Experiencing a pregnancy loss can be emotionally and physically difficult. When pregnancy loss happens more than once, the uncertainty can become even more distressing, particularly when you are trying to understand why it happened and whether a future pregnancy can progress normally.
Recurrent Pregnancy Loss (RPL) is a distinct reproductive health condition that deserves a structured evaluation rather than simply repeating the same treatment. Current guidance from the American Society for Reproductive Medicine defines recurrent pregnancy loss as the spontaneous loss of two or more pregnancies, and recommends a targeted, evidence-based approach to evaluation and care.
At Miraai Fertility, recurrent pregnancy loss care focuses on understanding your previous pregnancies, identifying potentially treatable factors, evaluating both partners when appropriate, and creating an individualized plan before and during a future pregnancy.
Book a consultation with Dr. Priya Khamatkar to discuss your pregnancy history and future pregnancy planning.
Recurrent pregnancy loss refers to experiencing two or more spontaneous pregnancy losses. The losses do not necessarily have to occur consecutively to warrant evaluation.
Pregnancy loss can happen for many different reasons, and in some cases, no single cause is identified even after evaluation.
Importantly, recurrent pregnancy loss is different from infertility. A woman may be able to conceive but experience difficulty maintaining a pregnancy. Therefore, the evaluation focuses not only on the ability to become pregnant but also on factors that may influence embryo development, implantation and continuation of pregnancy.
There is no single explanation for recurrent pregnancy loss.
Possible contributing factors can include:
Sometimes several factors may overlap, while in other cases the evaluation does not identify a definite cause.
This is why recurrent pregnancy loss should be approached through individualized assessment rather than assuming one cause applies to everyone.
A fertility consultation may be appropriate after two or more pregnancy losses, particularly when you want to understand possible causes before trying again.
Evaluation may be especially important if you have experienced:
You do not have to wait until you experience another loss before discussing your reproductive history with a fertility specialist.
There is no single test that can explain every miscarriage.
A comprehensive evaluation begins with a detailed review of your reproductive history and then uses targeted investigations based on your circumstances.
Your doctor may review:
Understanding the pattern of previous losses can help determine which investigations may be most useful.
Chromosomal abnormalities are an important cause of early pregnancy loss. When possible, chromosome testing of pregnancy-loss tissue may provide useful information about whether a particular loss was associated with a chromosomal abnormality. Current ASRM guidance recommends offering chromosome evaluation of miscarriage tissue when feasible in recurrent pregnancy loss.
Depending on the findings and family history, genetic testing of both partners may also be considered.
The shape and structure of the uterus can sometimes influence pregnancy outcomes. Depending on your history, assessment may include:
These investigations may help identify conditions such as uterine septum, certain fibroids or polyps, adhesions and other anatomical abnormalities. ASRM recommends uterine cavity evaluation as part of RPL assessment.
Hormonal and metabolic health can be relevant when planning another pregnancy. Depending on your history and risk factors, evaluation may consider:
Thyroid abnormalities may be relevant to reproductive health and pregnancy planning. Testing is considered when symptoms, risk factors or other clinical circumstances indicate it.
Poorly controlled diabetes can affect pregnancy outcomes. When appropriate, assessment of blood glucose control, including HbA1c, may form part of preconception evaluation.
Additional hormonal investigations are selected according to menstrual history, clinical findings and previous pregnancy history. The objective is to identify actionable problems, rather than perform unnecessary testing.
Patients experiencing repeated pregnancy loss are sometimes offered extensive immune testing or treatments marketed as ways to improve pregnancy outcomes.
However, evidence for routine immune testing and immune-based treatments in recurrent pregnancy loss remains limited. Current ASRM guidance does not recommend routine immune testing or treatment for RPL. At Miraai Fertility, investigations are considered based on established clinical indications rather than automatically adding tests that may not provide useful answers.
Certain acquired conditions, particularly Antiphospholipid Syndrome (APS), can be associated with recurrent pregnancy loss.
Testing may be considered when clinical criteria or relevant pregnancy and medical history suggest APS. Tests can include specific antiphospholipid antibodies such as lupus anticoagulant, anticardiolipin antibodies and anti-beta-2 glycoprotein I antibodies.
Routine testing for inherited thrombophilias is not recommended for every woman with recurrent pregnancy loss, and treatment should not be started simply because a patient has experienced miscarriages. If a relevant condition is identified, treatment can be planned according to the diagnosis and current medical guidance.
Yes. Recurrent pregnancy loss is a concern involving the couple, not only the woman.
Depending on the circumstances, assessment of the male partner may include: medical and reproductive history, age and lifestyle factors, semen analysis when clinically appropriate, review of medications and health conditions, and assessment for factors that may affect sperm health.
Current evidence also suggests that sperm DNA fragmentation may be associated with recurrent pregnancy loss, although testing is generally considered in selected circumstances rather than automatically for every couple. Evaluating both partners can help create a more complete picture of the reproductive situation.
Lifestyle does not explain every miscarriage, and pregnancy loss should never automatically be attributed to something a woman did or did not do.
However, preparing for another pregnancy provides an opportunity to optimize overall health.
ASRM recommends preconception counseling, healthy lifestyle measures, folic acid support and avoidance of harmful exposures when planning another pregnancy.
Treatment depends entirely on what the evaluation identifies. There is no universal treatment for recurrent miscarriage.
If a relevant thyroid, metabolic or other medical condition is identified, it can be appropriately managed before conception and during pregnancy.
Certain uterine abnormalities may be treated surgically when there is a clear clinical indication. The specific procedure depends on the type and severity.
Women who meet appropriate criteria for APS may require specific treatment during pregnancy under specialist supervision.
If chromosome testing identifies a genetic issue, genetic counseling can help explain recurrence considerations and available reproductive options.
Sometimes the most appropriate treatment is to correct modifiable health factors and carefully prepare for pregnancy rather than immediately moving to assisted reproduction.
For some patients, closer monitoring during the early stages of a subsequent pregnancy can provide reassurance and allow appropriate care when clinically indicated.
Not necessarily. Having recurrent pregnancy loss does not automatically mean that IVF is the next step.
The appropriate approach depends on: the cause of previous losses, age, fertility status, ovarian and reproductive factors, sperm factors, uterine findings, genetic findings, previous fertility treatment, and personal reproductive goals.
In selected couples, IVF and genetic testing of embryos may be discussed, particularly when there is a specific genetic or reproductive indication. However, preimplantation genetic testing for aneuploidy (PGT-A) has not been shown to universally improve live-birth outcomes for all patients with recurrent pregnancy loss, so the decision should be individualized.
This is one of the most difficult situations for patients. Even after appropriate investigation, some couples will not receive a single definitive explanation for their pregnancy losses.
An unexplained diagnosis does not mean that a future pregnancy cannot be successful. Current ASRM guidance notes that many patients with unexplained recurrent pregnancy loss subsequently achieve a successful pregnancy without a specific intervention.
Fine-tuning lifestyle, nutrition, metabolic factors, and overall health prior to attempting another pregnancy.
Avoiding unproven or unnecessary treatments while adhering strictly to established clinical guidelines.
Close clinical surveillance, frequent early ultrasounds, and hormone monitoring during initial weeks.
Compassionate, continuous care, open communication, and reassuring psychological guidance.
Goal: Avoid unnecessary treatments while providing appropriate medical and emotional support.
A future pregnancy can be approached as a carefully planned process rather than simply waiting and hoping for a different outcome.
Detailed review of pregnancy timing, gestational age at loss, cardiac activity, and ultrasound records.
Comprehensive uterine imaging, partner evaluation, and targeted diagnostic testing.
Pinpointing hormonal, anatomical, genetic, APS, or metabolic factors if present.
Folic acid supplementation, lifestyle management, and optimizing health prior to conceiving.
Developing an individualized treatment and monitoring schedule tailored to your history.
Frequent early scans, ongoing medical monitoring, and emotional reassurance.
At Miraai Fertility, recurrent pregnancy loss care begins by listening carefully to your pregnancy history and understanding what has already been investigated or treated. Dr. Priya Khamatkar may recommend a stepwise assessment rather than ordering every available test at once.
The timeline depends on the investigations required. Some assessments can be completed relatively quickly, while genetic testing, uterine evaluation or specialist investigations may require additional time.
Rather than rushing through multiple tests, your doctor can prioritize investigations according to your number and pattern of losses, previous test results, age, medical history, fertility history, findings from previous pregnancies, and your plans for another pregnancy.
Recurrent pregnancy loss is not only a medical experience. It can bring grief, anxiety, fear of another loss, self-blame and uncertainty about trying again.
Many patients also find that pregnancy after previous losses can feel emotionally difficult—even when everything appears medically reassuring.
It is important to remember that a miscarriage is not necessarily something you caused. Early pregnancy loss can occur because of biological or chromosomal problems that are outside your control.
At Miraai Fertility, emotional well-being is considered an important part of fertility care. Psychological support and counseling should be available to couples experiencing recurrent pregnancy loss and planning a future pregnancy.
MBBS, MS (OBGYN), FRM
Fellowship in Reproductive Medicine
Director, Advanced Fertility Care Center
Dr. Priya Khamatkar is a fertility specialist focused on personalised and evidence-based reproductive care. Her approach combines fertility evaluation, assisted reproductive techniques and individualized treatment planning based on each patient's reproductive history and goals.
At Miraai Fertility, couples experiencing recurrent pregnancy loss receive a structured approach to identifying potentially treatable factors while avoiding unnecessary investigations and unsupported treatments. The focus is on ethical, transparent and compassionate fertility care, with clear communication throughout the evaluation and future pregnancy journey.
If you have experienced repeated pregnancy loss, you deserve more than uncertainty and generic advice. A structured recurrent pregnancy loss evaluation can help identify potential contributing factors, determine whether treatment is appropriate, and prepare you medically and emotionally for a future pregnancy.
Shop 1 & 2, The Signature, near HP Petrol Pump,
Seawoods West, Sector 44A, Seawoods,
Navi Mumbai, Maharashtra – 400706
MBBS, MS (OBGYN), FRM
Director & Lead Fertility Specialist