SPRINGCREEK FERTILITY • PATIENT EDUCATION
When to Ask for Testing After Recurrent Miscarriage
If you’ve lost more than one pregnancy, you deserve answers and support.
October 2026 • 8 min read
Losing a pregnancy is heartbreaking. Losing more than one can leave you feeling lost, frustrated and unsure of what to do next. If that’s where you are right now, we’re so sorry. What you’re feeling is real, and it matters.
Grief after a loss affects partners too, and the two of you may not experience it in the same way. That’s normal. When you’re ready, the next step is a conversation with a specialist. You don’t have to wait for a third loss to have it.
AT A GLANCE
2 or more
Losses that meet ASRM’s definition of RPL, back to back or not
1 to 2%
Of couples are affected by RPL, according to ESHRE
Up to 15%
Of all pregnancies end in loss, according to ESHRE
50 to 80%
Of people with RPL succeed later without specific treatment, per ASRM
WHEN TO ASK
Does having two losses mean I need testing?
Two losses meet the current medical definition, so it’s completely reasonable to ask. ASRM defines RPL as the spontaneous loss of two or more pregnancies. Very early losses confirmed only by a blood or urine pregnancy test count too. Ectopic and molar pregnancies aren’t included. The losses also don’t need to happen one after another.
Why two instead of three? An expert on ASRM’s SART Fertility Experts podcast explains that testing after two losses turns up about the same findings as testing after three. There’s no reason to make you wait.
If you’ve had one loss, your worry makes sense. The reassuring news is that one miscarriage doesn’t raise your risk of losing a future pregnancy. That risk does go up after a second loss, which is why two losses is the point where an evaluation makes sense. You’re always welcome to talk with your doctor about your history in the meantime.
THE WORKUP
Which tests do doctors usually order first?
ASRM’s 2026 guidance recommends two starting points. The first is chromosome testing of the miscarriage tissue when possible. The second is a look at the uterine cavity using an HSG, a saline sonogram or a hysteroscopy. Other tests are saved for certain situations instead of being ordered for everyone.
At SpringCreek, this diagnostic step is where we begin. Our goal is to help you understand the reasons behind your losses before we talk about treatment. Our recurrent miscarriage page explains more about what the workup can look like.
| Category | Test | What ASRM says |
|---|---|---|
| Genetic | Chromosome testing of miscarriage tissue | Recommended as a first step when possible. Testing the parents’ chromosomes is for certain situations. |
| Anatomical | Uterine cavity evaluation (HSG, saline sonogram or hysteroscopy) | Recommended for patients with RPL. |
| Hormonal and metabolic | Thyroid (TSH), HbA1c and prolactin | TSH should be checked. HbA1c is for patients with risk factors. Prolactin is only checked if there are symptoms. |
| Blood and antibodies | Antiphospholipid antibodies | Warranted after three or more losses in a row with no other explanation. |
| Male partner | Sperm DNA fragmentation | For certain situations. |
IF RESULTS ARE NORMAL
What if the first results are normal?
Normal results are common, and they aren’t bad news. ESHRE says no cause is found for most couples with RPL. It also says most couples have a good chance of a live birth in their next pregnancy, with the odds shaped by age, the number of losses and whether a likely cause was found. ASRM reports that about 50% to 80% of patients succeed without specific treatment, and it says trying again on your own should be discussed as a real option.
ESHRE also points out that even when a cause is found, there may not be a treatment for it, and no treatment can remove the risk of loss completely. A good plan can include support while you decide when and how to try again. If you’re diagnosed with antiphospholipid syndrome, ASRM recommends care from a hematologist or rheumatologist with expertise in the condition.
If you’re thinking about IVF, it’s worth asking about embryo genetic testing (PGT-A). SpringCreek offers PGT-A, and your doctor can talk through whether it fits your situation. It also helps to know what the research shows. ASRM states that for RPL, PGT-A hasn’t been shown to significantly reduce miscarriage or raise live birth rates compared with trying again on your own. ASRM does say it’s reasonable to discuss for women over 40 who have had a miscarriage with a confirmed chromosome abnormality.
SETTING EXPECTATIONS
What is still unknown about recurrent loss?
Honestly, quite a bit. Chromosome changes in the embryo are the most common reason for miscarriage. ASRM notes that roughly 50% to 60% of first-trimester losses happen for this reason. The expert on the SART podcast says about half of patients find nothing on a full workup, and he believes most of those losses come from embryo problems that current tests can’t detect.
The science is still growing too. ASRM’s 2026 opinion is its first updated guidance on RPL in more than a decade, and it focuses on avoiding routine tests and treatments without strong evidence behind them. Tests such as MTHFR, clotting gene mutations and natural killer cell levels fall into that group.
Not knowing why can be one of the hardest parts. If there’s one thing to hold onto, let it be this. Your losses are not your fault.
PREPARING
What should I ask my doctor?
It helps to bring a short list. These questions come from the guidance above, and you can adapt them to your own history.
| Question to ask | Why it matters |
|---|---|
| Which tests do you recommend for me, and why? | ASRM favors targeted testing based on your history over routine panels. |
| What would each result change about my care? | Some tests lead to a specific plan. Others don’t. |
| Was tissue from a past loss tested, and can it be tested next time? | Chromosome results from miscarriage tissue guide ASRM’s step-by-step approach. |
| Are any of the tests you suggest ones ASRM doesn’t recommend routinely? | Immune, inherited clotting and several other tests aren’t routinely recommended. |
| If everything is normal, what are our options? | Trying again on your own is a real option, and more testing may not find an answer. |
| What does the timeline look like? | Knowing when results arrive helps you plan and decide when to try again. |
| Can you refer us for counseling or support? | ASRM and ESHRE both describe emotional support as part of good care. |
SUPPORT
Where can I find support while I wait?
Waiting for answers is hard, and you shouldn’t have to do it alone. ASRM says psychological support is an essential part of miscarriage care and that doctors should offer a referral for counseling. ESHRE’s guide also points to professional support and patient organizations.
Share Pregnancy & Infant Loss Support is a national organization for anyone affected by the loss of a baby during pregnancy, at birth or in early infancy. Its Ohio page lists a Columbus chapter and other local bereavement groups. Share also offers free weekly online group chats focused on pregnancy loss and pregnancy after loss, plus a national phone line at 1-800-821-6819. Schedules change, so check the page before planning around a meeting.
Our team at SpringCreek is here for you too. Let us know how you’re doing, and ask about a counseling referral at any point along the way.
FREQUENTLY ASKED QUESTIONS
Quick answers
Q. Does having two losses mean I need testing?
A. Two losses meet ASRM’s definition of recurrent pregnancy loss, and the losses don’t need to be back to back. Asking about an evaluation at that point is completely reasonable.
Q. Which tests do doctors usually order first?
A. ASRM recommends chromosome testing of the miscarriage tissue when possible and a look at the uterine cavity. Other tests, such as thyroid, antiphospholipid antibodies and parental chromosomes, depend on your history.
Q. What happens at the first appointment?
A. At SpringCreek, your first visit is an hour-long consultation with a physician. Partners are encouraged to come. You’ll review your history and losses together and make a plan for testing.
Q. What if the first results are normal?
A. Normal results are common. ESHRE says no cause is found for most couples, and ASRM reports that about 50% to 80% of patients succeed in a later pregnancy without specific treatment.
Q. What is still unknown about recurrent loss?
A. In many cases no cause is found, and the research is still growing. ASRM’s 2026 guidance focuses on avoiding tests and treatments without strong evidence behind them.
Q. What should I ask my doctor?
A. Ask which tests are recommended for you and why, what each result would change, whether tissue from a past loss was tested and what your options are if results come back normal.
Q. Where can I find support while I wait?
A. Ask your care team about a counseling referral, and consider national organizations such as Share Pregnancy & Infant Loss Support, which hosts free online groups.
Ready to talk about testing?
If you’ve had two or more losses, we would be honored to help you look for answers. Call our Dayton office at (937) 458-5084 or our Columbus office in Dublin at (614) 401-4113. You can also request an appointment online.
Request an appointment → Recurrent miscarriage care → Fertility FAQs →
This article is for general education and is not medical or mental health advice. Every person’s history is different, and testing decisions should be made with your own physician. If grief, anxiety or low mood is affecting your daily life, please talk with a licensed mental health professional. SpringCreek Fertility provides care at locations in Dayton, Dublin and Mason, Ohio.
SOURCES
ASRM, Recurrent pregnancy loss: a committee opinion (2026), Fertil Steril 2026;125:1023–41
ASRM, ASRM releases first updated guidance on recurrent pregnancy loss in over a decade (June 1, 2026)
ESHRE, Recurrent pregnancy loss patient guideline, 2022 update
ASRM SART Fertility Experts, Recurrent pregnancy loss and implantation failure (podcast transcript)
Share Pregnancy & Infant Loss Support, Ohio
SpringCreek Fertility, Recurrent miscarriage
SpringCreek Fertility, Fertility FAQs
SpringCreek Fertility, Schedule an appointment
