Clinician-authored health information
This article supports informed conversations with your clinician. It does not replace an examination, diagnosis or emergency care.
By Dr. Berkheez Shabir, Consultant Gynaecologist, Obstetrician & Infertility Specialist
I see a particular kind of patient often in my clinic — someone who has been through two, sometimes three, pregnancy losses and is sitting across from me asking one question: what is actually wrong with me? Most of the time, they've already Googled everything. What they haven't gotten is a straight answer about what's actually being tested, why, and what happens next. That's what I want to lay out here.
First, some reassurance most people don't hear early enough
If you've had two miscarriages in a row, that's usually the point where I'd suggest starting a proper workup — you don't need to wait for a third. Some older definitions do say three, but in practice, two is when I want to start looking.
Here's the part patients are often relieved to hear: recurrent pregnancy loss is uncommon, but it's not rare, and most couples who go through it do go on to have a healthy pregnancy. I say this not to brush past the grief of it — I don't think that's helpful either — but because the fear in the room is usually "will this ever work," and statistically, the answer is very often yes.
Why does this happen?
There's rarely one tidy answer, and I try to be upfront about that from the first visit rather than let someone assume we'll definitely find "the cause."
A large share of miscarriages — roughly half — come down to the embryo ending up with the wrong number of chromosomes at fertilization. That's a random event. It isn't something either partner did, though the odds do go up with age. Beyond that, I'm looking at a handful of other possibilities: the shape of the uterus itself (a septum, fibroids, polyps, or old scar tissue can all get in the way), thyroid and blood sugar issues, and clotting-related immune conditions like antiphospholipid syndrome, which can interfere with how the placenta gets its blood supply.
And I'll be honest with patients about this too: even after a full evaluation, close to half the time we don't land on a clear cause. That's not because the testing failed — it's a genuine limit of what medicine currently understands about early pregnancy loss. It doesn't mean nothing can be done, though.
What the workup actually looks like
When someone comes to me after recurrent loss, here's roughly what I'm doing:
A detailed history first — timing of each loss, any symptoms, family history. Then a physical and pelvic exam. From there, if there's tissue available from a previous miscarriage, I'll usually want it tested chromosomally; the technology for this has improved a lot in recent years and gives us much better information than it used to.
I also run blood tests for two specific clotting-related antibodies. If the same one comes back positive twice, six to eight weeks apart, that tells me something concrete and treatable is going on. And I'll check the uterine cavity itself — usually with ultrasound, sometimes hysteroscopy — to rule in or out any structural issues that might need correcting.
One thing that's shifted in how I practice: testing both partners' chromosomes used to be almost automatic. Increasingly, the guidance is to be more selective about it — based on individual risk, or only after we find something specific in the miscarriage tissue itself. It's a more targeted approach than it used to be, and I think that's a good thing.
If we find a cause — and if we don't
Treatment really depends on what turns up. If it's a clotting disorder, low-dose aspirin combined with heparin in a future pregnancy is well-supported and something I use regularly. If it's a structural issue in the uterus, surgical correction — removing a septum, polyps, or scar tissue — can meaningfully improve the odds. Thyroid or metabolic issues get managed directly before we try again.
I also think it matters to say clearly what I don't recommend, because some of these treatments still get offered elsewhere. Intravenous immunoglobulin and certain immune-based treatments haven't been shown to actually prevent recurrent loss, despite being marketed that way in some places. Preimplantation genetic screening similarly hasn't been shown to improve outcomes specifically for recurrent pregnancy loss. I'd rather a patient spend their money and emotional energy on things we know help.
For the roughly half of cases where nothing specific turns up, that's not the end of the conversation. Closer monitoring in early pregnancy, more frequent check-ins, and just having someone tracking things carefully often makes a real difference — even without a named diagnosis.
When to come in
Two losses is a reasonable point to ask for a full evaluation rather than waiting. I see patients for this at Womb2Bloom Healthcare in Srinagar as part of my broader infertility and high-risk pregnancy work, and I'd rather walk someone through what we're testing and why than leave them guessing.
This is a well-studied area of medicine with real answers available for a lot of patients — even when the honest answer, at least at first, is that we don't fully know yet.