Recurrent Miscarriage: Diagnosis and Treatment
Specialist diagnosis, reproductive immunology and personalised treatment — London
Experiencing recurrent miscarriage can be emotionally and physically challenging. At Vita Fertility Clinic, we provide a comprehensive assessment to identify possible factors affecting early pregnancy development and reproductive success.
Specialist assessment
When it keeps happening, you deserve more than reassurance
A personalised investigation can help identify treatable causes and guide an evidence-based treatment plan tailored to each patient or couple.
Who this pathway is for
Does any of this sound like your story?
Two or more pregnancy losses
You have miscarried more than once — early, later, or both — and have been told it was simply bad luck.
Miscarriage after IVF
You finally saw a positive test after IVF or ICSI, and the pregnancy was lost — perhaps more than once.
Tests that all came back “normal”
Standard investigations found nothing, yet the same outcome keeps repeating and you are still without a plan.
If you recognise yourself here, a structured second look at your history is usually the fastest route to answers.
What is Recurrent Miscarriage?
Recurrent miscarriage is usually defined as two or more pregnancy losses. While many miscarriages occur due to random genetic abnormalities in the embryo, repeated pregnancy losses may sometimes be associated with underlying factors that can be investigated and treated.
Embryos that never implant?
If IVF transfers keep failing before a pregnancy begins, rather than ending in miscarriage, the questions and the investigations are different. We cover this on a dedicated page.
Recurrent implantation failure→How it works
Your pathway, step by step
A clear route from the first consultation to a plan you can act on.
In-depth consultation
We review your history in detail — every pregnancy, every cycle, every previous test and treatment — with your partner where relevant.
Targeted investigations
Only the tests your history justifies, across six areas: genetic, uterine, endometrial, immunological, thrombophilic and hormonal.
Results explained
We go through every result with you in plain language, and explain what it does — and does not — mean for your chances.
A personalised plan
One evidence-based treatment plan built around what we found, including the monitoring and support you will need in a next pregnancy.
Investigations for Recurrent Miscarriage
A thorough assessment may include:
Assessment of Embryo and Genetic Factors
- Embryo genetic testing
- Review of previous IVF cycles, embryo quality and development
- Consideration of preimplantation genetic testing for aneuploidy (PGT-A) in selected patients
- Assessment of parental chromosomes (karyotyping) when indicated
Chromosomal abnormalities in embryos are one of the most common causes of miscarriage, particularly with increasing maternal age.
Uterine and Endometrial Assessment
The uterus and endometrium play a crucial role in implantation and pregnancy maintenance. Investigations may include:
- 3D pelvic ultrasound to assess uterine anatomy
- Assessment for fibroids, polyps, adenomyosis or congenital uterine abnormalities
- Diagnostic hysteroscopy to evaluate the uterine cavity
- Endometrial assessment where clinically appropriate
Assessment of Endometrial Receptivity and Implantation Environment
In selected cases, additional tests may be considered to evaluate the timing and quality of implantation, including:
- Endometrial receptivity testing (such as ERA) in specific circumstances
- Assessment of chronic endometritis using endometrial biopsy and CD138 staining
- Microbiome assessment in selected patients
Autoimmune and Reproductive Immunology Assessment
The immune system has an important role in allowing implantation and maintaining pregnancy. In selected patients, investigations may include:
- Antiphospholipid antibody testing (APS screening)
- Thyroid autoimmune assessment (including thyroid peroxidase antibodies)
- Assessment of selected immune markers and cytokines where clinically appropriate
- Review of autoimmune conditions and inflammatory disorders
Treatment options, when indicated, may include targeted therapies such as aspirin, anticoagulation, thyroid optimisation or carefully selected immune-modulating approaches.
Blood Clotting and Thrombophilia Assessment
Some blood clotting disorders may increase the risk of pregnancy complications. Testing may include:
- Antiphospholipid syndrome screening
- Selected inherited thrombophilia investigations in appropriate patients
- Assessment of personal and family history of thrombosis
Hormonal and Metabolic Assessment
Optimising overall reproductive health is essential. Tests may include:
- Thyroid function testing
- Prolactin assessment
- Ovarian reserve evaluation (AMH and ultrasound assessment)
- Assessment of ovulation and luteal function when indicated
- Screening for metabolic conditions such as insulin resistance or polyendocrine metabolic ovary syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS)
Treatment Options
Treatment depends on the underlying cause identified and may include:
Why VITA
A specialist focus, not an add-on
Recurrent miscarriage sits where reproductive medicine, immunology and haematology meet. Dr Simone Rofena has over 25 years in fertility medicine — including many years leading one of London's best-known fertility clinics — and this pathway is built for the histories that are hardest to explain.
Questions patients ask
Frequently asked questions
When should I ask for a recurrent miscarriage assessment?
Investigation is usually offered after two or more consecutive pregnancy losses. You do not have to wait longer than that — and if you have had a later loss, a loss after a heartbeat was seen, or you are over 35, it is reasonable to ask sooner.
Do I need to have had IVF to be seen?
No. The pathway covers pregnancy loss after natural conception as well as after IVF, ICSI or frozen embryo transfer. If your embryos have not implanted at all, our recurrent implantation failure page explains how we investigate that instead.
What happens at the first consultation?
It is a detailed review of your history: previous pregnancies and losses, cycles and embryo quality, tests already done and their results. You leave with a clear list of the investigations that are indicated for you and why.
Will you always find a cause?
Not always. In a proportion of couples no single cause is identified even after a thorough work-up. What a structured assessment does give you is certainty about what has been excluded, and a plan for the next pregnancy — including closer monitoring and support.
Do you offer immune treatment?
Where it is clinically justified, and only then. Immune-modulating treatments are used selectively, on the basis of test results, and we always explain the reasoning and the limits of the current evidence before starting anything.
Can my partner be assessed at the same time?
Yes. Male factors, including sperm DNA fragmentation, can contribute to both miscarriage and implantation failure. Your partner can be assessed in parallel by Prof Fabio Castiglione through our Couple Fertility pathway.
A Personalised Approach to Improve Your Chances of Success
Recurrent miscarriage is a complex condition with multiple possible contributing factors. Our approach combines detailed clinical assessment, advanced diagnostic testing and personalised treatment planning to help couples understand their reproductive challenges and identify the most appropriate pathway towards a successful pregnancy.
At Vita Fertility Clinic, we provide specialist care in fertility, reproductive medicine and reproductive immunology, supporting patients with complex fertility histories through every stage of their journey.
Often the next step
Assess both partners together
Male factors — including sperm DNA fragmentation — can contribute to both miscarriage and implantation failure. The Couple Fertility assessment evaluates both partners as one biological unit, in a single day, with a single integrated plan.
