Recurrent Miscarriage After 35: When Is It Time to Look Deeper?

If you've had more than one miscarriage after 35, there is a good chance you've heard some version of this:

“Unfortunately, this is probably your age.”

There is truth inside that statement.

As we get older, the likelihood that an egg—and therefore an embryo—will have a chromosome abnormality increases. Chromosomal abnormalities are the most common cause of first-trimester miscarriage, and maternal age is one of the strongest factors affecting that risk.

But here is the part I don't want women to miss:

Age can increase miscarriage risk without being the only thing worth evaluating.

If you have experienced two or more pregnancy losses, you now meet the current definition of recurrent pregnancy loss.

That deserves a different conversation than:

“You're over 35. Try again.”

And it also deserves something more thoughtful than ordering every specialty test you can find online.

The real goal is to figure out:

What did the losses tell us?

What has already been evaluated?

What deserves a closer look now?

And:

What would actually change the plan for your next pregnancy?

First: Yes, Age Matters

I don't believe in minimizing age just to make women feel better.

Age is relevant to fertility.

And it is relevant to miscarriage.

The American Society for Reproductive Medicine estimates that approximately 50–60% of first-trimester miscarriages are caused by chromosomal abnormalities in the embryo, and the likelihood of those abnormalities increases with maternal age.

ASRM's updated 2026 recurrent-pregnancy-loss guidance reports chromosomal abnormalities in approximately half of tested miscarriages in women under 35 and approximately three-quarters of miscarriages in women over 40.

That is important information.

But it still doesn't mean:

“You're older, therefore we know that's why you miscarried.”

Unless the pregnancy tissue was actually tested, we often don't know whether a specific miscarriage was chromosomally abnormal.

That distinction becomes particularly important when losses repeat.

Recurrent Loss Is Not Just “More of the Same”

This is one of the most important changes in how I want women over 35 to think about miscarriage.

One isolated early miscarriage and recurrent pregnancy loss are not identical clinical situations.

Current ASRM guidance defines recurrent pregnancy loss as two or more pregnancy losses.

And the updated definition includes very early pregnancies confirmed by urine or blood hCG; the pregnancy does not have to have reached ultrasound confirmation to count.

ACOG also recommends evaluation after two miscarriages.

So if you've had two losses, you do not automatically need to wait for a third before asking for a more structured evaluation.

For a deeper explanation of what changes after one loss versus recurrent loss, start here:

One Miscarriage vs. Recurrent Loss: When Should Testing Start?

Here's the Part About Age That I Think Gets Oversimplified

The 2026 ASRM guidance makes a particularly important point:

Compared with women who experience an isolated miscarriage, women with recurrent pregnancy loss have a greater likelihood of experiencing a chromosomally normal—or euploid—miscarriage.

And the likelihood of a euploid miscarriage increases as the number of miscarriages increases.

Think about what that means.

Age increases the likelihood of chromosome abnormalities.

But when pregnancy losses keep happening, we shouldn't automatically assume that every loss must therefore have been chromosomal because you're over 35.

Sometimes it was.

Sometimes it wasn't.

And without information from the pregnancy itself, we may not know.

That is why I think the question after recurrent loss needs to change from:

“Am I just too old?”

to:

“What do we actually know about these losses?”

The Most Useful Starting Point May Be the Pregnancy Itself

One of the biggest changes in the new recurrent-loss guidance is the emphasis on chromosome testing of miscarriage tissue.

ASRM now recommends offering chromosome evaluation of miscarriage tissue after a second miscarriage or in someone with recurrent pregnancy loss, when testing is feasible.

This can provide an incredibly useful fork in the road.

If the pregnancy was chromosomally abnormal

That may provide a likely explanation for that particular loss.

It can also help your physician decide whether additional evaluation is likely to be useful.

If the pregnancy was chromosomally normal

That changes the conversation.

A euploid loss gives us more reason to ask whether another factor deserves evaluation.

If the pregnancy wasn't tested

You're working with less information.

That doesn't mean something was done wrong.

Many women have never been offered testing, particularly after expectant or medication-managed miscarriage.

But it means your provider may need to make decisions using your history and the pattern of losses rather than having the chromosome information available.

This is one reason I want women to know about tissue testing before another miscarriage happens, not after the opportunity has already passed.

I sincerely hope you never need that information.

But knowing your options ahead of time is different from trying to figure them out while you're actively miscarrying.

So What Deserves a Deeper Look After Recurrent Miscarriage?

“Deeper” does not mean:

Test everything.

It means we stop repeating the same surface-level evaluation when your history has changed.

Here are the areas I would want clearly accounted for.

1. Your Uterine Cavity

Current ASRM guidance recommends uterine-cavity evaluation for women with unexplained recurrent pregnancy loss.

Depending on your individual situation, your doctor may use:

HSG
Saline sonogram
Hysteroscopy

They may be looking for things such as:

A uterine septum
Submucosal fibroids
Polyps
Intrauterine adhesions
Retained pregnancy tissue
Other structural abnormalities

And this is worth emphasizing:

Previous miscarriages and uterine procedures can themselves change the uterine environment.

So even if you had imaging years ago, your history since then can matter.

If you've had fibroids, uterine surgery, D&C procedures, abnormal bleeding or another uterine issue, make sure that history is part of the discussion.

2. Antiphospholipid Syndrome—When Your History Supports Testing

This is where miscarriage conversations often become unnecessarily confusing.

There is a difference between:

antiphospholipid syndrome

and

inherited clotting disorders.

Antiphospholipid syndrome, or APS, is an autoimmune clotting disorder with an established relationship to pregnancy complications and pregnancy loss.

When clinical criteria are met, testing generally includes:

Lupus anticoagulant
Anticardiolipin IgG and IgM
Beta-2 glycoprotein I IgG and IgM

But current guidance does not recommend giving every woman with recurrent miscarriage a blanket inherited-thrombophilia panel.

That means Factor V Leiden, prothrombin mutations, MTHFR, protein C, protein S and other inherited-clotting tests are not automatically part of the routine recurrent-loss workup.

There is an important exception:

Your personal medical history matters.

If you've had a previous blood clot, already have a diagnosed thrombophilia, have a strong relevant family history or have had specific pregnancy complications, that can change what your medical team needs to consider.

The question should never be:

“Does every woman with miscarriage need clotting testing?”

It should be:

“Does this woman's history give us a medical reason to investigate clotting?”

3. Thyroid—and Whether a Known Condition Is Actually Being Managed for Pregnancy

This is an area where my coaching lens becomes especially important.

I don't want to know only whether someone ordered a TSH at some point.

I want to know:

Do you have known thyroid disease?
Are you on thyroid medication?
When was your dose last reviewed?
Have your levels changed?
Does the clinician managing your thyroid know you are trying to conceive?
Was your thyroid reassessed after the miscarriage?
Is pregnancy part of the treatment plan?

Current ASRM recurrent-loss guidance recommends TSH evaluation in certain RPL situations, particularly when there are thyroid symptoms or risk factors, when a loss was chromosomally normal or when miscarriage tissue wasn't tested.

What I don't recommend is inventing a universal “fertility optimal” thyroid number for every woman.

But I also don't believe a known thyroid condition deserves a casual:

“It's technically in range.”

A real medical condition deserves appropriate preconception management.

4. Metabolic Health When the History Points There

Uncontrolled diabetes is associated with pregnancy complications and pregnancy loss.

For women with recurrent loss who have risk factors—such as PCOS, previous gestational diabetes, metabolic concerns, family history or other relevant factors—ASRM recommends considering A1c as part of the evaluation.

Again, this is history-driven testing.

Not every woman needs every test.

But I don't want an important health issue overlooked because everyone is focusing only on egg quality.

5. The Male Partner

After recurrent miscarriage, the male side should not quietly disappear from the investigation.

A standard semen analysis is useful.

But it doesn't measure everything about sperm.

The 2026 ASRM guidance now specifically states that sperm DNA-fragmentation testing may be considered when recurrent miscarriage remains unexplained or when recurrent loss occurs alongside infertility.

That doesn't mean sperm DNA fragmentation caused the miscarriage.

And it doesn't mean every man needs the test after one loss.

It means repeated unexplained loss may justify looking beyond concentration, motility and morphology alone.

In some cases, reproductive-urology evaluation may also be appropriate.

This is one area where I think couples deserve to ask:

“Have we investigated both sides of this pregnancy?”

6. Your Basic Health—Not Just the Recurrent-Loss Panel

This is the piece I see missed over and over again.

A recurrent-pregnancy-loss evaluation answers one set of questions.

Your overall preconception health answers another.

You can have an appropriate miscarriage workup and still have basic health issues that deserve attention before another pregnancy.

I want women to know when they last had:

A preventive physical
A well-woman examination
A CBC
Iron/ferritin assessment when appropriate
Thyroid review
Vitamin D evaluation when clinically relevant
B12 or folate evaluation when diet, symptoms or gastrointestinal history create a reason
Metabolic testing when indicated

I'm not claiming that correcting ferritin, vitamin D or B12 prevents recurrent miscarriage.

That is not what the evidence says.

What I am saying is:

A nutritional deficiency or poorly controlled health condition still deserves care even when it isn't proven to be “the cause” of infertility or miscarriage.

If it has been more than a year since your routine preventive or well-woman care was updated, I would start there.

Your primary-care physician or OB/GYN can help determine which general-health testing is appropriate for you.

What About Progesterone?

Progesterone deserves personalized care.

A miscarriage does not automatically prove that you had a progesterone deficiency.

And checking a progesterone level during a failing pregnancy does not necessarily tell us whether low progesterone caused the loss—progesterone can decline because the pregnancy is no longer developing normally.

Current recurrent-loss guidance does not support assuming every woman with RPL needs progesterone supplementation. AND we DO know that progesterone begins to decline rapidly after 35.

However, ASRM notes that vaginal progesterone may be considered in certain situations, including early-pregnancy bleeding and/or unexplained recurrent miscarriage, using shared decision-making.

That is a conversation for your medical provider.

Not a conclusion to draw from one laboratory number.

What I Would Not Let “You're Over 35” End the Conversation About

Age can explain risk.

It does not automatically explain your individual losses.

I would not let age alone prevent you from asking:

Was either miscarriage genetically tested?
Has my uterine cavity been evaluated?
Does my history meet criteria for APS testing?
Is a known thyroid or metabolic condition appropriately managed?
Does our male-factor evaluation need to go further?
Is there something in my general health that deserves attention before another pregnancy?
Has someone actually looked at the pattern of these losses together?

Those are reasonable questions.

They are not a rejection of reproductive medicine.

They are part of using it well.

And I Wouldn't Let Recurrent Loss Turn Into Endless Testing Either

This is the other side of the conversation.

Once you've experienced multiple losses, it is completely understandable to want to find something.

Anything.

A number.

An infection.

An immune marker.

A supplement deficiency.

A genetic variant.

Something you can fix so you can guarantee this never happens again.

I understand that impulse.

But not every test being sold to fertility patients has evidence showing that finding and treating an abnormal result improves the chance of a live birth.

Current ASRM guidance does not recommend routinely ordering things such as:

Broad inherited-thrombophilia screening
NK-cell testing
Broad immune panels outside appropriate APS testing
Endometrial-receptivity testing
Routine microbiome testing
Routine Mycoplasma or Ureaplasma testing specifically as an RPL evaluation

Some of these tests may have legitimate roles in other medical circumstances.

That is different from saying every woman with recurrent loss needs them.

This is why I keep coming back to one question:

What would we do differently with the result?

This Is Where I Think the Best Fertility Coaching Happens

My job isn't to diagnose recurrent pregnancy loss.

That belongs with your doctors.

My job is to help you stop staring at disconnected pieces of information.

When I work with someone after pregnancy loss, I want to understand:

Exactly what happened in each pregnancy
How far along each pregnancy was
Whether tissue was tested
What imaging has been completed
What fertility testing was completed before conception
What your broader medical history shows
Which basic labs and health conditions have actually been reviewed
Whether your partner has been evaluated
Which recommendations came from your OB/GYN, REI, MFM, hematologist or other specialists
What remains unanswered
Which questions are evidence-based
Which next steps would actually change your plan

Sometimes that process identifies a gap.

Sometimes it helps a woman realize that she has already had an excellent evaluation.

Sometimes it shows us that the next step isn't another test at all.

Clarity is valuable even when the answer isn't “we found the cause.”

What If the Entire Recurrent-Loss Evaluation Is Normal?

This happens more often than most women realize.

ACOG notes that more than half of women with repeated miscarriages may never receive a definite explanation.

That can feel devastating.

But unexplained does not mean hopeless.

ACOG reports that roughly 65% of women with unexplained recurrent pregnancy loss have a successful next pregnancy without special treatment.

ASRM's newer 2026 review similarly reports successful subsequent pregnancy in many patients with unexplained RPL, with estimates ranging roughly from 50–80% depending on the population studied.

Those statistics aren't guarantees.

They don't erase what you've already been through.

But they matter because recurrent miscarriage can make you feel as though your body has demonstrated that it cannot carry a pregnancy.

The evidence does not support that conclusion.

If You're Over 35, the Goal Is Not to Ignore Age—

or Blame Everything on It

Both extremes fail women.

Age matters.

Chromosomal abnormalities matter.

Time matters.

But so do:

Pregnancy genetics
Uterine anatomy
APS when clinically relevant
Thyroid and metabolic health when indicated
Male factors
Your broader medical history
Your overall preconception health

And when you've had recurrent losses, those pieces deserve to be organized into an actual plan.

Not fear.

Not endless testing.

And not:

“It's probably just your age.”

If You've Had Two or More Losses and Still Don't Have a Clear Plan

You may not need another list of tests.

You may need someone to help you sort out:

what has already been done,

what your doctors have actually ruled out,

what your history makes worth asking about,

and

what your next pregnancy plan looks like.

That's exactly the kind of situation we can begin talking through on a free 20-minute Hope & Clarity Call.

We'll look at where you are now, what still feels unresolved and whether there is an obvious next question worth bringing back to your medical team.

No pressure.

No promise that one hidden test explains everything.

Just clearer direction.

Book Your Free Hope & Clarity Call

Quick Answers

Is recurrent miscarriage after 35 always caused by egg quality?

No. Age increases the risk of embryonic chromosome abnormalities, which are a major cause of miscarriage. But recurrent pregnancy loss can also involve uterine, autoimmune, metabolic, genetic or male factors, and some cases remain unexplained.

How many miscarriages count as recurrent pregnancy loss?

Current ASRM guidance defines recurrent pregnancy loss as two or more pregnancy losses. Pregnancies confirmed by urine or blood hCG count toward the definition.

Should I wait for three miscarriages before asking for testing?

No. Current ASRM and ACOG guidance supports evaluation after two pregnancy losses.

If I'm over 35, should miscarriage tissue be genetically tested?

Current ASRM guidance recommends offering chromosome testing of miscarriage tissue after a second miscarriage or in recurrent pregnancy loss when tissue is available. Age makes this information particularly useful because chromosomal abnormalities become more common as maternal age increases.

If the miscarriage was genetically normal, what does that mean?

A chromosomally normal miscarriage does not identify the cause by itself, but it makes it reasonable to look more closely at other potential contributors rather than assuming the loss was age-related aneuploidy.

Should recurrent-miscarriage testing include Factor V Leiden?

Not routinely. Current ASRM guidance does not recommend broad inherited-thrombophilia screening for every woman with recurrent loss. A personal history of blood clots, known thrombophilia or other relevant medical history can change that recommendation.

Should my partner be evaluated after recurrent miscarriage?

Yes. Male health should remain part of the evaluation. In recurrent unexplained miscarriage or when recurrent miscarriage occurs alongside infertility, current ASRM guidance says sperm DNA-fragmentation testing may be considered.

What if all my recurrent-miscarriage testing is normal?

That is common. Many cases remain unexplained, but the prognosis can still be encouraging. Both ASRM and ACOG report that many women with unexplained recurrent pregnancy loss subsequently have a successful pregnancy.

Sources

American Society for Reproductive Medicine. Recurrent Pregnancy Loss: A Committee Opinion. 2026.

American College of Obstetricians and Gynecologists. Repeated Miscarriages.

American Society for Reproductive Medicine. Fertility Evaluation of Infertile Women: A Committee Opinion.

About the author and editorial review
Written and personally reviewed by Erica Hoke, Certified Naturopathic Coach and founder of Infertility Empowered. Erica combines professional fertility-coaching experience with her personal experience conceiving four children naturally after age 35. This article has been reviewed for clarity, source accuracy and alignment with current fertility guidance. It is educational and is not a substitute for individualized medical advice, diagnosis or treatment.