Recurrent Pregnancy Loss: Causes, Workup, and the Chances of a Healthy Pregnancy Next
Recurrent pregnancy loss is two or more losses — and it deserves a specific workup. Covers causes, tests, treatments, and what the odds look like next.
Losing a pregnancy is devastating. Losing more than one can feel unbearable. If you're here, you deserve answers — and you deserve to be heard first. This page covers what recurrent pregnancy loss actually means, what the standard workup checks, and what the odds look like for a healthy pregnancy after multiple losses.
What is recurrent pregnancy loss?
Recurrent pregnancy loss is defined as two or more pregnancy losses. After two losses, a specific workup is recommended — because at that point, there may be a findable, treatable cause. This is different from a general fertility evaluation; it's a focused search for why pregnancies are being lost rather than why they aren't starting.
What causes recurrent miscarriage?
About 50% of the time, a cause is identified: chromosomal issues, uterine anatomy, blood clotting disorders like antiphospholipid syndrome, thyroid problems, or sperm DNA fragmentation. The other 50% remains unexplained — which is its own kind of hard. An identified cause is often something that can be addressed; an unexplained diagnosis doesn't mean nothing can be done, but it does mean the grief of not having an answer sits alongside the grief of the losses themselves.
How many miscarriages before getting a formal workup?
Two. After two losses, the standard of care is to offer a recurrent pregnancy loss workup rather than continue with routine prenatal care. Some people are told to wait for a third loss before testing — that's not consistent with current guidance, and it's reasonable to ask for the evaluation after two.
What tests are done to diagnose the cause of recurrent pregnancy loss?
The standard RPL workup checks things a routine fertility evaluation doesn't — parental karyotypes, antiphospholipid antibodies, uterine cavity evaluation, and thyroid. Not all OBs run the full panel, so it's worth confirming which tests have actually been done before concluding a workup is complete. Sperm DNA fragmentation is also undertested in RPL: a standard semen analysis can look normal while high DNA damage in sperm contributes to repeated early losses. It's worth asking about, especially if the rest of the workup comes back unremarkable.
Does genetic testing of embryos help prevent recurrent miscarriage?
For people with recurrent losses, PGT-A through IVF is one tool used to select chromosomally normal embryos before transfer. It isn't appropriate for every situation, and it doesn't address non-chromosomal causes like uterine anatomy, antiphospholipid syndrome, or thyroid disease — which is why the full workup comes first. Whether PGT-A fits your picture depends on what the workup reveals and what your fertility team recommends. <!-- H2 "What is antiphospholipid syndrome and how does it cause miscarriage?" has no source card detail on APS mechanism — skipped pending source deck expansion -->
Can recurrent pregnancy loss be treated?
When a cause is found, treatment is often effective — blood thinners for antiphospholipid syndrome, surgery for a uterine septum, thyroid medication, PGT-A to select chromosomally normal embryos. Different causes call for different treatments, and sometimes more than one factor is contributing, so the plan is shaped by what the workup actually finds. Alongside the medical side, the grief of recurrent loss is cumulative — each loss carries the weight of every one before it, and a reproductive mental health counselor who works specifically with RPL can help in a way that general grief support usually can't.