Experiencing one miscarriage can be devastating. For families who experience repeated losses, the grief can be compounded by an often-difficult question: Why does this keep happening?
Recurrent pregnancy loss is diagnosed after two or more miscarriages or pregnancy losses while trying to conceive. Approximately 5% of families trying to grow their families will experience at least two miscarriages along the way.
Guidelines from the American Society for Reproductive Medicine, updated on June 1, 2026, for the first time since 2012, aim to help more families get answers. The recommendations reflect an extensive review of 14 years of research, including advances in treatment and diagnostic testing, and rethink how recurrent pregnancy loss is defined and evaluated—including when testing should begin, what doctors should look for first, and how new diagnostic tools can be incorporated into a stepwise approach to caring for those with this complex condition.
Ruth Lathi, MD, professor of obstetrics and gynecology and director of the Recurrent Pregnancy Loss program at Stanford Medicine, contributed to the updated guidance. She explains what families should know about the changes and why recurrent pregnancy loss does not necessarily mean a healthy pregnancy is out of reach.
Q. When should someone who has experienced multiple miscarriages consider an evaluation?
Dr. Lathi: One of the main changes in the guidelines was that we are focusing not only on maternal and paternal causes of loss, but also on fetal and embryonic causes of loss. We know that the No. 1 cause of miscarriage is genetic abnormalities in the embryos, and that is an often-unrecognized cause of miscarriage.
Historically, the workup focused primarily on investigating the parents. But we know a majority of miscarriages are caused by de novo chromosomal or genetic problems in the pregnancy itself. By testing the miscarriage tissue first, we’re more likely to give patients answers earlier in the process.
Rather than immediately ordering extensive testing, clinicians can first determine whether the miscarriage was caused by a chromosomal abnormality. If it was chromosomally normal, additional evaluation may follow.
Q. What else might doctors look for?
Dr. Lathi: Depending on the circumstances, clinicians may evaluate factors such as uterine abnormalities, antiphospholipid syndrome, thyroid disease, diabetes, or sperm DNA fragmentation.
The idea is to use a stepwise approach. Finding an explanation earlier may spare patients from a battery of tests that can be non-informative and add anxiety about future pregnancies.
Q. Why does an explanation matter beyond determining the next medical steps?
Dr. Lathi: Finding answers can reduce some of the blame and guilt patients often feel after miscarriage. People often internalize these losses, when in many cases they are caused by random chromosomal events that were outside anyone’s control.
The most important message to a patient experiencing a miscarriage is that this is not their fault.
Q: How likely is it that patients will get an answer?
Dr. Lathi: Historically, only half of patients with recurrent pregnancy loss were given an identifiable cause. With this new algorithm and chromosome testing approach, we believe that between 80 and 90 percent of patients may come away with answers, and by finding answers, we can provide better care.
Q: What if doctors still can’t explain why the miscarriages happened?
Dr. Lathi: Unexplained recurrent pregnancy loss does not mean a patient cannot have a healthy pregnancy in the future. Many patients go on to have successful pregnancies without any intervention.
That is an important part of counseling patients: Not having an explanation does not preclude a successful future pregnancy.
The most important thing for patients experiencing miscarriage to know is that a successful pregnancy is possible. That most patients who have miscarriage, even recurrent miscarriage, can go on and have healthy babies and build their families as they desire with the right treatments and the right support from their care teams.
Q. How can repeated pregnancy loss affect emotional health?
Dr. Lathi: The psychological toll can be significant. Patients experiencing recurrent pregnancy loss face increased risks of anxiety, depression, and post-traumatic stress.
Improving miscarriage care is not just about better testing or treatment algorithms. It also means changing how clinicians communicate with patients and grounding their care in compassion and psychological support.
Q. What do researchers still need to understand about recurrent miscarriage?
Dr. Lathi: Major gaps remain, including racial disparities in reproductive health. Black women continue to experience the worst maternal health outcomes across almost every measure, recurrent pregnancy loss included. We need more research that helps us better understand those disparities and provide more individualized care.
We also need continued research into the genetic, immune, and biological causes of recurrent miscarriage. The field has made important progress, but there is still much more to understand.
Learn more about our Recurrent Pregnancy Loss program >