Recurrent Pregnancy Loss: Causes, Tests, Treatment & Chances of a Healthy Baby

Quick Answer Recurrent Pregnancy Loss means losing two or more pregnancies. The most common reason for any single miscarriage is a chromosome error in the embryo, which is usually down to chance and becomes more likely as a woman gets older. A proper check-up looks for the things that can be treated: problems with the womb, antiphospholipid syndrome, thyroid disease, diabetes and, in some couples, a chromosome change in one partner. And even when nothing is found, roughly 50 to 80 percent of couples still have a successful next pregnancy without any special treatment.

Medical review: Have this article medically reviewed and approved by Dr. Chitra Shankar MD (OG), MRCOG, DRM (Germany), FMAS, before publication.

If you’ve had two or more miscarriages, you’ve probably heard all the advice by now. Rest more. Don’t stress. Try again soon. Maybe someone even hinted that you did something to cause it.

You didn’t. Recurrent pregnancy loss is rarely anyone’s fault, and most couples who go through it do go on to have a healthy baby. That’s the part people forget to say out loud.

This guide covers what RPL actually means, why it happens, which tests are worth doing, and which treatments have real evidence behind them (and which don’t). It leans mainly on the 2026 update from the American Society for Reproductive Medicine (ASRM). That update changed a few things that many websites and clinics haven’t caught up with yet.

What is recurrent pregnancy loss?

Recurrent pregnancy loss, also called recurrent miscarriage or repeated pregnancy loss, means losing two or more pregnancies before 22 weeks. In India you may also hear the phrase “habitual abortion”. It sounds frightening, but it’s just the older medical term for repeated miscarriage. It has nothing to do with a deliberate abortion.

The definition has shifted in the last few years, and this matters if anyone has told you to “come back after the third one”.

•     Two is enough. The 2026 ASRM opinion defines RPL as two or more losses, in line with ESHRE. Older guidance, and plenty of websites, still say three. Waiting for a third loss only delays answers.
•     Chemical pregnancies count. If a pregnancy was only ever confirmed by a positive urine or blood hCG test, it still counts. The chance of it happening again looks much like a loss seen on a scan.
•     They don’t have to be back-to-back. Consecutive losses may have a slightly poorer outlook, but your doctor can still look into losses that weren’t consecutive.

Ectopic and molar pregnancies are left out. A loss after 22 weeks is called a stillbirth and is assessed differently.

How common are miscarriage and recurrent pregnancy loss?

Miscarriage is far more common than most people realise. Depending on age, the risk with each pregnancy runs from about 15 percent to 50 percent or more. It climbs steeply as a woman gets older, because eggs are more likely to carry chromosome errors with time.

Recurrent pregnancy loss is much rarer. It affects roughly 1 to 2 in every 100 couples trying to conceive. So two miscarriages in a row is often just bad luck, not a sign of some hidden disease. A check-up is still worth doing, though, because it picks out the smaller group of couples who do have something fixable.

What causes recurrent pregnancy loss?

There’s rarely one neat answer. RPL usually has several possible contributors, and in many couples nothing specific turns up. Here’s what doctors look for.

Cause	What it means
Chromosome errors in the embryo	The most common cause of miscarriage overall, behind roughly 50 to 60 percent of first-trimester losses. Mostly random, and more likely with age. When miscarriage tissue was tested, about half of the losses in women under 35 and about three quarters in women over 40 were chromosomally abnormal.
A chromosome change in one partner	A small number of couples carry a “balanced translocation”. It doesn’t affect their own health, but it can lead to embryos with unbalanced chromosomes.
The womb	A uterine septum or other differences in shape, polyps, fibroids that bulge into the cavity, or scar tissue inside the womb (intrauterine adhesions, also called Asherman syndrome).
Antiphospholipid syndrome (APS)	An autoimmune condition that makes the blood more likely to clot and can affect the placenta. It’s treatable.
Hormone and metabolic problems	Overt hypothyroidism, poorly controlled diabetes and, in some women, PCOS, obesity and insulin resistance.
Chronic endometritis	Low-grade inflammation of the womb lining. It’s linked to RPL, but recent evidence on whether treating it helps is mixed.
The male partner	Older paternal age and high sperm DNA fragmentation have both been linked to miscarriage.
A weak cervix	A cause of repeated losses in the second trimester, usually when the cervix opens painlessly. It’s assessed separately from early losses.
Lifestyle	Smoking and tobacco, heavy drinking and high caffeine intake are linked to a higher risk.
No cause found	Very common, even after thorough testing. It doesn’t mean your outlook is poor.

 

And a word on what doesn’t cause RPL: everyday stress, an argument, exercise, a fall, a fright, lifting a bucket, travel or sex. If a relative has suggested otherwise, you can let that go. None of it is backed by evidence.

Testing the miscarriage tissue: the step many people miss

This is one of the biggest changes in the 2026 guidance. ASRM now recommends that every woman who has a second miscarriage, or who has a history of recurrent miscarriage, should be offered genetic testing of the miscarriage tissue whenever that’s possible.

The reasoning is simple. If the tissue shows a chromosome error in the embryo, that very often explains the loss. You may be spared an expensive, stressful round of other tests, your doctor can counsel you better, and many people feel a real weight lift when they learn it wasn’t something they did.

A few practical points:

•     The test. Microarray or sequencing-based tests are preferred over the older karyotype, because they don’t need living cells to grow, they come back faster and they fail less often. Contamination with the mother’s own cells can give a falsely “normal female” result, so careful sample handling matters.
•     Collecting the tissue. It works best when collected during a procedure, but at-home collection kits exist for women who miscarry naturally or with tablets. Ask your doctor before the tissue is thrown away, and ask how to store it.
•     Reading the result. A chromosomally abnormal embryo points to a random event. If the tissue is chromosomally normal, other causes become more likely and the work-up goes on.

Availability and cost vary across India, so ask which laboratory is used and whether tissue already sent for routine pathology can still be tested. You can read more about genetic testing and counselling.

Uterine causes and the scans used to find them

Every woman with RPL should have the shape and lining of her womb checked. Differences in the shape of the womb turn up more often in women with RPL: about 13 percent, compared with roughly 5.5 percent in other women.

The tests include a 3D ultrasound, a saline sonogram, a hysterosalpingogram (HSG) or a hysteroscopy, where a thin camera looks inside the womb. MRI is kept for more complicated cases.

If a uterine septum (a band of tissue dividing the cavity) is found, it can be removed through a hysteroscope. ASRM suggests offering this to women with a septum and RPL, as a shared decision, because trials haven’t clearly proven a higher live birth rate. Polyps, fibroids that press into the cavity and mild to moderate scarring can be treated the same way, although good-quality trials are still missing. Fibroids that sit outside the cavity usually don’t need to be removed. Related reading: hysteroscopy and other diagnostic procedures.

Medical causes: Antiphospholipid Syndrome, Thyroid, Diabetes and PCOS

Antiphospholipid syndrome (APS)

APS is the most important treatable immune cause of RPL. To diagnose it, you need certain clinical features, such as a past blood clot, a loss after 10 weeks, a premature delivery caused by severe pre-eclampsia, or three or more unexplained early losses. You also need persistent antibodies on two tests at least 12 weeks apart: lupus anticoagulant, anticardiolipin and anti-beta-2-glycoprotein I. One positive result isn’t enough, because these tests throw up false positives. For women with confirmed obstetric APS, low-dose aspirin before pregnancy and heparin once the pregnancy is confirmed can improve the chance of a live birth.

Thyroid

A TSH blood test is recommended for selected women, especially when the miscarriage was chromosomally normal or the tissue wasn’t tested. Overt hypothyroidism should be treated with levothyroxine before pregnancy, and treatment is also advised when TSH is above 4 mIU/L or above the lab’s upper limit. Checking thyroid antibodies on their own isn’t recommended, because treating women with normal thyroid function but positive antibodies hasn’t been shown to help.

Diabetes, PCOS and weight

Uncontrolled diabetes raises the risk of miscarriage, so an HbA1c test is advised if you have risk factors such as obesity, PCOS, a family history of diabetes, age over 40 or gestational diabetes in a past pregnancy. If you have PCOS with signs of insulin resistance, metformin is reasonable to consider, though direct evidence in RPL is limited. Prolactin only needs testing if you have symptoms such as milk discharge or irregular ovulation.

The male partner: Age, Health and Sperm DNA Fragmentation

RPL gets talked about as a woman’s problem, but the man matters too. Older fathers and men with poorer metabolic health have partners with more miscarriages, and so do men with high sperm DNA fragmentation (SDF). A normal semen analysis doesn’t predict this, so SDF testing can be considered when RPL stays unexplained, or when the couple has trouble conceiving too.

We don’t yet have firm proof that treating high SDF lowers the chance of another loss. Even so, it makes sense for the man to see a urologist or andrologist to look for things like a varicocele, and to stop smoking and avoid heat and toxins where he can. More on the semen analysis and DNA fragmentation test and male infertility.

The recurrent pregnancy loss work-up: which tests to expect

A sensible work-up goes step by step, so you aren’t sent for every test at once. Roughly, it looks like this:

1.     A detailed conversation and examination. How many losses, at what stage, whether a heartbeat was seen, past surgeries or infections, your periods, medicines, medical conditions and family history.
2.     Chromosome testing of the miscarriage tissue after the second loss, if it can be done.
3.     A check of the womb in every woman, by 3D ultrasound, saline sonogram, HSG or hysteroscopy.
4.     A few targeted blood tests, chosen by your history: antiphospholipid antibodies if you meet the criteria, TSH, and HbA1c if you have diabetes risk factors. Prolactin only if you have symptoms.
5.     Parental chromosome tests (karyotypes) if the tissue showed an unbalanced rearrangement, or if the tissue was never tested.
6.     Extra tests in selected cases, such as an endometrial biopsy for chronic endometritis, or sperm DNA fragmentation testing if things are still unexplained.
7.     A look at lifestyle and general health: smoking, alcohol, caffeine, weight and any long-term conditions.

When to see a doctor

See a specialist after your second miscarriage. Don’t wait if you’re over 35, if you lost a pregnancy after a heartbeat was seen, or if you had a loss in the second trimester. And in any pregnancy, get urgent help for heavy bleeding, severe one-sided pain, fainting or fever.

Tests you may not need

Many labs and clinics in India offer long “RPL panels”. The 2026 ASRM opinion advises against several of the tests in them. If you’ve been offered one, a fair question to ask is: “What would we do differently depending on the result?”

Test	What the guidance says
Inherited thrombophilia panel (Factor V Leiden, prothrombin gene, MTHFR, protein C, protein S, antithrombin III, homocysteine)	Not recommended. Women with RPL don’t have these conditions more often than other women, and treating them hasn’t improved live births.
NK cell tests and other routine immune tests	Not recommended. The tests aren’t standardised and there are no proven treatments for the results.
Thyroid antibodies on their own (anti-TPO)	Not recommended. Treating women with normal thyroid function and positive antibodies hasn’t helped.
Endometrial receptivity testing	Not recommended in RPL.
Vaginal or uterine microbiome testing (including mycoplasma and ureaplasma)	Not recommended.
Routine ovarian reserve testing (AMH)	Not routinely recommended. The link with RPL is unclear and no treatment follows from the result.
Prolactin without symptoms	Not recommended unless you have symptoms like milk discharge or irregular ovulation.

Guidelines change, and your doctor may have good reasons to order a test based on your own history. The aim is to ask questions, not to refuse care.

RPL treatment: what works, what might help and what doesn’t

Category	Examples
Recommended	Getting health conditions under control before pregnancy (lupus, high blood pressure); low-dose aspirin plus heparin for confirmed antiphospholipid syndrome; treating overt thyroid disease; controlling diabetes; treating high prolactin when there are symptoms; genetic counselling when a genetic cause is known; psychological support.
Might help, but evidence is limited or mixed	Removing a uterine septum, polyps, cavity-distorting fibroids or adhesions; progesterone in early pregnancy if there’s bleeding (or in selected women); treating chronic endometritis; seeing a urologist if sperm DNA fragmentation is high; metformin for women with PCOS and insulin resistance; IVF with PGT-A or PGT-SR in selected couples; donor eggs or sperm in specific situations.
No proven benefit	Aspirin or blood thinners without confirmed APS; treating inherited thrombophilia; treating endometriosis or adenomyosis only because of RPL; thyroid hormone for isolated antibodies or a TSH below 4; IVIG, intralipids and steroids such as prednisone.

 The same guidance adds that lymphocyte immunisation, G-CSF and endometrial scratching haven’t been shown to help in RPL either. If a clinic recommends an expensive treatment from that last row, ask to see the published evidence that it works for recurrent pregnancy loss.

Progesterone, aspirin, heparin and “immune injections”

These are the medicines couples ask about most, so here’s the honest picture.

Progesterone

It’s one of the most commonly prescribed medicines in early pregnancy in India. A large trial called PROMISE found that starting vaginal progesterone after a positive test didn’t significantly raise the live birth rate in unexplained RPL. ASRM says it may be considered, through shared decision-making, if you have early bleeding or unexplained recurrent miscarriage, and it’s generally low-risk. What has no evidence behind it is checking progesterone levels in a natural pregnancy and topping up according to the number.

Aspirin and heparin

They help when you have confirmed antiphospholipid syndrome. For unexplained RPL or inherited thrombophilia, good trials (including the ALIFE study) found no benefit, so ASRM doesn’t recommend them. They also carry a bleeding risk, and heparin means daily injections.

IVIG, intralipids and steroids

No proven benefit in RPL, and some potential for harm. Not recommended.

Folic acid

Every woman planning a pregnancy should take it, whatever her miscarriage history.

Please don’t start or stop any of these on your own. Ask your doctor why each one is being prescribed for you.

IVF, PGT-A and PGT-SR: Do they help in recurrent pregnancy loss?

Since chromosome errors in the embryo are the leading cause of miscarriage, it seems logical that screening embryos before transfer (preimplantation genetic testing for aneuploidy, or PGT-A) would solve the problem. In practice the evidence is less convincing.

For couples with RPL, PGT-A hasn’t been shown to reduce miscarriage or increase live births compared with simply trying naturally, and it adds cost and time. ASRM says it’s reasonable to discuss PGT-A for women over 40 who’ve had a proven chromosomally abnormal miscarriage, as a shared decision.

PGT-SR is different. If one partner carries a balanced translocation, IVF with PGT-SR can be offered so that unbalanced embryos aren’t transferred. Keep in mind that many carriers conceive naturally (live birth rates of around 70 percent have been reported in some studies), and a carrier may end up with fewer usable embryos in an IVF cycle.

Donor eggs or sperm, or a gestational carrier, come into the picture only in specific situations: repeated genetic causes, very low ovarian reserve or serious damage to the womb. IVF on its own isn’t a standard treatment for RPL. More on preimplantation genetic testing and IVF.

Unexplained recurrent pregnancy loss: your chances of a healthy baby

When all the tests come back normal, doctors call it unexplained RPL. It’s frustrating, because you want an answer. But it’s also, oddly, reassuring. Studies show that about 50 to 80 percent of couples with unexplained RPL have a successful pregnancy the next time, without any specific treatment. Your own odds depend mostly on your age, how many losses you’ve had and whether a cause was found.

What can help in the next pregnancy?

•     Early, regular care. An early scan, frequent check-ups and a team that listens. In one study of couples with three or more unexplained losses, a “tender loving care” programme of frequent visits and emotional support had a far higher live birth rate (about 85 percent) than routine care (about 36 percent). The study wasn’t randomised, so we can’t say how much of that gap was the care itself. Still, it shows how much monitoring and reassurance can matter.
•     Good health before you conceive. Well-controlled diabetes and thyroid levels, a healthy weight, folic acid and a review of your medicines.
•     Realistic expectations. Another miscarriage can still happen, and it wouldn’t mean you did anything wrong.
  

Lifestyle, diet and common myths

Lifestyle changes can’t cure RPL, but a few are worth making, especially before you conceive.

•     Stop tobacco in every form and avoid second-hand smoke. Of all the lifestyle advice, this is the one the guidance backs most strongly.
•     Cut down on alcohol. More than about three drinks a week has been linked to a higher risk of miscarriage, and many couples choose to avoid it altogether while trying.
•     Keep caffeine modest. Intake above about 100 mg a day, roughly one cup of coffee, has been linked to a higher risk, although the evidence is mixed.
•     Aim for a healthy weight. Obesity is an independent risk factor for miscarriage.
•     Light or moderate exercise is fine. It isn’t linked to miscarriage.
•     Eat a balanced diet and take folic acid. Ask your doctor whether testing for deficiencies like vitamin D or B12 makes sense for you. It isn’t part of the standard RPL work-up.

Myths worth letting go of

•     “Papaya or pineapple caused it.” There’s no good evidence that normal amounts of food cause miscarriage.
•     “I should have stayed in bed.” Bed rest doesn’t prevent miscarriage.
•     “It was stress, the trip, the fall or the evil eye.” Miscarriage is overwhelmingly caused by a problem in the embryo, not by anything the mother did.

Emotional health, stigma and family pressure

Repeated miscarriage takes a heavy emotional toll. Women with RPL are about five times more likely to become depressed, and anxiety, guilt and trauma symptoms are common. Partners hurt too, even though they’re often expected to stay strong and say nothing. In India there can be extra layers: silence, blame from relatives, or pressure to “try again quickly”.

A few things that may help:

•     Talk openly with your partner. You may grieve in different ways, and that’s okay.
•     Pick one or two people you trust, and ask everyone else to skip the advice that blames you.
•     Think about counselling or a support group, especially if you’ve felt low for weeks, can’t sleep or find everyday life hard.
•     Give yourself time before the next attempt if you need it.

If you ever have thoughts of harming yourself, please reach out to a doctor, someone you trust or a local emergency or helpline service straight away.

Cost of recurrent pregnancy loss evaluation in India

Costs differ a lot between cities and hospitals, so one number would only mislead you. It helps to know what usually adds up:

If you’ve been through recurrent pregnancy loss (RPL), you already know how emotionally draining it is. The last thing you need is confusion about what the tests will cost. In India, a diagnostic panel for RPL generally falls somewhere between ₹4,700 and ₹34,500. That’s a wide range, and the final bill depends on a few things: which lab or hospital you choose, how many tests are included, and whether you opt for a basic screening or a comprehensive workup covering genetic and autoimmune factors.

A good tip: ask the center for an itemized list before you book. Some panels bundle tests you may have already done, and your doctor can help you decide what’s actually needed for your situation.

Questions worth taking to your appointment

•     Can the tissue from my miscarriage be tested, and which method will you use?
•     Which tests do I really need based on my history, and which are optional?
•     Will this test or medicine change my treatment, and what’s the evidence for it?
•     Do I meet the criteria for antiphospholipid syndrome?
•     Should my partner be assessed too, and for what?
•     What should we do the moment I get a positive pregnancy test?
•     What emotional support is available?

Frequently asked questions

How many miscarriages count as recurrent pregnancy loss?

The latest ASRM guidance (2026) says two or more. Some older guidelines and many websites still say three. If you’ve had two, it’s reasonable to ask for an evaluation.

Does a chemical pregnancy count as a miscarriage for RPL?

Yes. The 2026 ASRM definition includes pregnancies confirmed only by a positive hCG test, because the chance of it happening again is similar.

What is the most common cause of recurrent miscarriage?

A chromosome error in the embryo is the most common cause of miscarriage overall, particularly as a woman gets older. Other causes include problems with the womb, antiphospholipid syndrome, thyroid disease, diabetes and chromosome changes in a parent. Many cases stay unexplained.

Can I still have a healthy baby after recurrent miscarriages?

Yes, most couples do. Even with unexplained RPL, an estimated 50 to 80 percent have a successful next pregnancy without specific treatment. Your own chances depend on your age and on any cause that’s found.

Which tests are needed for recurrent pregnancy loss?

Chromosome testing of the miscarriage tissue, a scan of the womb, and a few targeted blood tests such as antiphospholipid antibodies, TSH and HbA1c, depending on your history. Parental karyotypes and sperm DNA fragmentation testing are used in selected cases.

Do I need heparin injections for recurrent miscarriage?

Only if you have confirmed antiphospholipid syndrome, or in certain other medical situations such as a past blood clot. For unexplained RPL or inherited thrombophilia, trials haven’t shown a benefit.

Does progesterone prevent miscarriage?

The evidence for routine use in unexplained RPL is limited. It may be considered after a conversation with your doctor, especially if you have bleeding in early pregnancy, and it’s generally low-risk.

Does recurrent miscarriage mean I can’t get pregnant?

No. RPL isn’t the same as infertility. Many women with RPL conceive easily but have trouble holding on to the pregnancy.

What causes miscarriage in the second trimester?

The causes are different from early losses. They include a weak cervix, differences in the shape of the womb, antiphospholipid syndrome and infection. A second-trimester loss needs a specialist’s evaluation.

Do stress or physical work cause recurrent pregnancy loss?

Ordinary stress and normal daily activity don’t cause miscarriage. Severe, long-lasting distress deserves attention for your own wellbeing, but it shouldn’t be blamed for the loss.