Recurrent Miscarriage: Why It Happens, and What Happens Next

If you are reading this in the days after a loss, you do not need statistics yet. You need to know that what you are feeling is real, that it is not weakness, and that grief for a pregnancy is grief for a person you had already begun to imagine. Come back to the rest of this page when you are ready. It will still be here.

And when you are ready, here is what I want you to know: recurrent miscarriage is one of the few situations in medicine where the odds are far better than they feel. Even after three losses with no explanation found, roughly three women in four go on to have a baby. That is not false comfort. It is the number from the largest studies we have.

Is this my fault?

No. And I want to spend a moment on this before anything else, because it is the question underneath every other question.

When a pregnancy ends early, the commonest reason by a long way is that the embryo had the wrong number of chromosomes. This happens at the moment of fertilisation, before you knew you were pregnant, before you had done or not done a single thing. Around half of sporadic miscarriages and roughly 40% of losses in women with recurrent miscarriage are caused by these chromosomal accidents.

It was not the flight. It was not lifting your older child. It was not the day you were upset, or the food you ate, or the fact that you went back to work, or that you did not rest enough, or that you rested too much. It was not the sex. It was not because you were not happy enough, or were too happy too soon.

What actually counts as "recurrent" miscarriage?

This matters practically, because it decides when you get investigated — and the definitions genuinely differ.

• The European guideline (ESHRE) defines it as two or more pregnancy losses. They do not have to be consecutive.
• The American guideline (ASRM) also says two or more.
• The UK's RCOG traditionally says three or more first-trimester losses, but explicitly allows investigation after two at the doctor's discretion.

What I do in practice: if you have had two losses and you are worried, that is enough reason to sit down and look properly. Making a woman produce a third loss to earn a set of blood tests is not, to my mind, defensible.

How common is this? Am I the only one?

You are very far from alone, and the reason it feels lonely is that almost nobody talks about it.

Miscarriage itself is common — it ends somewhere between 1 in 10 and 1 in 8 recognised pregnancies in women in their twenties, rising steeply with age. Recurrent loss is less common but not rare: about 2% of women have two miscarriages, and about 1% have three. In a city the size of Gurugram, that is thousands of women.

Will I ever have a baby?

This is the question you actually came here for. Here are the numbers, plainly.

I am not going to pretend the numbers are the same at every age — they are not, and I cover that below. But if you are in your twenties or early thirties and you have had two or three losses, the most likely outcome by some distance is a baby.

Why does it happen?

In the majority of couples, no single cause is ever found. Of the causes that are findable, these are the ones that matter:

Which tests are actually worth doing?

A focused set. Not a panel of forty things.

Which tests should I be careful about?

I want to be direct here, because this is where a great deal of money and hope is spent in India for no benefit at all.

The major guidelines specifically advise against the following outside a research study:

• Natural killer (NK) cell testing, in blood or from the uterine lining. The evidence does not support it, and the treatments it leads to are worse.
• Immunotherapy — paternal cell immunisation, donor white cells, intravenous immunoglobulin (IVIG), intralipids. A Cochrane review of 20 trials in over 1,100 women found no benefit whatsoever on live birth.
• Routine thrombophilia panels — protein C, antithrombin, MTHFR. Weakly associated at best, and the treatment does not help. The definitive trial gave blood thinners to women with proven inherited thrombophilia and found live birth of 71.6% with treatment against 70.9% without.
• Blood thinners for unexplained recurrent miscarriage. Aspirin and heparin should not be given. This one is stated flatly by every guideline.
• Endometrial scratch, HLA typing, cytokine panels, sperm DNA fragmentation as routine, ovarian reserve testing and homocysteine levels — all specifically not recommended.
• Genetic testing of embryos (PGT-A) for unexplained recurrent miscarriage — not shown to improve live birth, at considerable cost.

One honest complication, because you may read about it: the European guideline recently softened its position on high-dose IVIG for women with four or more unexplained losses, calling it a conditional suggestion based on low-quality evidence. The British and American guidelines and Cochrane all remain against it. That is not a green light — it is a narrow, heavily-qualified exception being sold in some places as a breakthrough.

If someone offers you an expensive immune treatment after two losses, the question worth asking out loud is: which guideline recommends this, and what did the randomised trials show?

What treatments genuinely work?

The list is short, which is frustrating — but the things on it work well.

• Aspirin and heparin, for antiphospholipid syndrome. The clearest success story in this field. If you have APS, this changes your outcome substantially. If you do not, it does nothing.
• Levothyroxine, for an underactive thyroid. Correcting overt hypothyroidism before and during pregnancy matters. Note that giving thyroxine to women whose thyroid function is normal but who have thyroid antibodies has been tested, and does not improve live birth.
• Surgery, for the right structural problem. Adhesions inside the cavity, or a polyp or submucous fibroid distorting it, are worth dealing with. A uterine septum is more contested than you would think — the one randomised trial found no benefit from resecting it, so this is a decision to make together rather than a foregone conclusion.
• Progesterone, for the right woman. See below, because the detail matters.
• Supportive care. Early scans, someone who knows your history, and being able to call when you are frightened. It sounds soft. It is part of the 75%.

Should I be taking progesterone?

Possibly — and this is worth getting exactly right, because progesterone is handed out very freely in India and the evidence is quite specific about who it helps.

Two large trials answered this.

The first gave vaginal progesterone to 836 women with three or more unexplained losses who were not bleeding. Live birth was 65.8% with progesterone and 63.3% with placebo — no meaningful difference. For a woman with recurrent loss and no bleeding, progesterone does not appear to help.

The second gave it to more than 4,000 women who were bleeding in early pregnancy. Overall the result was not statistically significant — but the effect rose steadily with the number of previous miscarriages. In women with three or more previous losses who were bleeding, live birth was 72% with progesterone against 57% with placebo. That is a large difference.

So the position now, following NICE and RCOG: vaginal micronised progesterone 400 mg twice daily is offered to a woman who has had a previous miscarriage and is bleeding in this pregnancy, once a scan confirms the pregnancy is inside the uterus, continued to 16 weeks if a heartbeat is seen. The European guideline sets the bar higher, at three or more losses.

What that means for you: bleeding plus a previous loss is a good reason to be on it. Recurrent loss without bleeding is not, whatever anyone tells you. If you are bleeding now, our guide to bleeding in pregnancy explains what needs assessing urgently.

What if every test comes back normal?

This is the commonest outcome — and it is the one women find hardest, because it feels like being sent away with nothing.

I understand that completely. But turn it over. Unexplained means no disease was found in you. It also means you are in the group with roughly a 75% chance of a successful next pregnancy without any treatment at all. Many of the women in that 75% were, at some point, sitting where you are, convinced that "unexplained" meant "hopeless".

What unexplained does not mean is that nothing will be done. It means the plan becomes early scanning, close support, correcting anything correctable, and someone at the end of a phone. That is not a consolation prize. It is the intervention with the best evidence behind it.

Does my husband need testing too?

Sometimes, and more often he needs including.

Parental chromosome testing, where it is indicated, involves both partners. Beyond that, routine sperm DNA fragmentation testing is not recommended by the UK guideline, though the European one allows it for explanatory purposes.

What is well established is that his health matters. Smoking, heavy drinking and obesity in the male partner are all worth addressing, and the European guideline strengthened its wording on exactly this. Recurrent miscarriage is treated as a woman's problem far too often, both medically and at home. It happened to both of you.

How much does my age matter?

More than any other single factor, and I would rather tell you than let you find out later.

The risk of miscarriage in any pregnancy is about 11 to 12% in your twenties, around 15% at 30 to 34, 25% at 35 to 39, and over 50% from 40. This is almost entirely about the rising proportion of eggs with chromosomal errors, which is a fact of biology and not a judgement about you.

Why say it at all? Because it changes the urgency of investigating rather than waiting. If you are 38 and have had two losses, I would not make you wait for a third before looking properly. Time is the one thing we cannot get back.

Is there anything I can do myself?

Yes — and I want to frame this carefully, because "things you can do" too easily becomes "things you failed to do".

None of these caused your miscarriages. All of them are worth doing anyway:

• Aim for a BMI between 19 and 25. This is the lifestyle factor with the strongest evidence behind it.
• Stop smoking — both of you.
• Keep alcohol low, and caffeine under about 200 mg a day, which is roughly two cups of coffee.
• Take folic acid, started before you conceive rather than after. More on the dose below.
• Get your thyroid and blood sugar checked and corrected before the next pregnancy rather than during it.

What is not on the list: bed rest, avoiding stairs, giving up work, avoiding sex, or any of the hundred restrictions well-meaning people will suggest. None of them prevent miscarriage, and all of them quietly reinforce the idea that this is something you can control by being careful enough.

How long should we wait before trying again?

Probably less time than you have been told.

The advice to wait six months is still repeated constantly in India. It comes from a WHO recommendation made in 2005, which rested on a single study that did not separate miscarriage from termination.

Since then, a systematic review pooling data from more than a million women has looked at exactly this. Conceiving within six months of a miscarriage, compared with waiting longer, was associated with a lower risk of another miscarriage, a higher live birth rate, and a lower risk of preterm birth. Not equivalent — better.

One caveat so this is not misread: this evidence is about pregnancy loss. Spacing after a live birth is a different question with different answers.

How do I plan the next pregnancy?

This is where the anxiety usually goes once the grief has moved a little — and it is where a plan genuinely helps, because it converts helplessness into a list. Here is the outline. I am writing a fuller guide to this next, because it deserves its own page.

The single most useful thing I can offer a woman planning again after loss is not a drug. It is an early scan and a phone number. Knowing there is a date in the diary, and that you will not have to explain your history to a stranger at the worst moment, changes the whole shape of the first trimester.

Is it normal to feel like this?

Yes. And the evidence on this is stronger than most people realise.

In a study following more than 500 women after early pregnancy loss, 29% had symptoms of post-traumatic stress one month afterwards, and 18% still did at nine months. A quarter had moderate to severe anxiety at one month. This is not fragility. It is a well-documented response to a genuine bereavement, and one that often goes unrecognised because there is nobody to bury and no ritual to mark it.

Partners feel it too, differently and usually more silently. In the same research group's work, over 80% of partners reported feeling helpless at every time point, and around 70% re-experienced the event — while reporting far fewer symptoms that met formal criteria. If your husband seems to have moved on and you have not, it is worth knowing that this is a very common pattern and does not mean he cared less.

If the sadness is not lifting at all, if you cannot sleep or function, or if the thought of trying again is unbearable rather than just frightening, please tell someone — me, your family doctor, or a counsellor. Needing help with this is not a complication. It is proportionate.

How do I get through the next pregnancy?

Honestly? Week by week, and with more support than you think you should need.

Most women describe the next pregnancy as anxious rather than joyful, at least until they pass the point where they lost before. That is normal, it does not harm the baby, and it does not mean you are not grateful. What helps, in my experience: an early scan booked before you need to ask for it, permission to come in whenever you are worried without justifying it, and a clear plan for what happens if you bleed. Our guide to what is normal in the first trimester is worth reading in a calm moment rather than a frightened one.

Getting care for recurrent miscarriage in Gurugram

What a first appointment looks like: a proper history of every pregnancy, including the ones other doctors did not count; the focused set of tests above and not a forty-item panel; an examination and a scan, arranged by referral and timed correctly; and an honest conversation about what your own numbers look like given your age and history.

If a cause is found, we treat it. If none is found — which is the likeliest outcome — the plan is early scanning, close contact, and correcting anything correctable before you conceive again. You will not be told to relax and try again.

Our two clinics — Sector 51 (Mayfield Garden) and Sector 56 — see patients from across Gurugram, Golf Course Road, Golf Course Extension, Sohna Road, the DLF Phases, South Delhi and nearby NCR, 7 days a week including Sundays. You can read more about our pregnancy and maternity care, including antenatal care for higher-risk pregnancies.

The bottom line

Recurrent miscarriage is not a verdict. It is a situation with a small number of findable causes, a shorter list of treatments that genuinely work, and a large amount of unnecessary testing sold around the edges of it.

Most of the time no cause is found. Most of the time, a baby follows anyway — about three times in four. And the thing that most reliably improves the odds is not an expensive infusion. It is getting the few things that matter right, avoiding the things that do not, and not going through the next pregnancy alone.

Whatever number of losses you are carrying: it was not your fault, and it is not finished.