaging of the uterine cavity — such as a saline infusion sonogram, a hysterosalpingogram (HSG), or a hysteroscopy — can identify septa, polyps, fibroids, or scar tissue.
Blood work. This commonly includes thyroid and other hormone levels, blood sugar, and testing for antiphospholipid syndrome.
Your physician will tailor the workup to your history rather than running every test on everyone. The goal is to find what's findable and treatable — not to test for testing's sake.
How Is Recurrent Pregnancy Loss Treated?
Treatment is directed at whatever cause is identified, which is exactly why the evaluation matters. Depending on the findings, that might mean:
-
Correcting a uterine issue — for example, a minor surgical procedure to remove a septum, polyp, fibroid, or scar tissue
-
Treating a hormonal condition — such as managing a thyroid disorder or optimizing blood sugar before and during pregnancy
-
Managing antiphospholipid syndrome — typically with medications that support healthy blood flow in pregnancy, under close supervision
-
Considering IVF with genetic testing — for couples with a chromosomal rearrangement, in vitro fertilization with preimplantation genetic testing is one option that can help select embryos with the expected amount of genetic material
-
Supportive care and preconception optimization — for unexplained loss, close monitoring, early support in the next pregnancy, and attention to overall health can make a meaningful difference
Current guidance also strongly emphasizes something that isn't a lab test at all: emotional and psychological support for anyone going through recurrent loss, as a core part of care rather than an afterthought.
The Part No One Should Have to Carry Alone
Recurrent loss is not only a medical experience — it's a grief experience. It's normal to feel sadness, anger, anxiety about trying again, or a sense of distance from friends and family who may not know what to say. None of that means you're handling it "wrong." Support can come from a partner, a counselor or therapist who works with pregnancy loss, a support group, or your care team. If the weight of it starts to feel like too much to carry day to day, please reach out to a professional who can help — you deserve support, not just a diagnosis.
There Is Reason for Hope
It can be hard to believe after loss, but the outlook is often more hopeful than it feels in the moment. Many causes of recurrent loss are identifiable and treatable, and even when no cause is found, a large share of patients go on to carry a healthy pregnancy. An evaluation won't erase what you've been through — but it can replace some of the uncertainty with a plan, and that plan is often the first step toward better news.
Recurrent Pregnancy Loss Care at Indiana Fertility Institute
If you've experienced recurrent pregnancy loss, the team at Indiana Fertility Institute is here to help you find answers and a path forward — with thorough, evidence-based evaluation and genuine compassion at every step.
When you're ready, request a consultation. There's no pressure and no wrong time to simply ask questions.