Repeated Miscarriage: The Hidden Cause Most Doctors Miss
Dr Mannan Gupta
Medically Reviewed by Dr. Mannan Gupta On June 9, 2026
If you have lost two or more pregnancies, you already know that no amount of “it was just bad luck” makes the pain easier to carry.
But here is what you may not know: in many cases of recurrent pregnancy loss, there is a real, identifiable, and treatable cause — one that a standard check-up will often miss entirely.
For couples seeking answers and recurrent miscarriage treatment in New Delhi, the right specialist with the right tests can change everything.
Key Takeaways
- What recurrent pregnancy loss actually means and how common it is
- The most frequently missed causes — including one that involves the father, not the mother
- Which diagnostic tests you should insist on
- The most effective treatments available today
- How to protect your emotional health through this journey
Why Do Some Women Keep Losing Pregnancies?
What Counts as Recurrent Pregnancy Loss?
Recurrent pregnancy loss (RPL) is medically defined as two or more consecutive miscarriages before 20 weeks of pregnancy.
Some specialists begin investigation after just two losses, while others wait for three — but most modern guidelines, including those from the American Society of Reproductive Medicine (ASRM), recommend evaluation after two consecutive losses. Every pregnancy loss is a medical event worth investigating, not just grieving.
How Common Is It, Really?
Miscarriage itself is surprisingly common, affecting roughly one in four recognized pregnancies. But recurrent pregnancy loss is less common — it affects approximately 1% of couples trying to conceive.
That 1% still represents millions of families worldwide, and in India, the number of women suffering in silence without a proper diagnosis is significant.
Why It Often Goes Undiagnosed for Too Long?
Many women are told after one or even two losses to “try again” without any investigation. This is not always negligence — sometimes it is standard protocol.
But waiting without testing means missing a window to identify causes that are highly treatable.
Recurrent pregnancy loss also places a woman firmly in the high-risk pregnancy category, which means her care requires a level of specialist oversight that routine antenatal follow-up cannot provide.
If you are navigating this in New Delhi, High-Risk Pregnancy Care in New Delhi outlines what that specialist-level care involves and why it matters.
The sooner a structured investigation begins, the sooner answers — and solutions — become possible.
What Are the Most Common Causes of Recurrent Pregnancy Loss?
Chromosomal Abnormalities in the Embryo
Around 50–60% of early miscarriages are caused by chromosomal abnormalities in the embryo itself — random errors during egg or sperm development that make the pregnancy non-viable.
In some couples, one partner carries what is called a “balanced translocation,” a rearrangement of genetic material that looks normal in the carrier but significantly raises the risk of miscarriage. A simple blood test called a karyotype can identify this.
Uterine Structural Problems
The shape of the uterus matters enormously for carrying a pregnancy. A septate uterus (a wall dividing the uterine cavity), fibroids pressing into the uterine cavity, polyps, or adhesions from past procedures can all prevent a healthy implantation.
These structural problems are often entirely correctable with minimally invasive surgery, and detecting them can be the turning point in a couple’s journey.
Hormonal Imbalances — Thyroid, Progesterone, Insulin
Thyroid dysfunction is one of the most underdiagnosed contributors to repeated pregnancy loss. Even a “borderline” TSH level that a general physician might overlook can impair embryo implantation and early development.
Progesterone, the hormone that prepares and maintains the uterine lining, is equally critical — low progesterone in early pregnancy is a well-established cause of loss that responds well to supplementation.
Poorly controlled diabetes and polycystic ovarian syndrome (PCOS) also disrupt the hormonal environment needed to sustain a pregnancy.
Blood Clotting Disorders — Thrombophilia and APS
Antiphospholipid syndrome (APS) is an immune disorder that causes the blood to clot too easily, cutting off blood flow to the developing placenta and causing miscarriage.
It is one of the most important — and treatable — causes of RPL. Beyond APS, inherited thrombophilia gene mutations such as Factor V Leiden or MTHFR variants can similarly impair placental circulation.
These are identified through targeted blood panels, and treatment with low-dose aspirin and blood thinners (heparin) has a strong success record.
Immunological Dysfunction and Uterine NK Cells
The immune system plays a complex and fascinating role in pregnancy. The body must partially “suppress” its immune response to accept the embryo, which it would otherwise identify as foreign tissue.
In some women, uterine natural killer (NK) cells are overactive, attacking the embryo rather than protecting it.
This is an emerging field, and specialist centres can test NK cell activity through an endometrial biopsy, opening the door to immunological treatment pathways.
The Hidden Cause Most Doctors Miss — Could It Be the Male Factor?
This is the section that surprises most patients — and even some doctors.
Sperm DNA Fragmentation Explained
A standard semen analysis checks sperm count, shape, and movement. It does not check the genetic health of the sperm itself.
Sperm DNA fragmentation refers to breaks or damage within the DNA strands of sperm cells. When a sperm with fragmented DNA fertilizes an egg, the embryo may begin to develop but then fail — often in the first trimester.
Research published in leading reproductive medicine journals confirms that men in couples experiencing RPL have significantly higher rates of sperm DNA fragmentation.
Why Routine Semen Analysis Misses It?
A man can have a “perfectly normal” semen report — good count, good motility, good morphology — and still have high DNA fragmentation.
This is precisely why sperm DNA fragmentation is the hidden cause in many cases of unexplained recurrent miscarriage.
It requires a dedicated test called the Sperm DNA Fragmentation Index (DFI), which is separate from and more revealing than a routine semen analysis.
How to Test and What It Means?
The DFI test is a blood/semen test available at specialized fertility centres.
A DFI above 25–30% is considered clinically significant and associated with higher miscarriage rates.
The good news: this is often improvable with targeted interventions including antioxidant therapy, lifestyle changes, and in some cases, surgical sperm retrieval to obtain healthier sperm directly from the testes.
Dr Mannan IVF Centre
Experience world-class fertility care with Dr. Mannan Gupta at the Best IVF Centre in Delhi
How Is Recurrent Pregnancy Loss Properly Diagnosed?
A thorough RPL workup is not a single test — it is a structured investigation.
The Right Panel of Blood Tests
Every woman with RPL should be tested for antiphospholipid antibodies, a full thyroid panel (including TSH and free T4), fasting blood sugar, prolactin levels, and a thrombophilia screen. Hormonal profiling mid-cycle is also valuable. These blood tests alone can identify causes in a significant proportion of patients.
Uterine Imaging — What to Look For
A 3D pelvic ultrasound or saline infusion sonography (SIS) can reveal structural problems inside the uterine cavity with remarkable clarity.
A hysteroscopy — a small camera passed into the uterus — is the gold standard for diagnosing and simultaneously treating polyps, septums, and adhesions.
If your doctor has only performed a standard 2D ultrasound, it may not be enough.
Genetic Testing for Both Partners
Karyotyping of both partners identifies chromosomal rearrangements. If the pregnancy tissue from a prior miscarriage was saved, chromosomal microarray analysis of the products of conception can reveal whether that specific loss was due to a genetic abnormality — information that guides the entire treatment plan going forward.
What Are the Most Effective Treatment Options Today?
Progesterone Support and Hormonal Therapy
For women with luteal phase deficiency or low progesterone, progesterone supplementation started immediately after ovulation or a positive pregnancy test has been shown to improve live birth rates.
Thyroid optimization with medication is similarly straightforward and highly effective.
Blood Thinners for Clotting Disorders
Women diagnosed with APS or thrombophilia are typically placed on a combination of low-dose aspirin and low molecular weight heparin (LMWH) injections during pregnancy.
This protocol has transformed outcomes for women who previously lost every pregnancy — many go on to deliver healthy babies with this treatment alone.
PGT-A With IVF for Chromosomal Causes
When chromosomal factors are the underlying cause — particularly in women of advanced maternal age or couples with balanced translocations — IVF combined with Preimplantation Genetic Testing for Aneuploidies (PGT-A) allows only chromosomally normal embryos to be transferred, dramatically improving success rates and reducing miscarriage risk.
Surgical Correction of Uterine Anomalies
A uterine septum or significant intrauterine adhesions can be corrected via hysteroscopic surgery, a minimally invasive outpatient procedure.
Many women who have undergone uterine surgery go on to carry their next pregnancy to term without any further intervention.
If you are in Delhi and have experienced two or more miscarriages without a clear answer, it is time for a specialist-level evaluation. Dr. Mannan Gupta at Dr. Mannan IVF Centre has helped hundreds of couples in New Delhi navigate this exact journey — from investigation through to a successful pregnancy. You can explore your options and book an appointment.
What Does the Emotional Journey Look Like — and How Can You Cope?
Grief, Guilt, and Why Both Are Normal
Grief after repeated pregnancy loss is real, valid, and medically recognized. Many women also carry intense guilt — wondering if they did something wrong, if their body has “failed” them.
The science is unambiguous: the vast majority of miscarriages are caused by biological factors outside any individual’s control. Acknowledging this is not just emotionally important — it is clinically accurate.
Psychological Support as Part of Treatment
Psychological counselling and peer support groups are now considered a legitimate and important component of RPL management by reproductive medicine guidelines worldwide.
Anxiety and depression following repeated losses can affect hormonal balance and general health. Addressing mental wellbeing is not separate from fertility treatment — it is part of it.
Can Lifestyle Changes Actually Make a Difference?
Weight, Sleep, and Stress
Both underweight and overweight states negatively affect hormonal balance and implantation.
Chronic sleep deprivation elevates cortisol, which suppresses reproductive hormones.
While lifestyle changes alone rarely “cure” RPL, they create a significantly better physiological environment for treatment to succeed.
Diet, Antioxidants, and Supplements
A Mediterranean-style diet rich in vegetables, whole grains, and lean proteins supports reproductive health.
Antioxidant supplements — particularly CoQ10 for egg quality and Vitamin D for immune regulation — are increasingly recommended by fertility specialists.
Folate (folic acid) remains essential for all women trying to conceive and should be started before pregnancy.
Final Thoughts
Repeated miscarriage is one of the most emotionally devastating experiences a couple can face — but it is not one without answers.
Most cases of recurrent pregnancy loss have an identifiable cause, and most of those causes have effective treatments available today.
The key is a thorough, specialist-level investigation that goes beyond routine tests — one that looks at clotting disorders, immune function, uterine anatomy, hormonal health, and the male factor.
Do not accept “try again and hope for the best” as a plan. You deserve a diagnosis. You deserve a strategy. And with the right care, the chances of a successful pregnancy are genuinely strong.
Frequently Asked Questions
1. How many miscarriages should I have before seeing a specialist?
Most international reproductive medicine guidelines recommend a full evaluation after two consecutive miscarriages. You do not need to wait for three losses. Each pregnancy loss is clinically significant, and early investigation often reveals treatable causes. If you have had even one miscarriage with a known risk factor — such as a family history of clotting disorders, irregular periods, or advancing maternal age — speak to a fertility specialist sooner rather than later.
2. Can my husband's sperm be causing my repeated miscarriages even if his semen report is normal?
Yes — and this is one of the most commonly missed causes of recurrent pregnancy loss. A routine semen analysis does not test sperm DNA integrity. High sperm DNA fragmentation can cause embryos to fail even when sperm count, motility, and morphology appear normal. A dedicated Sperm DNA Fragmentation Index (DFI) test is required, and it should be part of any thorough RPL investigation.
3. Does stress cause repeated miscarriage?
Chronic, severe stress can disrupt hormonal balance and may contribute to implantation difficulties, but stress alone is rarely the primary cause of recurrent pregnancy loss. The vast majority of RPL cases are rooted in biological causes — chromosomal, anatomical, immunological, or clotting-related. Reducing stress is beneficial for overall health and wellbeing, but please do not carry the guilt of believing you caused your own losses through worry. That is almost never the case.
4. Is IVF necessary for everyone with recurrent miscarriage?
No. Many couples with RPL conceive naturally and successfully carry a pregnancy after the underlying cause is identified and treated — for example, through thyroid medication, blood thinners, progesterone supplementation, or uterine surgery. IVF is specifically recommended when chromosomal abnormalities are the primary cause, since it enables genetic testing of embryos before transfer. Your specialist will recommend the pathway most suited to your individual diagnosis.
5. Can recurrent miscarriage affect my chances of getting pregnant at all?
Recurrent pregnancy loss and infertility are two different conditions, though they can overlap. Most women with RPL are able to get pregnant — the challenge is maintaining the pregnancy. With a proper diagnosis and targeted treatment, studies show that the majority of couples affected by RPL go on to have a successful pregnancy. The prognosis is genuinely hopeful, and treatment has come a long way in recent years.
