Recurrent miscarriage investigation (Investigation of recurrent (repeated) miscarriage)

A set of tests offered after repeated miscarriages to look for a treatable cause, while recognising that in most couples no clear cause is found.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

These tests look for a treatable cause of repeated miscarriage, such as antiphospholipid syndrome, thyroid problems or a womb-shape problem.
In about half of couples no clear cause is found, even after a full set of tests; this is common and is not your fault.
Most blood results come back within a few weeks, but the clotting (antiphospholipid) tests are repeated 12 weeks apart before they are called positive.
Be very cautious about clinics offering immune tests (such as natural killer cell testing) and immune treatments, which are not supported by good evidence.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSet of tests and a specialist review

AnaestheticNot needed

How long it takesBlood tests and a scan over one or more visits

Hospital stayOutpatient

Time off workUsually none beyond appointment time

When you'll see resultsOften within a few weeks; some clotting tests are repeated 12 weeks apart

On the NHS?Available on the NHS, usually after three miscarriages (sometimes two); private access is mainly for speed or choice

A general guide. Your specialist will give you advice for your situation.

Best fit

Can find a treatable cause such as antiphospholipid syndrome or a thyroid problem

Pause if

A single early miscarriage usually does not need this full set of tests, as most are isolated and due to chance.

Main recovery point

History taken, blood tests done, and a womb scan arranged. You may be given written information and support details.

Good aftercare

A results appointment where findings are explained together, with a written plan.

At the appointment

History taken, blood tests done, and a womb scan arranged. You may be given written information and support...

First few weeks

Most blood and scan results come back. Some results may prompt further tests.

12 weeks later

If antiphospholipid antibodies were positive, the test is repeated; the diagnosis is only confirmed if it is...

Results appointment

The team explains the findings together, what they mean, and the plan for a future pregnancy or any treatment.

Medical line illustration of miscarriage recurrent loss for Recurrent miscarriage investigation. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is recurrent miscarriage investigation?

Recurrent miscarriage investigation is a planned set of tests done after you have had repeated miscarriages, to look for a cause that can be treated and to help plan a future pregnancy. The Royal College of Obstetricians and Gynaecologists (RCOG) defines recurrent miscarriage as three or more miscarriages, but a fuller set of tests may be offered after two if there is reason to think the losses are not just bad luck.

The main tests look for antiphospholipid syndrome (a treatable clotting/immune problem), thyroid problems, and problems with the shape of the womb. Genetic testing of both partners, and of the pregnancy tissue, may be offered in some situations.

It is important to be honest about what these tests can and cannot do. Even after a full set of investigations, no clear cause is found in around half of couples. That does not mean nothing can be done, and it does not mean a future pregnancy is unlikely to succeed.

Miscarriage is common and is almost never caused by anything you did or did not do. The aim of investigation is to find the small number of treatable causes, to support you, and to give a realistic picture of your chances next time.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Antiphospholipid (clotting/immune) blood tests

Blood tests for lupus anticoagulant and anticardiolipin/anti-beta-2-glycoprotein antibodies. These look for antiphospholipid syndrome, the main treatable cause. A positive result must be confirmed on a second sample at least 12 weeks later.

Thyroid tests

Blood tests for thyroid function (TSH) and thyroid antibodies (TPO), because thyroid problems are linked to miscarriage and can be treated.

Pelvic ultrasound of the womb

A scan to look at the shape of the womb and check for problems such as a septum (a wall of tissue) or fibroids. Sometimes a 3D scan or other imaging is added.

Genetic (chromosome) testing

Testing the pregnancy tissue from a miscarriage where possible, and sometimes testing both partners' chromosomes (karyotype), to look for a chromosome rearrangement.

Tests for second-trimester or late losses

If losses happen later in pregnancy, the clinic may look at the cervix and consider other causes, as the pathway differs from early miscarriage.

Evidence-based tests vs tests to be wary of

Test	Where it fits
Antiphospholipid antibodies	Recommended; finds a treatable cause
Thyroid function and antibodies	Recommended; treatable
Pelvic ultrasound of the womb	Recommended; checks womb shape
Parental and pregnancy chromosome tests	Offered in selected couples
Natural killer (NK) cell testing	Not recommended outside research

Immune tests such as NK cell testing are not part of the standard evidence-based pathway. Ask why any test is being done and what it would change.

Preparing for your test

Bring dates and details of each miscarriage, including how many weeks each pregnancy reached, if you know.
Bring any previous test results, scan reports or hospital letters.
Both partners may be asked to attend, as some tests involve both of you.
Note any family history of miscarriage, blood clots, autoimmune conditions or inherited conditions.
List your medicines and supplements, and mention smoking, alcohol and caffeine honestly so advice can be tailored.
Think about questions you want to ask, including what each test would change.
It is normal to feel anxious or upset; you can ask about emotional support before the appointment.

What happens

You will usually be seen in a recurrent miscarriage or early pregnancy clinic by a specialist team. They will take a careful history of your pregnancies, your health and your family history.

Blood tests are taken for antiphospholipid antibodies and thyroid function, and sometimes other tests depending on your history. A pelvic ultrasound is arranged to look at the shape of the womb. Where pregnancy tissue is available from a miscarriage, it may be sent for genetic testing.

Results are then brought together at a follow-up appointment. The team explains what was and was not found, what it means for a future pregnancy, and any treatment or extra care that may help. If no cause is found, they should still explain your realistic chances and how you will be supported next time.

Is this test right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

A single early miscarriage usually does not need this full set of tests, as most are isolated and due to chance.
If you are currently bleeding heavily or have severe pain, you need urgent assessment first, not elective tests.
Immune tests such as NK cell testing are not an appropriate part of the pathway and may give misleading results.
If a different problem (such as an untreated thyroid or clotting disorder) is already known, that should be managed directly.

Delay or rearrange if…

You are in the middle of a current miscarriage or acute bleeding, which needs care first.
You have an active infection or are acutely unwell.
Key earlier results or pregnancy tissue results are still awaited.
You feel too distressed to take in results; it is reasonable to pause and arrange support.

Alternatives to discuss

Watchful, supportive care with early pregnancy scans in a future pregnancy, especially when no cause is found.
The standard NHS recurrent miscarriage pathway, which uses the same evidence-based tests.
Lifestyle support (weight, smoking, alcohol, caffeine) which is linked to miscarriage risk.
Genetic counselling if a chromosome rearrangement is found or suspected.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Benefits

Can find a treatable cause such as antiphospholipid syndrome or a thyroid problem
Helps plan care and treatment for a future pregnancy
Can give a realistic idea of your chances next time
Can offer reassurance and a clear plan, even when no cause is found
Opens the door to emotional support and early pregnancy monitoring

Risks & complications

More common

Many couples have completely normal results and no cause is found, which can feel frustrating
Blood tests can cause brief discomfort or bruising
Waiting for results, including the 12-week repeat clotting test, can be stressful
Tests may pick up borderline or uncertain findings that need repeating

Less common

A finding (such as a chromosome rearrangement) that has wider implications for the family and needs genetic counselling
An unexpected result that raises new questions or anxiety

Rare but serious

Being offered unproven 'immune' tests or treatments that carry their own risks and costs without good evidence of benefit

The biggest risk here is not the tests themselves but being steered towards unproven add-ons. Natural killer (NK) cell testing and immune treatments are not part of the evidence-based pathway. Ask your clinician which tests are recommended by RCOG, what each result would actually change, and what the plan is if everything comes back normal.

Published figures to discuss

Numbers vary a lot depending on how many losses you have had, your age, and your individual history. The figures below are from RCOG patient information and are best understood as general guides, not promises. Importantly, a normal set of results does not mean a low chance of success, and finding no cause is common.

Figure	Reported range	How to interpret it	Source / confidence
No cause found after full investigation	Around half of couples	Very common. It does not mean a future pregnancy is unlikely to succeed.	Guide sourcesClinical context
Recurrent miscarriage (three or more) in the population	About 1 in 100 women	RCOG figure; one or two miscarriages are much more common.	RCOG — Recurrent miscarriage (patient information)rcog.org.ukPublished figure
Future successful pregnancy with unexplained recurrent miscarriage	RCOG guideline cites prognosis in the region of 75% with supportive care in a dedicated setting	This is a population guide, not a promise; age and previous pregnancy history matter.	RCOG — Recurrent miscarriage (patient information)rcog.org.ukPublished figure
Unproven immune or add-on treatments	Recognised risk of overtreatment	Steroids, intralipids, IVIG and similar treatments should not replace evidence-based recurrent miscarriage assessment.	HFEA — Immunological tests and treatments for fertilityhfea.gov.ukSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from these tests. What matters is the wait for results, understanding what they mean, and the emotional impact of investigating repeated loss.

At the appointment

History taken, blood tests done, and a womb scan arranged. You may be given written information and support details.

First few weeks

Most blood and scan results come back. Some results may prompt further tests.

12 weeks later

If antiphospholipid antibodies were positive, the test is repeated; the diagnosis is only confirmed if it is positive again.

Results appointment

The team explains the findings together, what they mean, and the plan for a future pregnancy or any treatment.

In a future pregnancy

You may be offered early scans, extra monitoring, and treatment such as aspirin and heparin if antiphospholipid syndrome was confirmed.

What's normal — and not a worry

Feeling anxious or low while waiting for results
Mixed feelings if no cause is found, including relief and frustration
Wanting time to take in genetic or specialist findings
Needing more than one conversation to understand the plan

Aftercare

Make sure you understand each result and what it changes.
Ask for a written summary or plan for a future pregnancy.
If antiphospholipid syndrome is confirmed, understand the aspirin and heparin plan and when it starts.
If a thyroid problem is found, understand any treatment and monitoring.
Take up the offer of emotional support or counselling if you want it.
Know how to access early pregnancy care quickly if you conceive again.
Keep copies of your results for future pregnancies or referrals.

Before your test

Dates and details of previous miscarriages gathered
Previous results and letters collected
Both partners available if needed
Family history of clots, autoimmune or inherited conditions noted
List of medicines and supplements ready
Questions written down, including 'what will this change?'
Support contact (charity or counsellor) noted

⚠ Get urgent help if…

Heavy vaginal bleeding (soaking pads, passing large clots) in a current pregnancy
Severe or one-sided lower tummy pain, shoulder-tip pain or feeling faint, which can suggest an ectopic pregnancy and needs emergency care
A positive pregnancy test with pain or bleeding before a scan has confirmed where the pregnancy is
Signs of a blood clot, such as a swollen, painful calf or sudden breathlessness, especially if you have antiphospholipid syndrome
Feeling unable to cope, hopeless, or having thoughts of harming yourself

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A 'result' here is information, not a cure. A normal set of tests is reassuring in that it rules out the main treatable problems, but it does not guarantee a future pregnancy will be straightforward, and it does not mean there was no real reason for your losses. When a cause such as antiphospholipid syndrome is found, treatment in a future pregnancy can meaningfully improve the chance of a successful outcome.

Whatever the results, most couples who have had recurrent miscarriage go on to have a successful pregnancy, especially with support and monitoring. Your age and individual history affect this, so ask your clinician for a realistic picture for your situation.

How long it lasts

Most of these results stay useful for future pregnancies, although your clinician may repeat some tests if your circumstances change or if you have further losses. A confirmed diagnosis such as antiphospholipid syndrome or a thyroid condition usually guides care in every future pregnancy.

Related tests, treatments or support

These tests are often done alongside general health checks and advice on weight, smoking, alcohol and caffeine, which are linked to miscarriage risk. If you are also having fertility treatment, the clinic may coordinate the investigations with that care.

Follow-up & long-term care

You should have a follow-up appointment to go through all the results together, not just receive them by post. If antiphospholipid antibodies were positive, expect a repeat test at 12 weeks before any diagnosis is confirmed. A plan for early pregnancy care and any treatment should be written down, and you should know how to get back in touch quickly if you conceive again.

Keep copies of confirmed diagnoses for future pregnancies and referrals.
Contact early pregnancy services promptly if you become pregnant again.
Continue any agreed treatment (for example, thyroid medication) as advised.
Revisit the plan with your clinician if you have a further loss or your health changes.

Repeat, follow-on and what comes next

Some tests, especially antiphospholipid antibodies, are repeated before a diagnosis is confirmed.
Borderline or uncertain results may need repeating or further specialist input.
If you have a further loss, the plan may be reviewed and some tests repeated.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

A results appointment where findings are explained together, with a written plan.
A clear plan for early pregnancy care and any treatment in a future pregnancy.
A named contact and quick route into early pregnancy services if you conceive again.
Access to counselling or charity support for the emotional impact.
Honest discussion of realistic chances, without false reassurance or blame.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

How many and which tests are done, and whether both partners are tested
Whether pregnancy tissue is sent for genetic testing
Ultrasound and any specialist imaging of the womb
Number of clinic appointments, including the repeat clotting test at 12 weeks
Whether counselling or emotional support is included
Any add-on tests (which may not be evidence-based) a clinic suggests

Make sure your written quote includes

Which specific tests are included and who interprets them
Whether a results/follow-up appointment is included, not just the tests
Cost of the repeat antiphospholipid test at 12 weeks
Whether genetic testing of partners or pregnancy tissue is included
Whether counselling or support is included
What happens, and what it costs, if results are inconclusive and need repeating
Whether any recommended test is outside the RCOG-recommended pathway

On the NHS? Recurrent miscarriage investigation is available on the NHS, usually after three miscarriages (and sometimes after two); private clinics are mainly used for speed or choice, and should follow the same evidence-based pathway.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

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Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

Which tests are you recommending for me, and are they the RCOG-recommended ones?
What would each result actually change about my care?
What happens if all my tests come back normal?
Do you offer or recommend immune tests or treatments, and what is the evidence?
What is my realistic chance of a successful pregnancy next time?
How will a future pregnancy be monitored, and how do I access early pregnancy care quickly?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my test, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this test not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

How many miscarriages before I can be investigated?

RCOG recommends a full set of tests after three miscarriages, but a fuller assessment may be offered after two if there is concern the losses are not just chance. You can ask to discuss your situation.

Will the tests tell me why it happened?

Sometimes. They find a treatable cause in some couples, but in around half no clear cause is found. That is common and does not mean a future pregnancy is unlikely to succeed.

Is recurrent miscarriage my fault?

No. Miscarriage is common and is almost never caused by normal activity, exercise, work or stress. The tests are about finding treatable causes, not about blame.

Should I pay for natural killer (NK) cell testing or immune treatments?

These are not part of the evidence-based pathway. RCOG and the HFEA advise against them outside research, and the treatments carry real risks. Be very cautious if a clinic recommends them.

Can I get this on the NHS?

Yes, recurrent miscarriage investigation is available on the NHS, usually after three losses (sometimes two). Private clinics are mainly used for speed or choice, not for better tests.

What treatment might help if a cause is found?

If antiphospholipid syndrome is confirmed, low-dose aspirin and heparin injections in a future pregnancy improve outcomes. Thyroid problems can be treated. Some womb-shape problems can be corrected surgically.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: RCOG — Recurrent miscarriage (patient information) RCOG — Recurrent Miscarriage (Green-top Guideline No. 17) HFEA — Immunological tests and treatments for fertility Tommy's — Recurrent miscarriage RCOG — The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage (full guideline PDF)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.