After loss · 6 min read
After recurrent miscarriage, many people want answers — and rightly so. While tests don't always find a cause, they can rule things in or out, point towards treatments that may help, and give you clearer ground to stand on. Here's an honest overview of what is usually offered, and why.
In the UK, investigations after recurrent miscarriage are guided by the Royal College of Obstetricians and Gynaecologists (RCOG) and offered through specialist recurrent miscarriage clinics. Most women are eligible for referral after three consecutive losses, and increasingly after two.
Antiphospholipid syndrome (APS) is one of the few treatable causes of recurrent miscarriage. It is diagnosed using two blood tests, taken at least 12 weeks apart. If found, treatment in a future pregnancy with low-dose aspirin and heparin has been shown to significantly improve the chance of a live birth.
A blood test from both partners can check for balanced chromosomal rearrangements, which are rare but important to identify because they affect counselling and future options. Where possible, tissue from a miscarriage can also be tested to see whether a chromosomal cause was involved in that pregnancy.
A transvaginal scan looks at the shape of the womb and checks for fibroids, polyps or signs of scarring. Sometimes a more detailed 3D scan or hysteroscopy is suggested. Treating a structural issue — when one is found and clearly relevant — can improve outcomes in some women.
A simple set of blood tests for thyroid function, blood sugar and sometimes prolactin can pick up conditions which, when treated, reduce miscarriage risk. These overlap with the basic fertility tests many people will have already had.
You may read online about "natural killer cell" testing, extensive immune panels or thrombophilia screens beyond APS. The RCOG and NICE currently do not recommend these as routine investigations, because the evidence does not support clear benefit. A good clinic will be honest with you about what tests can — and cannot — change.
Around half of couples will be told that no cause has been identified. This is one of the hardest parts of the process, but it is genuinely not bad news: large studies show that even with unexplained recurrent miscarriage, the chance of a successful future pregnancy with supportive care remains high. Early reassurance scans and continuity of care make a meaningful difference.
If you'd like to talk through what investigations might be right for you, please get in touch. We'll listen first, and explain things gently.
