You've experienced a loss
First: this is not your fault, and you don't have to be ready for anything yet. When you want it, this Path covers what to ask, when an evaluation is appropriate, and what support exists. One thing to know right now: a guideline threshold is when testing gets offered, not when you're allowed to ask. Two or more losses meets the definition (they don't have to be consecutive, and chemical pregnancies count) — and a single loss at or after 10 weeks is already a recognised reason to ask for antiphospholipid antibody testing. You can ask before you try again, and there are good reasons to. Here's the panel, and how to ask for it. Most women who've had losses go on to have a successful pregnancy, including many with no treatment at all.
Early miscarriage is common, and most are caused by chromosomal problems no one could have prevented. The search for something you did wrong will come up empty.
ASRM defines recurrent pregnancy loss as two or more losses, not necessarily consecutive. That's the point at which an evaluation is offered.
The evaluation is targeted rather than one giant panel: chromosome testing of the pregnancy tissue where possible, antiphospholipid antibodies, thyroid, and a look at the uterine cavity.
Not every test is right for everyone, and it's completely fair to ask why each one is or isn't being ordered.
You don't have to wait to start. Antiphospholipid syndrome can't be diagnosed from one blood draw — a positive must be confirmed 12 weeks later.
And the treatment, low-dose aspirin plus heparin, has to begin in early pregnancy. Starting the clock before you conceive is how you get an answer in time.
- Look after your body first. Ask for follow-up to confirm your pregnancy hormone returns to zero, and whether your blood type (Rh status) means you need treatment. Seek care urgently for heavy bleeding, fever or severe pain.
- Ask about testing the tissue, if it's not too late. If tissue was sent to pathology, ask whether a preserved sample was kept.
- Strong evidence Keep taking a prenatal. It's one less thing to start later, whenever you're ready.
- Get support in early. Counselling and support groups are part of care. Where to find it.
The recurrent loss panel, by name
Antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-β2-glycoprotein I), TSH, and a uterine cavity evaluation, plus tissue testing when possible. Asking for the pieces by name gets you further than asking for "the panel." What each one looks for →Testing the pregnancy tissue
When possible, chromosome testing of the tissue can explain a loss and is now the recommended first step. Time-sensitive: if it isn't collected, that window closes for good.Antiphospholipid antibodies
Lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein antibodies. A treatable cause of recurrent loss; treatment usually involves low-dose aspirin and heparin during pregnancy.Thyroid
TSH, and thyroid antibodies in some cases.Uterine cavity
Ultrasound, saline sonogram, or hysteroscopy to look for a septum, polyps, fibroids, or scarring.Parental chromosomes
Karyotyping of both partners is considered in some situations rather than routinely; ask whether it applies to you.Diabetes and other conditions
Screening when history suggests it.Support
Counseling and support groups are part of care, not an afterthought.
- Can we start the recurrent pregnancy loss evaluation before I try again, rather than waiting?A threshold is when testing is offered, not when you're allowed to ask. Two or more losses meets the ASRM definition (non-consecutive counts, chemical pregnancies count), and one loss at or after 10 weeks is already a recognised reason to ask for APS testing.
- If you don't think it's indicated for me, can you help me understand why, and note in my chart that I asked?This turns a no into a reason. A reason is something you can take to a second opinion.
- Can the pregnancy tissue be tested for chromosomes? If it happens again, what's the plan to make sure the tissue actually gets collected and sent?Agree this in advance. In the moment, nobody is thinking about lab logistics.
- Have I been tested for antiphospholipid antibodies — lupus anticoagulant, anticardiolipin, and anti-β2-glycoprotein I? If not, can we start now?The most commonly skipped treatable cause. A positive needs a confirmatory repeat 12 weeks later, so starting before you conceive is how you get a usable answer in time.
Plus 8 more on your appointment checklist.
If an evaluation finds something, there's usually a specific treatment right behind it. Antiphospholipid syndrome, thyroid conditions, uterine septa and blood sugar are all treatable — and all of them are treated between pregnancies or from the very start of the next one, which is the whole argument for testing before you try again.
If nothing is found, that's not the same as nothing can be done: early monitoring and support in a next pregnancy are reasonable to ask for, and your odds remain good.
There's no timeline for trying again. When you're ready, this same Path, entered through I'm trying again, covers what to ask.
Know the numbers before this conversation. ASRM and ESHRE define recurrent pregnancy loss as two or more losses, not necessarily consecutive. The WHO and the UK's RCOG have used three consecutive losses. In one study of the same population, 15.3% met the ASRM/ESHRE definition and 5.3% met the WHO/RCOG one, so which definition your doctor uses can decide whether you're evaluated now or told to try again. If you're at two losses, that's worth naming out loud.
It's reasonable to seek another opinion if you asked for the evaluation and were told to keep trying without one, or without a reason; if the antiphospholipid tests haven't been done; if you're told 'it's just bad luck' after two or more losses without any evaluation; or if you don't feel heard. Reproductive endocrinologists and maternal-fetal medicine specialists both see recurrent loss. See I want a second opinion.