Why two miscarriages deserve a full investigation, not a reassurance

Lucknow : Second miscarriage , It is different from the first. The questions become sharper, the need for an explanation becomes stronger, and the couple is no longer only processing loss. They are asking why it happened again.

Dr Shreya Gupta, Fertility Specialist, Birla Fertility & IVF, Lucknow, explains that pregnancy loss is common. Around 15 to 20 % of clinically recognised pregnancies end in miscarriage. A single loss can often be sporadic. But after two miscarriages, the clinical conversation should change. At this point, couples should be advised to consult a fertility specialist for a structured recurrent pregnancy loss evaluation, instead of being told to simply wait and try again.

This is reflected in current international clinical thinking. The European Society of Human Reproduction and Embryology defines recurrent pregnancy loss as the loss of two or more pregnancies. The American Society for Reproductive Medicine also recognises recurrent pregnancy loss after two pregnancy losses. While some guidelines have traditionally used three miscarriages as the threshold, clinical discretion allows earlier evaluation after two losses, especially when the pattern suggests that the losses may not be sporadic.

The reasons behind repeated pregnancy loss can vary. Chromosomal abnormalities are among the most common causes of early miscarriage, especially with advancing maternal age. But they are not the only possible factor. Uterine structural concerns, thyroid dysfunction, uncontrolled diabetes, antiphospholipid syndrome, hormonal factors, lifestyle factors, and in selected cases, sperm-related factors may also contribute.

Many of these conditions may not cause obvious symptoms. Routine reports can look normal, which is why a focused evaluation becomes important. This may include reviewing the couple’s pregnancy history, maternal age, medical conditions, ultrasound findings, hormonal health, metabolic status, autoimmune or clotting-related factors, and where clinically indicated, genetic or embryo-related factors.

This becomes especially important when fertility treatment is being considered. In IVF, decisions around embryo assessment, endometrial preparation, medical support, and treatment planning depend on whether a possible cause has been identified. Without that clarity, treatment may begin without addressing the factor that may have contributed to the previous loss.

Reassurance has value when it is based on evidence. After two miscarriages, reassurance alone is not enough. The right next step is not panic, but specialist evaluation.

Earlier evaluation may not always give one simple answer. But it can help couples understand what needs to be checked, what can be treated, and what should be planned differently before the next pregnancy. After two miscarriages, couples should not wait for another loss before seeking medical guidance.