One loss usually isn't a clue about anything. Combining two sets of chromosomes correctly fails at a dice-roll rate of about one in seven pregnancies, rising with age: near 30% at 25, 50% at 35, 80% at 42 ¹. Two in a row is where random chance stops being enough to explain it. It might still be bad luck stacking; it might also be something the body does every pregnancy that an ordinary visit can't see.

The workup looks in five places, but they aren't equal. Antiphospholipid syndrome, an autoimmune clotting condition, is the transformative finding: daily low-dose aspirin plus a heparin injection roughly halves the loss rate ². The other four (thyroid, uterus, chromosomes, metabolism) screen for real problems with far narrower payoffs.

Half the time it finds nothing. "Unexplained" is not defeat. Even after three losses with no cause found, about 60–70% of women have a live birth next time on supportive monitoring alone ³.

Start after the second loss, at the right clinic. Waiting for a third is the old standard. A general OB often runs a thin version; ask reproductive endocrinology or a recurrent-loss clinic for the full panel ⁴.

It runs 2–4 visits over 6–12 weeks, roughly $500–$2,000 in the US when uncovered ⁶.

The relief starts before any treatment does. During the testing weeks, the mornings stop being diagnostic; you stop running silent loops about last night's wine. Then it ends one of three ways.

• A named cause with a real fix. Antiphospholipid syndrome confirmed: aspirin and heparin from the positive test, success from about 40% to 70–80% ². It also flags a lifelong clotting risk decades early ⁷.
• A finding that reshapes the plan. A uterine septum, a parental translocation, a metabolic problem. No quick fix, but the next attempt is planned instead of blind.
• Nothing on the panel. The 60–70% number lands differently once the looking has been done ³.

This is the workup for early loss. A single first miscarriage doesn't need it. Losses after about ten weeks belong to maternal-fetal medicine instead.