Recurrent Miscarriage: Causes, Tests and Treatment in Lucknow

Losing a pregnancy once is a grief that is hard to put into words. Losing two or more is something that changes the way a couple thinks about the future. If you are reading this, you are probably not here for reassurance. You are here for answers.

Recurrent miscarriage, baar baar garbhapat, is defined as two or more pregnancy losses. It is not simply bad luck and it is not your fault. In most cases it has a cause that can be investigated and, in many cases, a treatment that can help. Dr. Kumudini Chauhan at Ganga Laxmi IVF, Lucknow, has guided many couples through exactly this process. This article explains what she looks for, what she tests, and what she does when she finds a cause.

What Is Recurrent Miscarriage? The 2026 ASRM Definition

Recurrent miscarriage, also called recurrent pregnancy loss (RPL), means two or more pregnancy losses. Under the latest 2026 ASRM Committee Opinion, the losses do not have to be consecutive, and pregnancy losses confirmed by blood or urine hCG — including very early biochemical pregnancies — may also be included in the count. This is a meaningful update from older guidance, which required losses to be consecutive.

The ASRM also updated its recommendation for when investigation should begin: after two losses, not three. Waiting for a third loss causes unnecessary emotional and physical harm to couples who deserve answers sooner. At Ganga Laxmi IVF, a full evaluation is offered after two losses.

There are two types:

• Primary recurrent miscarriage means losses without any successful pregnancy before them.
• Secondary recurrent miscarriage means losses that occurred after at least one successful pregnancy. Secondary recurrent miscarriage generally carries a somewhat better prognosis, but both types deserve the same systematic investigation.

Reference: ASRM Committee Opinion: Recurrent Pregnancy Loss (2026)

What Causes Recurrent Miscarriage?

Dr. Kumudini Chauhan looks for specific causes in every patient she sees with recurrent losses. Here are the most common reasons.

Chromosomal Abnormalities in the Embryo

Chromosomal abnormalities are the most common cause of individual early miscarriages. As a fertilised egg divides, errors in chromosome distribution can occur. The resulting embryo cannot develop normally and the pregnancy ends.

Chromosomal error rates increase with maternal age, which is why recurrent miscarriage becomes more common in women in their late 30s and early 40s. However, chromosomal causes can occur at any age.

Uterine Structural Problems

Abnormalities inside the uterine cavity can prevent implantation or disrupt early pregnancy development. These include:

• Uterine septum: a wall of tissue running down the middle of the cavity, the most common correctable structural cause
• Submucosal fibroids: fibroids growing inside the cavity that distort its shape
• Endometrial polyps: small growths on the uterine lining
• Asherman's syndrome: intrauterine adhesions (scar tissue) from prior surgery or infection

Some of these may require more detailed assessment, such as 3D ultrasound or hysteroscopic evaluation and treatment, when a standard ultrasound does not provide enough information.

Antiphospholipid Syndrome (APS)

APS is an autoimmune condition in which the body produces antibodies that cause abnormal blood clotting in the small vessels supplying the placenta. This cuts off the embryo's blood supply and causes pregnancy loss, often in the second trimester. APS is one of the most treatable causes of recurrent miscarriage, with established protocols using low-dose aspirin combined with low-molecular-weight heparin.

Inherited Thrombophilia: A Studied but Not Routinely Tested Factor

Inherited thrombophilias — including Factor V Leiden mutation, MTHFR variant, and deficiencies of Protein C and Protein S — have been investigated as possible contributors to recurrent pregnancy loss. However, the relationship between these variants and RPL is not clearly established, and treating a positive result has not been shown to reliably improve outcomes. For this reason, the 2026 ASRM guidance does not recommend routine inherited thrombophilia screening in RPL (see “Investigations for Recurrent Miscarriage” below). This is distinct from antiphospholipid syndrome above, which is an acquired condition with an established, evidence-based treatment.

Thyroid Dysfunction

Both underactive and overactive thyroid, when inadequately controlled, are associated with pregnancy loss. Thyroid function is one of the most commonly correctable causes of recurrent miscarriage, and it is straightforward to test and treat. Dr. Kumudini Chauhan includes thyroid function testing in every recurrent miscarriage workup, without exception.

PCOS and Hormonal Imbalance

PCOS is associated with metabolic and reproductive factors — elevated luteinising hormone (LH), insulin resistance, and hormonal imbalance — that may affect egg quality and uterine receptivity, but PCOS alone should not be assumed to be the cause of recurrent pregnancy loss. This is particularly relevant for patients in Uttar Pradesh, where PCOS prevalence is high. Dr. Chauhan addresses the hormonal environment before the next conception attempt when PCOS is identified in a patient with recurrent losses.

Sperm DNA Fragmentation

Recurrent miscarriage is not exclusively a female-side concern. Even when a male partner's standard semen analysis is entirely normal, high sperm DNA fragmentation can contribute to embryo quality problems and early pregnancy losses. Dr. Kumudini Chauhan recommends sperm DNA fragmentation testing for the male partner in appropriate cases, particularly when female-side investigations are negative.

Unexplained Recurrent Miscarriage

In many couples with recurrent pregnancy loss, no single clear cause is identified even after a thorough investigation. This is known as unexplained recurrent pregnancy loss. It is frustrating, but a normal investigation does not mean treatment cannot help — ongoing monitoring and supportive care in early pregnancy, along with IVF and PGT-A testing where appropriate, have improved outcomes significantly for these couples.

Can Genetic Testing Be Done on Miscarriage Tissue?

This is an important investigation that is often not discussed with couples after a loss, and it is newly emphasised in the 2026 ASRM guidance.

Where miscarriage tissue is available — either passed naturally or obtained during a surgical procedure (D&C) — chromosome evaluation of that tissue can often identify whether a chromosomal abnormality was the cause of that specific loss. This matters because:

• A chromosomally abnormal miscarriage (aneuploid) is most likely a sporadic event that does not necessarily indicate an ongoing problem in the parents
• A chromosomally normal miscarriage (euploid) despite a healthy embryo points the investigation more firmly toward the uterine or maternal environment
• A consistent pattern of aneuploid losses may support the consideration of IVF with PGT-A in selected patients
• A chromosomally normal loss in a patient with no other identified cause may prompt further uterine investigation

If genetic testing on miscarriage tissue was not done at the time of a previous loss, this does not prevent a full investigation now. However, where future losses occur, Dr. Chauhan will advise on the option of tissue testing at the time.

Parental karyotyping — chromosomal analysis of both partners — may follow where tissue testing identifies a structural chromosomal abnormality, or where the clinical history suggests a possible inherited cause. This is done in selected cases, not routinely.

Investigations for Recurrent Miscarriage: What Is and Is Not Recommended

The 2026 ASRM Committee Opinion specifically emphasises that recurrent miscarriage investigation should be targeted — not a matter of ordering every available test. Some tests that are widely offered by fertility clinics are not supported by current evidence and may add cost and anxiety without changing clinical management.

At Ganga Laxmi IVF, the investigation is designed based on individual clinical history, not a standard panel applied to every patient.

Tests That Are Commonly Recommended

Tests Considered in Selected Patients Only

Tests That Are NOT Routinely Recommended

The following tests are commonly offered or self-requested by patients based on online research. The 2026 ASRM guidance explicitly states that these are not recommended as routine investigations for RPL, as evidence does not support routine use:

Reference: ASRM Committee Opinion: Recurrent Pregnancy Loss (2026)

Uterine Investigations Dr. Chauhan Orders

Blood tests investigate systemic and hormonal causes. Uterine investigations examine the physical environment where the pregnancy must implant and grow.

Dr. Kumudini Chauhan's standard uterine evaluation for recurrent miscarriage begins with a pelvic ultrasound, which provides an overview of the uterus, ovaries, and any obvious structural abnormalities. Where the cavity shape needs more precise assessment, a 3D ultrasound gives a clearer three-dimensional view of the uterus that a standard 2D scan cannot provide.

When direct evaluation of the uterine cavity is needed, hysteroscopy — a thin camera passed through the cervix — allows direct visualisation of the inside of the cavity. It identifies abnormalities that scans can miss, including small polyps, adhesions, and subtle septae, and when an abnormality is found, it can often be corrected in the same procedure.

Step-by-Step: The Recurrent Miscarriage Evaluation at Ganga Laxmi IVF

Treatments That Can Help After Recurrent Miscarriage

Dr. Kumudini Chauhan does not prescribe a protocol until the investigation is complete. Treatment for antiphospholipid syndrome is different from treatment for a uterine septum, which is different again from treatment for unexplained loss. The diagnosis comes first.

Antiphospholipid Syndrome

Low-dose aspirin combined with low-molecular-weight heparin (LMWH) injections, started in early pregnancy and continued until the third trimester. This is the established, evidence-based first-line treatment for APS-related recurrent miscarriage. Clinical decision on dosage and duration is made by Dr. Chauhan based on your individual case.

Uterine Structural Issues

Hysteroscopic surgery to remove septa, polyps, submucosal fibroids, or intrauterine adhesions. This is a day-care procedure at Ganga Laxmi IVF, carried out by Dr. Chauhan personally. After the procedure, the cavity is reassessed to confirm the correction before the next conception attempt.

Thyroid Dysfunction

Medication to normalise thyroid hormone levels before attempting pregnancy. The target TSH for women trying to conceive is tighter than the standard laboratory reference range. Dr. Chauhan monitors thyroid function through early pregnancy in patients with a history of thyroid-related loss.

Progesterone Supplementation

Vaginal progesterone may be considered in early pregnancy, particularly in the setting of vaginal bleeding or unexplained recurrent early loss, using shared decision-making. The 2026 ASRM guidance notes that evidence remains insufficient for routine use, but progesterone may be offered in appropriate clinical contexts. Where it is used, it is most likely to be beneficial when started in the luteal phase before the implantation window rather than after a positive pregnancy test.

Unexplained Recurrent Miscarriage

IVF with preimplantation genetic testing (PGT-A) may be discussed in selected patients to select chromosomally normal embryos for transfer. While this targets the most common cause of individual miscarriages — chromosomal abnormality in the embryo — the 2026 ASRM guidance notes that PGT-A has not been shown to significantly reduce miscarriage rates or improve live birth rates compared with expectant management in unselected RPL patients. It is one option to weigh through shared decision-making, not a default treatment.

When Can IVF with PGT-A Help with Recurrent Miscarriage?

IVF with preimplantation genetic testing for aneuploidy (PGT-A) is sometimes discussed as a treatment option for recurrent miscarriage. Understanding what it can and cannot offer is important before considering it.

What PGT-A does: PGT-A tests each embryo's chromosomes before transfer and allows only chromosomally normal (euploid) embryos to be transferred. Because chromosomal abnormality in the embryo is the most common cause of individual miscarriages, this approach aims to reduce the likelihood of transferring an aneuploid embryo that would miscarry.

What the evidence shows: The 2026 ASRM Committee Opinion states clearly that PGT-A has not been shown to significantly reduce miscarriage rates or improve live birth rates compared with expectant management in unselected RPL patients. This does not mean PGT-A is never appropriate in RPL — it means it should be considered through shared decision-making based on individual clinical factors.

When IVF with PGT-A may be worth discussing

• Women over 38 to 40 where age-related aneuploidy is likely to be a significant contributor to losses
• Couples where a previous miscarriage was confirmed aneuploid and there is a pattern of chromosomally abnormal losses
• Couples where one partner carries a balanced chromosomal translocation (PGT-SR, not PGT-A, is the appropriate test in this case)
• Couples who have had multiple losses with a fully normal RPL workup and who are willing to accept the costs and process of IVF in exchange for the ability to test embryos before transfer
• Couples with concurrent fertility concerns where IVF may be indicated on other grounds

Dr. Kumudini Chauhan discusses IVF and PGT-A as a considered option in appropriate clinical situations, with a full explanation of the evidence, the limitations, and the alternatives, so that each couple can make an informed decision based on their own circumstances.

References: ASRM Committee Opinion: Recurrent Pregnancy Loss (2026) | ASRM: The Use of PGT-A: A Committee Opinion (2024)

Does PCOS Increase Miscarriage Risk?

PCOS is associated with factors that may increase pregnancy complications, including insulin resistance, elevated LH levels, and metabolic abnormalities that can affect egg quality and the uterine environment in early pregnancy. However, the relationship between PCOS and miscarriage is not a simple or direct causal one, and PCOS alone should not be assumed to be the sole explanation for recurrent loss.

In a patient with both PCOS and recurrent pregnancy loss, Dr. Kumudini Chauhan focuses the assessment on the individual's specific metabolic, ovulatory, and hormonal profile rather than treating PCOS as a generic cause. Where insulin resistance is confirmed, metformin may be considered — the 2026 ASRM guidance notes that metformin may reasonably be offered in women with PCOS and otherwise unexplained miscarriage, while acknowledging that more research is needed. Thyroid optimisation is always checked, as thyroid dysfunction is common alongside PCOS in Indian women. Ovulation induction with careful monitoring is preferred over relying on spontaneous cycles in which hormonal conditions may be less predictable.

The starting point is a thorough assessment of what is driving the picture in your specific case, not a generic protocol for everyone with a PCOS diagnosis.

Is There Hope After Recurrent Miscarriage? What the Evidence Says

The honest answer is yes, and it is grounded in evidence.

The ASRM 2026 guidance includes an important natural history finding: 50 to 80 percent of patients with unexplained RPL will go on to have a successful pregnancy in a subsequent attempt, even without specific intervention. This is not a reason to skip investigation or decline treatment where a cause is identified — it is context that matters when weighing options and setting expectations.

For couples where a specific cause is identified and treated, the prognosis is generally better still: APS treated with aspirin and heparin, uterine abnormalities corrected with hysteroscopic surgery, and thyroid dysfunction managed before the next conception attempt all carry meaningful evidence of benefit.

The path is rarely straightforward. But for most couples, it exists.

What Dr. Kumudini Chauhan offers is not a guarantee. She offers a thorough, evidence-led investigation that gives you the best possible chance of understanding why this has been happening, and a treatment plan calibrated to what she finds — not a generic protocol applied to every patient regardless of their individual picture.

Reference: ASRM Committee Opinion: Recurrent Pregnancy Loss (2026)