Heavy bleeding with dizziness, or severe one-sided pain with a positive test, needs emergency care now. Heavy bleeding in pregnancy and ectopic pregnancy are both emergencies. Go to the nearest hospital.
Two or more consecutive pregnancy losses. It is far more common than most couples realise, and in around half no cause is ever identified — which is difficult to hear and, oddly, carries a reasonably hopeful outlook.
This is a field with a great deal of unproven and expensive treatment. The investigations that genuinely change management are few, and they are worth doing properly before anyone sells you anything else.
Recurrent pregnancy loss is usually defined as two or more consecutive miscarriages. Individual miscarriage is common — roughly one in five recognised pregnancies — and the majority are caused by chromosomal abnormalities in the embryo that occur by chance and do not recur.
That is why investigation is offered after repeated losses rather than one. The purpose is to identify the minority of couples with a treatable underlying cause.
The causes that are genuinely established are relatively few. Antiphospholipid syndrome, an autoimmune clotting disorder, is the most important because it is treatable and identifying it substantially improves outcomes. Structural abnormalities of the uterus, particularly a septum, can be corrected. Thyroid disease and poorly controlled diabetes are treatable. And in a small proportion of couples, one partner carries a balanced chromosomal rearrangement.
In around half of couples, thorough investigation finds nothing. This is frustrating, but it carries better news than it sounds: couples with unexplained recurrent miscarriage have a reasonably good chance of a successful pregnancy with supportive care alone, and that figure remains encouraging even after three or four losses.
Recurrent miscarriage attracts more unproven and expensive treatment than almost any other area of medicine, because couples are desperate and the outcome without treatment is often good — which makes almost anything look effective. Immune therapies including intravenous immunoglobulin and intralipid, steroids given without a specific indication, and routine use of blood thinners in women without antiphospholipid syndrome are all widely sold and not supported by good evidence. Preimplantation genetic testing is frequently offered and its benefit in this setting remains debated. Ask of any proposed treatment: what specifically has been found in me that this treats? If there is no answer, be cautious.
A short list of tests that change management, and a long list that does not.
Tell us how many pregnancies there have been, at what gestation each ended, whether a heartbeat was ever seen, and whether any tissue was tested. Losses before and after a heartbeat have different implications, and losses at a consistent stage can point towards a cause. Send that alongside your antiphospholipid results, thyroid function, pelvic ultrasound and both partners' karyotypes if done.
Treat what is found. Where nothing is found, supportive care has genuine value.
Low-dose aspirin with heparin from the confirmation of pregnancy substantially improves live birth rates in women with confirmed antiphospholipid syndrome. This is the clearest treatable cause in recurrent miscarriage and the strongest argument for proper testing — the antibodies must be positive on two occasions twelve weeks apart.
Thyroid hormone replacement for hypothyroidism, tight diabetes control before conception, hysteroscopic removal of a uterine septum, and treatment of genital tuberculosis where identified. Each of these is straightforward and each meaningfully changes the outlook where present.
Frequent early scans, easy access to the clinic, and continuity of care. This is not merely reassurance — supportive care in dedicated recurrent miscarriage clinics is associated with better outcomes, and couples with unexplained recurrent loss have a reasonably good chance of success without any specific intervention.
Progesterone in early pregnancy benefits women who have had recurrent miscarriage and are bleeding in the current pregnancy; the evidence is weaker in other groups. Preimplantation genetic testing is offered where a parental chromosomal rearrangement exists, and more contentiously in unexplained cases where its benefit is debated.
Two positive results twelve weeks apart. This is the most important treatable cause and the testing is frequently done only once.
A septum is correctable, and three-dimensional ultrasound or hysteroscopy is needed to see it.
For any proposed treatment, ask what specific finding in you it addresses. If there is no finding, ask why it is being offered.
If your investigations are normal, we will tell you that supportive care and trying again is a reasonable plan with a genuinely fair chance — rather than selling you an immune therapy.
Bleeding heavily in pregnancy or suspected ectopic pregnancy are emergencies treated where you are. Investigation for recurrent loss happens between pregnancies, not during a crisis.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Two consecutive losses is the usual threshold for investigation, though many units will investigate after two and almost all after three. If the losses occurred later in pregnancy, or if there is a relevant personal or family history, investigation after two is clearly appropriate. Do not accept being told to simply keep trying without assessment.
It is frustrating but it is not bad news. Around half of couples have no cause identified, and this group has a reasonably good chance of a successful pregnancy with supportive care alone — a figure that remains encouraging even after three or four losses. Not finding a cause frequently means there is no persistent underlying problem.
Only if you have confirmed antiphospholipid syndrome, where aspirin with heparin substantially improves outcomes. In women without it, routine blood thinners have not been shown to help and carry their own risks. This is one of the most commonly over-prescribed treatments in the field, and you are entitled to ask what specific finding justifies it.
Intravenous immunoglobulin, intralipid infusions and steroids given without a specific indication are widely marketed for recurrent miscarriage and are not supported by good evidence. They are expensive and not without risk. Because outcomes without treatment are often good, almost anything appears to work — which is exactly why this field attracts so much unproven therapy.
Where one partner carries a balanced chromosomal rearrangement, preimplantation genetic testing has a clear rationale. In unexplained recurrent miscarriage its benefit is debated and it is frequently oversold, adding substantial cost without clear improvement in live birth rates. Ask what specifically has been found in you before agreeing to it.
Framing it as fault is not useful, but yes, male factors matter. Both partners should have a karyotype, since a balanced translocation in either can cause repeated loss. Sperm DNA fragmentation has been associated with miscarriage, though its role remains debated and testing is not universally recommended. This is a couple's investigation, not only the woman's.
Tell us how many losses there have been and at what stage each ended, and whether a heartbeat was ever seen. Send your antiphospholipid results and thyroid function.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.