Why Do I Keep Having Miscarriages and What Testing Can Help?
Recurrent pregnancy loss is one of the most painful experiences in fertility care, and one of the most treatable once the cause is identified. Here’s the standard workup, what it looks for, and what happens if nothing shows up.
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SCRC Editorial Team
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8 min read
Losing a pregnancy once is devastating. Losing more than one, and hearing “it’s probably just bad luck” each time, is a different kind of exhausting. Patients who come to us after a second or third loss have almost always already searched for answers, and many arrive believing there simply isn’t one to find.
There usually is. Recurrent pregnancy loss has a defined, methodical evaluation built around a small number of categories: genetics, uterine anatomy, hormones, and immune function. About half of couples who complete the full workup get a specific, treatable answer. The other half get something that still matters: a normal result that changes how the next pregnancy is monitored and managed. Here’s what that evaluation actually involves.
THE SHORT ANSWER
Recurrent pregnancy loss, generally defined as two or more clinical pregnancy losses, is evaluated with a focused set of tests: a chromosome analysis (karyotype) for both partners, an evaluation of the uterine cavity for structural issues, an antiphospholipid antibody panel for an autoimmune clotting cause, and thyroid and metabolic screening. If tissue from a loss is available, testing it directly can identify a chromosomal cause specific to that pregnancy. Roughly half of couples who complete this workup will have no cause identified, and that unexplained group still has a favorable outlook for a future pregnancy with the right monitoring.
WHY IT MATTERS
Why identifying a cause changes what happens next
A recurrent pregnancy loss workup isn’t about assigning blame for what happened. It’s about finding the specific things that are treatable. A uterine septum can be corrected surgically. An antiphospholipid antibody result changes your medication plan in the next pregnancy. A parental chromosomal translocation changes whether IVF with embryo testing might meaningfully improve your odds. None of that is available until someone looks for it.
Traditional guidance recommended waiting for three losses before starting testing. In practice, most reproductive endocrinologists now start after two, particularly for patients over 35 or with a personal history that raises other concerns, since the emotional and time cost of waiting for a third loss is real and the testing itself carries little downside.
It’s also worth sitting with the other half of the picture. When a full workup finds nothing, that’s not a dead end. Unexplained recurrent pregnancy loss carries a genuinely reassuring prognosis: most couples in this category go on to a successful pregnancy, especially with early monitoring in place. A normal result rules out the things that would have changed your plan, which is meaningful information even when it doesn’t come with a diagnosis.
THE WORKUP
Six categories of testing for recurrent pregnancy loss
A thorough evaluation moves through these systematically. Not every category applies to every patient, and your doctor will prioritize based on your specific history.
1
Parental chromosome testing (karyotype)
A blood test for both partners looks for a balanced chromosomal translocation, a rearrangement that causes no health issues for the carrier but can raise the risk of miscarriage or an unbalanced pregnancy. This is found in roughly 2 to 5 percent of couples with recurrent loss, small but significant since it directly changes what IVF with embryo testing can offer.
Ask: “Should both of us have karyotype testing, and if a translocation is found, what would our next steps realistically look like?”
2
Testing the pregnancy tissue itself
If tissue from a loss is available, sending it for chromosomal testing can identify whether that specific pregnancy had a one-time genetic error, which is common and doesn’t necessarily predict future losses, versus a pattern that points toward a maternal or paternal factor. This is easiest to arrange if you discuss it with your OB or clinic in advance, rather than in the moment of a loss.
Ask: “If I have another loss, can the tissue be sent for genetic testing, and what would I need to do in advance to make that possible?”
3
Uterine cavity evaluation
A saline sonogram, hysterosalpingogram (HSG), or hysteroscopy checks for a uterine septum, fibroids, polyps, or scar tissue that can interfere with implantation or a pregnancy’s ability to grow normally. Many of these findings are correctable, and correcting them is one of the more directly actionable outcomes of an RPL workup.
Ask: “Which imaging test do you recommend for me specifically, and if something is found, is it something that can be corrected before I try again?”
4
Antiphospholipid antibody panel
This blood panel, which checks for lupus anticoagulant, anticardiolipin antibodies, and anti-beta2 glycoprotein I antibodies, looks for an autoimmune cause of clotting in the placenta. It’s one of the most clearly treatable findings in the entire workup, but a positive result has to be confirmed on a second draw at least 12 weeks later before it’s considered diagnostic, since a single elevated result can be a temporary, unrelated finding.
Ask: “If my antibody panel comes back positive, will it be repeated to confirm, and what would treatment look like in a future pregnancy?”
5
Thyroid and metabolic screening
Untreated or under-treated hypothyroidism and poorly controlled blood sugar are both associated with pregnancy loss and are straightforward to correct before conceiving again. Pregnancy has a narrower optimal range for thyroid function than general adult health, so ask specifically whether your result is being read against a pregnancy-specific target.
Ask: “Is my thyroid level being evaluated against the range that’s optimal for pregnancy, not just the standard adult reference range?”
6
Inherited clotting disorder testing, selectively
Tests for inherited clotting mutations like Factor V Leiden or the prothrombin gene mutation are sometimes ordered for recurrent loss, but current ASRM and ACOG guidance doesn’t support this as a routine part of the workup, because the evidence linking these specific genes to pregnancy loss is weak. It’s generally reserved for patients with a personal or family history of blood clots, not ordered by default.
Ask: “Given my history, is inherited clotting testing likely to change my treatment, or would it mainly add cost without a clear benefit?”
WHAT EACH TEST CAN FIND
What each category can find, and whether it’s treatable
A quick reference for what a positive finding in each category typically means for your next steps.
| Test category | What it can find | Is it treatable? |
|---|---|---|
| Parental karyotype | A balanced chromosomal translocation in either partner | Often, via IVF with embryo testing |
| Uterine cavity evaluation | Septum, fibroids, polyps, or scar tissue | Frequently, with surgical correction |
| Antiphospholipid antibodies | An autoimmune clotting risk | Yes, with aspirin and/or heparin |
| Thyroid and metabolic screening | Hypothyroidism or poorly controlled blood sugar | Yes, with medication before conceiving |
| Products of conception karyotype | A chromosomal abnormality specific to that pregnancy | Informational, often reassuring |
BEYOND THE BLOODWORK
What a thorough evaluation includes beyond bloodwork
A few logistics make the difference between a workup that’s actually useful and one that just adds appointments.
- Timing: Most of this testing can be done between pregnancies on your own schedule. You don’t have to decide everything in the immediate aftermath of a loss.
- Confirming antibody results: Any positive antiphospholipid result needs a second draw at least 12 weeks later before it’s treated as diagnostic, not acted on after a single test.
- Planning ahead with your OB: If a loss happens after about 10 weeks, ask in advance whether the tissue can be preserved and sent for genetic testing.
- PGT-SR: If a parental translocation is found, preimplantation genetic testing for structural rearrangements can identify unaffected embryos during a future IVF cycle.
- Support alongside testing: Many patients going through this benefit from counseling or a pregnancy loss support group running in parallel with the medical workup, not after it.
QUESTIONS TO ASK YOUR DOCTOR
Questions to bring to your evaluation
These help you understand not just what’s being tested, but what each result would actually change.
- Based on my history, would you recommend starting a workup now, or waiting for another loss?
- Which specific tests are you ordering, and what would each result change about my plan?
- If my antiphospholipid panel is positive, will it be repeated before it’s considered confirmed?
- Can I arrange in advance to have tissue from a future loss tested, if needed?
- Is my thyroid result being read against a pregnancy-specific reference range?
- If everything comes back normal, what’s the recommended plan for monitoring my next pregnancy?
- Are there pregnancy loss support resources you’d recommend alongside the medical workup?
WHEN TO LOOK CLOSER
Situations that call for a closer look
None of these mean something is necessarily wrong. They’re reasons to ask more questions rather than accept a general reassurance.
- You’ve had two or more losses and are over 35 — testing is often reasonable now rather than waiting for a third
- A positive antiphospholipid result was treated as final without a confirming second test 12 weeks later
- Pregnancy tissue wasn’t preserved and testing options weren’t discussed before a loss
- Thyroid results were called “normal” using a general reference range rather than a pregnancy-specific one
- Inherited clotting testing was ordered and treated as an explanation with no personal or family clotting history behind it
- You were told “it’s just bad luck” without any discussion specific to your own history
- Uterine imaging was never brought up despite two or more losses
COMMON QUESTIONS
Frequently asked questions
ASRM defines recurrent pregnancy loss as two or more clinical pregnancy losses, confirmed by ultrasound or tissue exam, and the losses don’t need to be consecutive. Older guidance required three losses before starting an evaluation, but most reproductive endocrinologists now begin testing after two, especially for patients over 35 or with other risk factors.
This happens in roughly half of recurrent pregnancy loss evaluations, and it’s a genuinely more reassuring outcome than it might feel like. Unexplained recurrent loss has a favorable prognosis overall, and most couples in this category go on to a successful pregnancy, particularly with early monitoring in the next one. A normal workup rules out the things that would have changed your plan.
No. A single miscarriage is common, occurring in an estimated 10 to 15 percent of known pregnancies, and is usually caused by a one-time chromosomal error in that particular embryo. It typically doesn’t call for testing on its own. Recurrent pregnancy loss refers specifically to a pattern of two or more losses, which is what prompts a fuller evaluation.
Yes, for the genetic portion of the workup. A karyotype is drawn from both partners, since a balanced chromosomal translocation carried by either person can raise the risk of recurrent loss even though that partner is otherwise completely healthy.
Not routinely. Current ASRM and ACOG guidance doesn’t support testing for inherited clotting disorders as a standard part of an RPL workup unless you have a personal or family history of blood clots, since the evidence linking those specific genes to pregnancy loss is weak. The antiphospholipid antibody panel, which tests for a different and better-established autoimmune cause, is the clotting-related test with clear treatment value.
Most of it, yes. Karyotyping, thyroid testing, and uterine imaging generally don’t require you to pause trying. The one test worth timing carefully is the antiphospholipid antibody panel, which gives the clearest results when you’re not currently pregnant, so it’s worth discussing the timing with your care team.
HOW SCRC APPROACHES RECURRENT PREGNANCY LOSS
A structured workup, and support beyond the bloodwork
SCRC coordinates the full recurrent pregnancy loss evaluation, genetic, anatomic, immunologic, and endocrine, under one plan, so you’re not chasing referrals between specialists while you’re already going through something difficult. Our goal is a clear answer where one exists, and a clear plan even when it doesn’t.
- Comprehensive RPL workup — parental karyotype, uterine imaging, antiphospholipid antibody testing, and thyroid and metabolic screening, coordinated as one evaluation.
- Products of conception testing — we help you plan in advance so tissue from a future loss can be tested if needed.
- PGT-SR access — if a parental translocation is identified, our lab can perform preimplantation genetic testing to help select unaffected embryos during IVF.
- Evidence-based testing — we follow current ASRM guidance rather than ordering panels without a clear reason to.
- Support alongside the medical plan — our team can connect you with counseling and support resources for pregnancy loss throughout your evaluation.
