Assessment after recurrent miscarriages

After repeated miscarriages, assessment aims to find an explanation and help plan the next steps. Investigations are tailored to each individual situation.

When should assessment be considered?

A consultation may be offered after two pregnancy losses. Definitions vary between two and three losses across guidelines. Age and medical history guide the approach; assessment is not restricted to women under 40.

The consultation comes first

Your doctor reviews your pregnancy history and both partners’ medical and family histories. Bring the available reports and a list of your medicines. You can also make a note of the questions you would like to discuss during the consultation.

Assessing the uterus

A pelvic ultrasound, ideally using three-dimensional imaging to assess the shape of the uterus, can identify certain abnormalities. Depending on the findings, further assessment of the uterine cavity, such as hysteroscopy, may be discussed.

Selecting blood tests

Depending on the circumstances, your doctor may investigate thyroid disease or antiphospholipid syndrome (APS). Diabetes screening depends partly on your medical history. A single result cannot confirm APS: repeat blood tests are needed.

Distinguishing genetic investigations

When possible, testing miscarriage tissue can look for a chromosomal abnormality. Parental karyotyping is considered according to the findings and family history. An identified abnormality may lead to genetic counselling.

Additional investigations in selected situations

An endometrial biopsy to investigate chronic endometritis may be considered when losses remain unexplained or infertility is also present.

Sperm DNA fragmentation testing is separate from a standard semen analysis and may be considered in some of these circumstances. These investigations are not routine for everyone; their purpose and limitations should be explained.

Avoiding unnecessary testing

Broad immune testing, inherited thrombophilia screening and endometrial receptivity tests are not part of a routine assessment for every patient.

If a parental chromosomal rearrangement is identified

In France, preimplantation genetic testing for aneuploidy (PGT-A), which screens embryos for abnormalities in chromosome number, is not authorised. Targeted preimplantation genetic testing may be considered for a parental structural chromosomal rearrangement, particularly a translocation, following specialist assessment under French law. It examines embryos created through IVF before transfer.

Genetic counselling helps explain the options that may be available and the conditions for access to this pathway. Repeated miscarriages do not, on their own, automatically mean that IVF with preimplantation genetic testing is indicated.

Understanding the findings and planning ahead

Assessment does not always identify a cause. A follow-up consultation helps explain the results, discuss treatments that are indicated and plan care for a future pregnancy. Psychological support can be offered to both partners.