Why a miscarriage can occur
Miscarriages are common and, especially in early pregnancy, are usually caused by random chromosomal changes in the embryo. A single miscarriage therefore often remains a one-time event and does not automatically mean that an illness or disorder is present. In many cases, no further diagnostic work-up is required after a single miscarriage. Many women subsequently become pregnant again and experience a normally progressing pregnancy with the birth of a healthy child.
If miscarriages occur repeatedly, a targeted evaluation may be useful. Possible influencing factors range from genetic and anatomical causes to hormonal conditions and certain clotting or autoimmune disorders. It is not always possible to identify a clear cause. The aim of diagnostics is to identify possible risk factors and plan the next steps individually.
The immune system plays an important role in implantation, early placental development, and maintaining a pregnancy. Certain autoimmune diseases and immunological changes can be associated with an increased risk of miscarriage. These include, for example, antiphospholipid syndrome, certain autoimmune thyroid diseases, or previously undiagnosed coeliac disease. In addition, other changes in the maternal immune response are being investigated as possible influencing factors in recurrent miscarriages.
Especially in cases of recurrent miscarriages with no identifiable cause to date, further immunological diagnostics may therefore be useful in selected situations. We assess which tests are actually helpful on an individual basis, taking into account your medical history and previous findings. We also consider that the scientific evidence for individual immunological tests varies.
Who may benefit from further miscarriage diagnostics
Women with recurrent miscarriages
Recurrent miscarriage is defined as the loss of two or more pregnancies. Even after two miscarriages, further diagnostics are often advisable—depending on age, medical history, and individual risk factors. As the number of previous miscarriages increases, the risk of another pregnancy loss also rises.
Women or couples with certain pre-existing conditions
Certain pre-existing conditions can increase the risk of miscarriage or play an important role in an individual evaluation. These include, for example, thyroid dysfunction, poorly controlled diabetes mellitus, certain autoimmune diseases such as antiphospholipid syndrome or coeliac disease, as well as other conditions that can affect the course of pregnancy. We also take gynaecological conditions such as endometriosis or changes in the uterus into account in the individual assessment.
Women of advanced age who wish to conceive
As age increases, the risk of miscarriage rises significantly. Data from the German IVF Registry show this association: In younger women, the miscarriage rate is around 15%, but by age 40 it is already about one third. After that, it increases markedly with each additional year of age and is around two thirds or higher from age 45.
The main reason is the increasing likelihood of chromosomal changes in the eggs—and therefore in the resulting embryos—as age increases. At the same time, both egg number and egg quality decline. In cases of recurrent miscarriages and an ongoing wish to conceive, timely evaluation is therefore particularly advisable as age increases, in order to identify possible causes and plan the next steps individually.
Expert assessment for recurrent miscarriages
Recurrent miscarriages can have different causes. These include hormonal factors such as thyroid or metabolic disorders, genetic changes, anatomical abnormalities of the uterus, certain clotting and autoimmune disorders, or other immunological factors. Age and the associated egg and embryo quality also play an important role. However, it is not always possible to identify a clear cause—often several factors come together.
This makes careful medical assessment of previous pregnancies and all available findings all the more important. Targeted diagnostics can help identify possible risk factors and derive individually appropriate next steps. And even after several miscarriages, in many cases there is still a good chance of a successful pregnancy and the birth of a healthy child.
Overview of diagnostic procedures
Diagnostics are used to specifically clarify possible causes and risk factors for recurrent miscarriages. Which tests are appropriate depends on your personal medical history and previous findings.
Anatomical changes of the uterus are found in about 5% of all women, but are significantly more common in women with recurrent miscarriages—around 10–15%. These include, for example, a uterine septum or other congenital forms. Using high-resolution ultrasound and 3D ultrasound, we can assess the shape of the uterus and, in particular, the uterine cavity.
Findings such as a congenital uterine septum, fibroids, polyps, or adhesions can affect implantation or the course of a pregnancy. If indicated, hysteroscopy may also be useful. This allows changes in the uterine cavity to be assessed particularly precisely and—where possible and appropriate—treated directly.
Certain blood clotting disorders can be associated with recurrent miscarriages and pregnancy complications. Antiphospholipid syndrome (APS) is of particular importance—an autoimmune disease in which certain antibodies can affect blood clotting and placental development. For evaluation, so-called antiphospholipid antibodies are specifically tested in the blood.
Depending on your personal and family history, other acquired or inherited changes in blood clotting may also be included in the diagnostic work-up. We decide which coagulation parameters are appropriate in your individual situation based on your previous pregnancies, possible risk factors, and any existing findings.
Genetic changes are among the most common causes of early miscarriages. Often, these are random changes in the number or structure of the embryo’s chromosomes, the risk of which increases with the woman’s age.
In some cases, however, genetic changes in the parents can also play a role—even if both are completely healthy. In about 2–5% of couples with recurrent miscarriages, a so-called balanced chromosomal rearrangement is found, often a translocation. In this case, the entire genetic material is present, but individual chromosome segments are arranged differently. For the carrier, this usually has no health consequences; however, during the formation of egg or sperm cells, an unfavourable distribution of chromosomes can occur, increasing the risk of miscarriage.
Further evaluation may therefore include a chromosome analysis of both parents. In addition, genetic testing of pregnancy tissue can provide important clues about possible causes. We work with specialised human genetics institutes for this purpose.
Male factor and sperm quality
The male factor can also play an important role in recurrent miscarriages and should always be included in the joint evaluation. In addition to standard sperm parameters, sperm DNA integrity in particular, as well as the man’s age, pre-existing conditions, and lifestyle, can influence reproductive health.
A semen analysis initially provides information about sperm count, motility, and morphology. In addition, especially in cases of recurrent miscarriages, a DNA fragmentation test may be useful. This examines the proportion of sperm with increased DNA strand breaks. Elevated DNA fragmentation can be associated, among other things, with oxidative stress, smoking, overweight, inflammation, a varicocele, or increasing paternal age, and may be linked to an increased risk of miscarriage.
For this reason, in miscarriage diagnostics we do not only assess the woman, but also include sperm quality and potentially modifiable risk factors in the man.
The immune system plays an important role in implantation, placental development, and maintaining a pregnancy. Certain autoimmune diseases and changes in the maternal immune response may be associated with recurrent miscarriages.
Established immunological causes include, in particular, antiphospholipid syndrome (APS). Depending on your history, further indicators of autoimmune disease may also be investigated, such as thyroid autoantibodies, antinuclear antibodies (ANA), or previously undiagnosed coeliac disease.
In selected situations, extended reproductive immunology diagnostics may also be considered. This can include, for example, testing various immune cell populations and natural killer cells (NK cells) and—depending on the clinical question—other immunological constellations such as KIR and HLA characteristics.
Not all immunological tests are equally well established scientifically, and not every abnormal laboratory value is automatically the cause of a miscarriage. Therefore, we select tests individually based on your medical history and previous findings and always interpret the results in the overall context. For specialised analyses, we work with experienced immunology laboratories.
Hormones play an important role in egg maturation, the build-up of the uterine lining, and the early development of a pregnancy. In cases of recurrent miscarriages, we therefore specifically include possible hormonal and metabolic influencing factors in the diagnostic work-up.
The thyroid plays a particularly important role. Both underactive and overactive thyroid function can affect the cycle and the course of pregnancy. In addition to the TSH level, free thyroid hormones and thyroid autoantibodies may also be measured depending on your history.
Cycle and ovulation disorders as well as polycystic ovary syndrome (PCOS) can also be associated with an increased risk of miscarriage. In PCOS, in addition to hormonal changes, metabolic factors such as insulin resistance often play a role.
Progesterone is of central importance for the uterine lining and maintaining pregnancy, especially after ovulation and in early pregnancy. Depending on the clinical question, the second half of the cycle and progesterone production may therefore also be assessed. As progesterone levels fluctuate significantly in the natural cycle, results are always evaluated in the context of the cycle pattern and the other findings.
We determine which hormonal tests are appropriate on an individual basis, based on your medical history, your cycle, and any existing findings.
Support after a miscarriage: The path to an individual evaluation
With modern diagnostics and many years of experience, we support you in evaluating recurrent miscarriages.
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Initial Consultation
At the beginning, we take time to review your medical history, the course of your previous pregnancies, and possible risk factors. Together, we assess which tests are appropriate in your personal situation.
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Blood tests
Depending on your history and previous findings, various laboratory tests may be useful. These include, for example, hormone levels, thyroid parameters, certain autoantibodies, and selected coagulation and immunological parameters.
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Ultrasound and further examinations
Using high-resolution ultrasound, we can assess the uterus and its structure. Depending on the clinical question, a 3D ultrasound or, in some cases, hysteroscopy may also be useful.
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Genetic tests (if required)
In cases of recurrent miscarriages, a chromosome analysis of both partners may be useful. If pregnancy tissue is available, genetic testing of this tissue can also provide important clues about the cause of a miscarriage.
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Bringing the findings together
We carefully evaluate all results and discuss them with you to obtain a comprehensive picture of the possible causes.
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Individual recommendation
Based on the results, we discuss together which further steps are appropriate—from targeted treatment of individual risk factors to individual support when trying to conceive again or during a subsequent pregnancy.
Trying to conceive after recurrent miscarriages: Possible treatment approaches
Which treatment is appropriate after recurrent miscarriages depends on the possible causes, the previous test results, and your personal fertility history. It is not always possible to find a clear cause, and not every abnormal finding requires treatment. Therefore, together with you, we decide which therapeutic measures are appropriate in your individual situation.
Depending on the cause and individual situation, different therapeutic approaches may be considered to specifically support a pregnancy.
Hormonal disorders such as underactive or overactive thyroid function, elevated prolactin levels, or certain metabolic and cycle disorders can be treated in a targeted manner. Progesterone also plays an important role for the uterine lining and maintaining early pregnancy. Whether additional progesterone supplementation is advisable is decided based on your medical history, your cycle, and the course of a subsequent pregnancy.
In certain confirmed clotting disorders, anticoagulant treatment—for example with heparin or low-dose acetylsalicylic acid—may be useful. Whether and which treatment is recommended depends on the specific findings and your medical history.
In cases of recurrent miscarriages, immunological factors may also play a role in some cases. If the extended immunological diagnostics show relevant abnormalities, we assess these in a differentiated way and in the context of your fertility history and the other findings.
Depending on the individual situation, different immunomodulatory treatment approaches may be considered. Which therapy may be appropriate depends on the type of abnormality, possible comorbidities, and previous pregnancy courses. We discuss with you the various options, their potential benefits and risks, as well as the respective scientific data and evidence. Together with you, we carefully weigh whether and which immunomodulatory treatment may be appropriate in your personal situation.
If changes in the uterus are identified—for example certain polyps, fibroids, adhesions, or a malformation of the uterine cavity—surgical treatment may be useful. Whether an intervention is recommended depends on the type and extent of the findings.
After previous miscarriages, a new pregnancy is often associated with great uncertainty. Close monitoring and personal care in the first weeks of pregnancy provide reassurance and enable us to assess the development of the pregnancy early and respond individually if abnormalities occur.
IVF or ICSI may be useful if, in addition to recurrent miscarriages, other factors are present that make it more difficult to achieve pregnancy. We assess individually whether reproductive medical treatment offers an advantage, based on your medical history and the diagnostic results.
Tender Loving Care: Compassionate support after a miscarriage
After recurrent miscarriages, a new pregnancy is often associated with many worries and fears. As part of what is known as Tender Loving Care, we therefore support you particularly closely, especially in the first weeks of pregnancy—with regular ultrasound checks, personal consultations, and continuous medical care.
Studies suggest that such intensive and supportive care after recurrent miscarriages can have a positive effect on the further course of pregnancy. At the same time, the regular check-ups provide reassurance and enable us to assess the development of the pregnancy early and respond individually if needed.
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Time for your story
After recurrent miscarriages, many questions and uncertainties often remain. We take the time to understand your medical history in detail, carry out thorough diagnostics, and plan the next steps together with you.
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Comprehensive diagnostics
We clarify possible causes in a structured manner and in line with current scientific evidence. A particular focus is on extended and immunological diagnostics.
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Psychological support
Miscarriages can be emotionally very distressing. If you would like additional support, we can arrange accompanying psychological care.
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Support in the next pregnancy
Even after you become pregnant again, we remain by your side. With close monitoring and personal medical care, we support you especially in the first weeks of pregnancy.
What Our Patients Say
Costs of miscarriage diagnostics
The costs depend on the examinations required in your individual case. Which diagnostic steps are appropriate depends on your personal situation and previous findings.
To the cost overviewDetailed medical history, ultrasound, and initial basic hormone tests as an introduction to the evaluation. Helpful for classifying the course to date and planning the next diagnostic steps in a targeted manner.
*Note: Consultation only without diagnostics approx. €120
Make an appointmentThis examination is primarily part of fertility diagnostics. If needed, it can be used as an additional test, especially if a longer period of unsuccessful attempts to conceive is also to be evaluated. In addition, there are costs for a special contrast foam of approx. €90.
Make an appointmentBrief tissue sampling from the uterine lining for extended diagnostics (e.g. microbiome, immune markers/uterine NK cells, ERA test). Additional costs are incurred for the external laboratories that analyse the samples. These are billed directly by the external laboratory.
Make an appointmentIn addition to diagnostics for the woman, a semen analysis is useful to also include the male factor (e.g. sperm count, motility, and morphology) in the evaluation of miscarriages.
Make an appointmentIf a current semen analysis is available, sperm DNA fragmentation can also be tested separately. The analysis is performed in our in-house andrology laboratory and evaluated by a specialist. You will usually receive the results within a few days, encrypted by email.
Make an appointmentNo fixed or flat-rate prices: We bill on the basis of the official scale of fees for doctors (GOÄ). According to the GOÄ, we are not allowed to quote fixed or flat-rate prices for medical services. The prices mentioned are intended to provide orientation and are typical for the treatments mentioned.
Possible VAT liability: Medical services may be subject to VAT (currently 19%). This applies if, after diagnostics have been carried out, no medical indication or confirmed diagnosis is present and it is therefore not a medical treatment in the strict sense. This can be the case in particular with social freezing treatments, but also with the treatment of single moms and same-sex couples.
We would be happy to provide you with detailed cost information for the planned treatment in advance. This allows you to clarify cost coverage with your private health insurance (PKV) as best as possible beforehand. Statutory health insurance (GKV) does not cover costs at our center.
Frequently asked questions after a miscarriage
How do you recognise a miscarriage, and what does it feel like?
A miscarriage can present with different symptoms. Bleeding, cramp-like lower abdominal pain, or back pain are common. A sudden decrease in pregnancy symptoms such as nausea or breast tenderness can also be a sign.
However, not every miscarriage causes symptoms. In a so-called missed miscarriage, the pregnancy initially continues even though the embryo is no longer developing. The diagnosis is then often only made at the next ultrasound.
What does the bleeding look like in a miscarriage?
Bleeding during a miscarriage can vary greatly. It may start like a light period or spotting, but can also become heavier and be accompanied by lower abdominal cramps.
The blood may be bright or dark red, sometimes brownish. With heavier bleeding, blood clots and—depending on the week of pregnancy—tissue may also pass.
Important: The colour, amount, or appearance of bleeding alone does not reliably indicate whether a miscarriage has occurred. Bleeding can also occur in an ongoing pregnancy. Therefore, bleeding during pregnancy should always be medically evaluated, especially if symptoms are more severe.
How long bleeding lasts after a miscarriage varies from person to person. It often lasts a few days, sometimes longer than a week.
When can you become pregnant again after a miscarriage?
After a miscarriage, ovulation can generally occur again just a few weeks later—making a new pregnancy possible. However, when the right time is for a new attempt depends on the individual situation, physical recovery, and also when you feel emotionally ready again.
After an uncomplicated early miscarriage, from a medical perspective a longer waiting period is usually not necessary. Even after a curettage, you generally do not need to wait several months. We often recommend giving the body a few weeks to recover and waiting for the next menstrual period. After that, if the course is uncomplicated, pregnancy can usually be attempted again.
In cases of recurrent miscarriages or a longer period of trying to conceive, targeted diagnostics may be useful before a new pregnancy to clarify possible causes and plan the next steps individually.
If you become pregnant again, we can support you particularly closely in the first weeks if you wish—with personal consultations and regular check-ups.
What are common causes of recurrent miscarriages?
Recurrent miscarriages can have different causes—and sometimes several factors come together. Most commonly, chromosomal changes in the embryo are the underlying reason. These usually arise randomly during the development of the egg cell or embryo and become more frequent with increasing maternal age.
In addition, changes in the uterus, hormonal or metabolic conditions such as thyroid dysfunction or polycystic ovary syndrome (PCOS), as well as certain clotting disorders—especially antiphospholipid syndrome—can play a role. Endometriosis and adenomyosis may also be associated with an increased risk of miscarriage.
More rarely, an inherited chromosomal change is found in one of the partners. Male factors can also be involved: In particular, increased sperm DNA fragmentation is associated with recurrent miscarriages.
However, it is not possible to identify a clear cause in all couples. Structured diagnostics help us identify possible influencing factors and plan further treatment individually.
What most commonly triggers a miscarriage?
The most common cause of an early miscarriage is chromosomal changes in the embryo. These usually arise randomly during the development of the egg or sperm cell or during early embryonic development. As a result, the embryo cannot continue to develop normally and the pregnancy ends. Such chromosomal changes become more frequent with increasing maternal age.
In addition, other factors can also increase the likelihood of miscarriage, such as changes in the uterus, hormonal or metabolic conditions, certain autoimmune or clotting disorders, and other maternal or paternal factors. However, after a single miscarriage, it is often not possible to identify a clear cause.
A single miscarriage therefore usually does not mean that something is fundamentally wrong or that another pregnancy cannot be successful.
Can you still have a successful pregnancy after several miscarriages?
Yes—successful pregnancy is often still possible even after several miscarriages. What matters is an individual evaluation of possible risk factors and targeted support in early pregnancy. We discuss with you which next steps are medically appropriate.
What role do hormones or immune factors play in miscarriages?
Hormones play an important role in implantation and maintaining an early pregnancy. This includes progesterone in particular, which prepares the uterine lining for pregnancy and supports early pregnancy. Thyroid dysfunction, PCOS, or metabolic conditions such as diabetes can also affect the risk of miscarriage. However, it is not always possible to clearly determine whether an isolated progesterone deficiency is actually the cause of a miscarriage. In certain situations, treatment with progesterone may still be useful.
The immune system is also involved in implantation and pregnancy. Certain autoimmune diseases, especially antiphospholipid syndrome, are well established as possible causes of recurrent miscarriages. In addition, other immunological factors are being investigated, the significance of which has not yet been conclusively clarified scientifically.
Which examinations and treatments are appropriate therefore always depends on the individual medical history and previous findings.
Can genetic causes in the parents also play a role?
Yes. In addition to random chromosomal changes in the embryo, genetic changes in one parent can more rarely play a role. If needed, genetic testing of pregnancy tissue or a chromosome analysis of both partners is possible.
When is further miscarriage diagnostics advisable?
Further diagnostics are particularly advisable in cases of recurrent miscarriages or if additional risk factors or pre-existing conditions are present. The aim is to narrow down possible causes in a targeted manner and plan the next steps individually. We clarify which tests are necessary in a personal consultation.
What is the risk of another miscarriage?
After a single miscarriage, the chances of a successful next pregnancy remain very good. The key factors are the woman’s age and the number of previous miscarriages.
For example, the probability of a later live birth after a miscarriage is around 80–85% in women under 35, around 70% between 35 and 39, and around 50% between 40 and 44. With multiple previous miscarriages, the likelihood of a successful pregnancy decreases—nevertheless, a live birth is still very possible even after recurrent miscarriages (source: Kolte AM et al., Human Reproduction 2021).
