Recurrent Miscarriage — What to Investigate

What investigations are recommended after recurrent miscarriage, what each test is looking for, and what treatments are available based on results.

When to Investigate

Investigation is recommended after 2 or more consecutive miscarriages (at any gestation) or any second-trimester loss. Up to 50% of couples will have an identifiable cause.

Recommended Tests

Both Partners

Karyotype (chromosomal analysis) — looking for balanced translocation

Female Partner

Antiphospholipid antibodies × 2 tests 12 weeks apart — for APS
Thrombophilia screen (Factor V Leiden, protein C/S, antithrombin)
TSH, Free T4, anti-TPO antibodies
Uterine cavity assessment (sonohysterogram / hysteroscopy)
HbA1c and fasting glucose

Male Partner

Semen analysis
Sperm DNA fragmentation (DFI)

Treatments Based on Findings

APS: Aspirin 75–100 mg + LMWH heparin
Thrombophilia: LMWH heparin during conception and pregnancy
Thyroid disease: Levothyroxine, maintain TSH <2.5
Uterine septum: Hysteroscopic metroplasty
Chromosomal translocation: PGT-SR in IVF
No cause found: Supportive care + progesterone from positive test to 12 weeks