A real review. From your first loss.
Most patients with recurrent miscarriage believe their odds are dire. The published cohorts say otherwise — even after three losses at age 35, around 70% of women have a live birth in the next pregnancy.
The number gets even better when we identify and treat a cause. That's why we test from the first loss, not the second or third.
Adjust your inputs. The percentage is the probability of a live birth in the very next pregnancy attempt — based on real outcomes from the published cohorts.
This is your number for a spontaneous pregnancy with no specific treatment. Treating antiphospholipid syndrome alone, where present, lifts it from ~20% to ~75%. A separate route — IVF with PGT-A (transferring only chromosomally normal embryos) — typically delivers ~65–70% live birth per transfer largely independent of age, and is often the most effective option when previous losses are aneuploid or maternal age is over 38.
International guidelines (ESHRE, ASRM, RCOG) define recurrent pregnancy loss after two or more losses, and most public-system clinics begin formal workup at that threshold. Those guidelines are well evidenced for system-level care.
What we offer here is different in scope. After a single pregnancy loss we sit with you, look at the full picture — your age, the gestational age at loss, whether a heartbeat was seen, prior IVF, medical conditions, family history, your partner's history — and decide together what testing makes sense now. Where evidence supports early testing (late loss, heartbeat loss, age over 35, prior IVF, autoimmune or thrombotic family history) we test. Where it doesn't, we offer the comprehensive panel as a patient-choice option after counselling.
When a treatable cause exists, we'd rather find it now than after another loss.
The principle is individualised care, not blanket testing. We don't withhold investigations that have changed pregnancy outcomes for women with treatable causes — antiphospholipid syndrome treated with aspirin and LMWH lifts the next-pregnancy live-birth rate from around 20% to around 75%, and that is a diagnosis we want to find sooner rather than later.
Seven categories. Some sit on firm guideline-grade evidence; some are emerging fields where mainstream guidelines haven't caught up. We test both because the cost of testing is small, and the cost of missing a treatable cause is the next pregnancy.
The point of testing comprehensively is to find one of these. Each has a treatment that meaningfully shifts your next-pregnancy odds.
The most treatable cause. Aspirin + LMWH drops next-pregnancy loss from ~80% to ~20%.
Auto-antibodies bind phospholipids on cell membranes, triggering small clots in the placental microvasculature and impairing implantation. Diagnosed by persistent positive lupus anticoagulant, anti-cardiolipin, or anti-β2-glycoprotein-I on two occasions ≥12 weeks apart.
50–70% of miscarriages are aneuploid. Parental karyotype, POC analysis, and IVF with PGT-A as a high-success route.
Most early miscarriages are caused by random aneuploidy in the embryo (extra or missing chromosomes), incompatible with continued development. The risk rises sharply with maternal age — at 40 over half of all blastocysts are aneuploid. In about 3–5% of recurrent-loss couples, one parent also carries a balanced translocation, producing unbalanced embryos at high rates.
Septum, polyps, fibroids, adhesions. All correctable hysteroscopically.
A septate uterus distorts the cavity and reduces blood supply at the implantation site. Polyps and submucous fibroids interfere mechanically and inflammatorily. Adhesions (Asherman's syndrome) prevent normal endometrial response. All are correctable in a single hysteroscopic procedure.
Subclinical hypothyroidism, poorly-controlled diabetes, hyperprolactinaemia. All easily corrected.
Factor V Leiden, Prothrombin, Antithrombin/Protein C/S deficiency. Treatment is selective.
Inherited mutations that increase clotting tendency. Their causal role in early miscarriage is debated, but the strongest evidence supports anticoagulation in homozygous Factor V Leiden, homozygous Prothrombin, and Antithrombin III deficiency. Heterozygous forms carry less weight.
Elevated uNK, Th1-shift, autoimmune markers. Treatments individualised; evidence emerging.
Pregnancy requires the maternal immune system to tolerate a half-foreign embryo. In some women, that tolerance fails — uterine NK cells are too active, T-helper cells are inflammatory rather than supportive, or autoantibodies disrupt placental development. The field is real but the evidence base for specific treatments remains mixed.
Chronic endometritis is treated with one course of doxycycline. Cure rate >90%.
Vitamin D, B12, folate, iron, BMI, smoking, alcohol. Each correctable; effect compounds.
High SDF (>30%) raises miscarriage risk. Lifestyle, antioxidants, ICSI with selected sperm.
Higher than you fear. Most women with idiopathic recurrent loss have live birth in the next pregnancy without any specific treatment. The calculator above gives the published baseline. With identification and treatment of an underlying cause — antiphospholipid syndrome, thyroid, uterine anomaly — the figure rises further. Most couples take a baby home.
No. The clinical evidence is consistent: stress, sex during pregnancy, exercise, lifting, working, flying — none of these cause early miscarriage. The most common cause is random embryonic chromosomal abnormality, which is set at conception and beyond anyone's control. Your grief is real; the guilt is not earned.
The international guidelines define formal RPL workup at two or more losses because they're written for system-level care, where the threshold balances investigation breadth against the probability of finding a treatable cause across a population. Our practice is different in scope: we sit with you individually, look at the specific picture, and decide together. Where evidence supports early testing — late loss, heartbeat loss, age over 35, prior IVF, autoimmune or thrombotic family history — we test after a first loss. Where it doesn't, the comprehensive panel is a patient-choice option after counselling on the evidence base. This isn't a rejection of the guideline; it's individualised care that the guideline framework was never designed to deliver at the system level.
The biology is real. The treatments are still being refined. Uterine NK cells are well-studied (the Quenby group at Tommy's, UK, has the strongest evidence for prednisolone in elevated uNK). Th1/Th2 cytokine profiling has emerging evidence. IVIG and intralipid are reserved for very specific patterns and used with full disclosure that the evidence is mixed. We don't oversell, but we don't refuse to look either — that's a stance, not a guideline.
Medically, after one cycle of normal menstruation. Older advice to wait 3–6 months has been disproven — couples who try sooner have similar or better outcomes. Emotionally, take whatever time you need. The two timelines don't have to match. Use the gap to complete the workup.
Around 25–50% of recurrent losses remain unexplained even after a comprehensive workup. The reassuring data: women with idiopathic RPL have the same 65–75% next-pregnancy live-birth rate as those with treatable causes. Tender loving care (TLC) — early reassurance scans, intensive support, lifestyle optimisation — improves outcomes meaningfully even without a specific medication.
Rarely, as first-line. IVF doesn't fix recurrent loss unless there's a balanced parental translocation (where PGT-SR helps), severe sperm DNA fragmentation (where ICSI with sperm selection helps), or independent infertility. For most RPL couples, treating the identified cause and trying naturally gives equal or better outcomes than IVF. We discuss IVF when the workup points to it, not as a default.
The full panel — antiphospholipid, thrombotic, endocrine, immunology, micronutrient, semen analysis with SDF, parental karyotype, 3D ultrasound — typically runs KD 800–1500 depending on which add-ons (KIR/HLA, microbiome, hysteroscopy) are indicated. Most patients have results back within 2–3 weeks; some immune assays take longer. We discuss exactly what's clinically indicated for you at consultation rather than ordering everything blindly.
A 30-minute first consultation. We'll go through your history, plan the comprehensive workup, and discuss the next-pregnancy plan. Couples consultations welcomed.