What's in a recurrent loss evaluation?
The short answer
A full evaluation looks at parental chromosomes, the uterine cavity, thyroid and blood sugar, and antiphospholipid antibodies. It explains about half of cases — and finding nothing is compatible with a good outcome.
What to know
- Testing of the pregnancy tissue where available; the parents' chromosomes in selected situations.
- Uterine cavity assessment by saline sonogram or hysteroscopy.
- Thyroid function and diabetes screening where history suggests it.
- Antiphospholipid antibodies, with confirmation at least 12 weeks apart.
- Guidelines recommend against routine NK cell testing, inherited thrombophilia panels, ERA and immune therapies.
What you can do now
- Test between pregnancies. The lupus anticoagulant test is unreliable during pregnancy or on blood thinners.
- Strong evidence Keep taking a prenatal.
- Plan the next pregnancy now. Ask about aspirin and, if you bleed, progesterone. Protecting the placenta.
Read the full explanation
Under ASRM's 2026 guidance, recurrent pregnancy loss means two or more losses (excluding molar and ectopic pregnancies), which no longer need to be consecutive, and which can include very early losses confirmed by a blood or urine test. If that's you, you can ask for an evaluation.
The current approach
The guidance has moved away from broad panels of every possible test toward targeted testing based on your history and risk factors, and it recommends against tests and treatments without strong evidence of benefit. That means it's fair to ask why each test is being ordered, and why one isn't.
What it commonly includes
- Chromosome testing of the pregnancy tissue, when possible, now prioritized as the first step. It can explain a loss and change what's needed next.
- Antiphospholipid antibody testing: lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein antibodies. Antiphospholipid syndrome is a treatable cause; treatment in pregnancy usually involves low-dose aspirin and heparin.
- Thyroid testing, and diabetes screening when history suggests it.
- Uterine cavity assessment by ultrasound, saline sonogram, or hysteroscopy, looking for a septum, polyps, fibroids, or scarring.
- Parental karyotype in selected situations rather than routinely.
What it usually doesn't include
Routine testing for inherited clotting disorders, most immune tests, and empirical treatments without a diagnosis are not recommended by current guidance. If they're suggested, ask about the evidence.
The most important number
ASRM notes that the majority of people with recurrent loss, including those with no cause found, go on to have a successful pregnancy. Emotional support is part of the recommended care, not an extra.
What the research shows
Not rated, deliberately. This page explains how something works rather than claiming a treatment helps, so a rating would mean nothing. Everything traces to the sources below.
Questions for your doctor
Edit any of these before you add it — they're yours. Your list stays in this browser, and you can print a one-page sheet from it.
- Which parts of a full recurrent loss workup have we done, and which are missing?
- Which tests would you advise against for me, and why?