# 18 | Pregnancy Loss: What the Evidence Says and What Nobody Tells You

Miscarriage is one of the most common experiences in reproductive health and one of the least talked about. Around 1 in 10 women will have at least one miscarriage in their lifetime and the true figure is likely higher, because many losses happen before a pregnancy is confirmed. Despite how common it is, most women go into it knowing very little and come out of it with questions nobody has answered.

Why Miscarriage Happens

The single most important thing to know is that the overwhelming majority of miscarriages are not caused by anything the woman did. Most early losses happen because of a chromosomal problem in the developing pregnancy — an error that occurs at conception and cannot be prevented, predicted or corrected. It is not caused by lifting something heavy, going to work, exercising, having sex or having a stressful week.

Risk does increase with age, largely because chromosomal errors become more common as egg quality changes over time. Certain medical conditions — thyroid disorders, poorly controlled diabetes, some clotting conditions and structural differences in the uterus — can also play a role, which is why investigation is worthwhile when losses repeat.

What Counts as Recurrent and When to Investigate

Recurrent pregnancy loss is now defined by both ESHRE and the Royal College of Obstetricians and Gynaecologists as two or more losses, not three. This is important, because the old threshold left many women waiting through a third loss before anyone would investigate. If you have had two miscarriages, you are entitled to ask for a referral and testing.

Testing usually includes thyroid function, blood sugar, screening for antiphospholipid syndrome (a clotting condition) and an ultrasound to assess the shape of the uterus. Even after full investigation, around half of recurrent losses remain unexplained — which is frustrating, but not the same as hopeless.

What the Numbers Actually Say About What Comes Next

This is where the evidence is quite reassuring. A 2025 UK study following over 1,200 couples with recurrent miscarriage found that most went on to conceive, with the large majority of pregnancies occurring within the first year. Even among women with unexplained recurrent loss, live birth rates in subsequent pregnancies are consistently high — in one cohort, around 8 in 10.

The Part That Gets Overlooked

The psychological impact of miscarriage is significant and well documented. Research shows meaningfully raised rates of anxiety, depression and post-traumatic stress symptoms after early pregnancy loss, in many cases, persisting for months. Yet follow-up care is often minimal or absent entirely, and many women are discharged with no mental health support at all.

If you are struggling after a loss, that is a normal response to something truly difficult, not an overreaction. Support is available and asking for it is reasonable.

What You Can Ask For

You can ask what type of loss it was and what that means. You can ask whether testing is appropriate. You can ask for a referral after two losses. And you can ask for follow-up support, not just physical aftercare. None of these are unreasonable requests, even if the system does not always offer them without prompting.

References & Evidence Base

1.    Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021 Apr 24;397(10285):1658–1667. doi: 10.1016/S0140-6736(21)00682-6. PMID: 33915094.

2.    Koki C, et al. Fertility, time to pregnancy, and pregnancy outcomes among women with recurrent miscarriages in the UK: a prospective observational longitudinal study. Lancet Reg Health Eur. 2025 Aug;55:101372. doi: 10.1016/j.lanepe.2025.101372. PMCID: PMC12268084.

3.    ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open. 2023;2023(1):hoad002. doi: 10.1093/hropen/hoad002. PMID: 36873081; PMCID: PMC9982362.

4.    Regan L, Rai R, Saravelos S, Li TC; Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: green-top guideline No. 17. BJOG. 2023 Nov;130(12):e9–e39. doi: 10.1111/1471-0528.17515. PMID: 37417328.

5.    Mergl R, Quaatz SM, Lemke V, Allgaier AK. Prevalence of depression and depressive symptoms in women with previous miscarriages or stillbirths – a systematic review. J Psychiatr Res. 2024 Jan;169:84–96. doi: 10.1016/j.jpsychires.2023.11.017. PMID: 38006775.

6.    Farren J, Mitchell-Jones N, Verbakel JY, Timmerman D, Jalmbrant M, Bourne T. The psychological impact of early pregnancy loss. Hum Reprod Update. 2018 Nov 1;24(6):731–749. doi: 10.1093/humupd/dmy025. PMID: 30204882.

Medical Disclaimer: This article is intended for informational and educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional regarding pregnancy loss or any related concerns. HER is not a medical provider.