After Two Miscarriages: What Testing Is Recommended in Canada—and Where Acupuncture May Fit

Written By weijie xu

After one miscarriage, many people are told that pregnancy loss is common and to try again when they feel ready.

After a second loss, the questions often change.

Why did this happen again? Do two miscarriages count as recurrent pregnancy loss? Should testing begin now? Is it safe to try again? And can acupuncture or Chinese medicine do anything meaningful without creating false hope?

In Canada, the answer to the first practical question has recently become clearer. The Society of Obstetricians and Gynaecologists of Canada now defines recurrent pregnancy loss as two or more pregnancy losses, including losses that are not consecutive. The updated Canadian guidance means you do not necessarily need to wait for a third miscarriage before asking for an evaluation.

This guide explains what that change means, which questions may be worth discussing with your medical team, and where acupuncture may fit as complementary support for patients in Aurora and the Greater Toronto Area.

Medical note: This article is general education, not personal medical advice. Pregnancy loss can involve urgent complications. If you are currently bleeding, in pain, feeling faint, or concerned about an ectopic pregnancy, contact your medical provider or seek urgent care. Acupuncture and Chinese herbal medicine do not replace medical evaluation or treatment.

Do two miscarriages count as recurrent pregnancy loss in Canada?

Yes. Canada's 2025 SOGC guideline defines recurrent pregnancy loss, often shortened to RPL, as two or more losses. The losses do not have to happen one after another.

The guideline also includes biochemical pregnancies, sometimes called chemical pregnancies. These are very early pregnancies confirmed by urine or blood hCG that end before an ultrasound can show a pregnancy in the uterus.

The American Society for Reproductive Medicine's updated 2026 recurrent pregnancy loss guidance likewise defines RPL as two or more pregnancy losses. It explicitly includes biochemical and non-consecutive losses and states that ultrasound or pregnancy-tissue confirmation is not required when pregnancy was confirmed by urine or blood hCG.

That does not mean every person needs every possible test after two losses. It means the history deserves recognition and an individualized discussion now—not automatically waiting until another loss occurs.

First, miscarriage is usually not caused by something you did

Self-blame is extremely common after pregnancy loss. Patients often replay exercise, work stress, food, travel, sex, lifting, or one missed supplement and wonder whether a different choice could have saved the pregnancy.

Most early miscarriages are not caused by an ordinary daily activity. The SOGC notes that early pregnancy loss is most often related to chromosomal changes occurring at conception and is usually not preventable. ASRM estimates that approximately 50% to 60% of first-trimester miscarriages are caused by an abnormal number of chromosomes in the embryo, with the likelihood increasing with maternal age.

Stress after a miscarriage is real and deserves care. It should not be turned into another reason to blame yourself. Emotional distress may affect sleep, appetite, relationships and quality of life, but feeling worried does not mean you caused the loss.

There is also room for realistic hope. ASRM reports that, across recurrent-loss populations, approximately 50% to 80% of patients have a successful subsequent pregnancy without a specific intervention. Your own outlook depends on age, medical history, the number and timing of losses, genetic findings and other factors, so a population estimate cannot predict an individual result.

Emotional support is part of care

Pregnancy loss is not only a laboratory or ultrasound event. Grief may be intense even when the pregnancy ended very early, and partners can be affected differently.

Canada's updated guideline calls for compassionate, trauma-informed care and appropriate mental-health support. In Ontario, Sunnybrook's Pregnancy and Infant Loss Network offers peer-support programs and resources for families. Asking for counselling or peer support does not mean you are coping badly; it means the loss is being treated as the significant experience it was.

What recurrent pregnancy loss testing is recommended after two miscarriages?

A recurrent-pregnancy-loss evaluation should be guided by your history rather than ordered as one enormous panel. ASRM's 2026 opinion uses a stepwise approach: begin with the information most likely to explain the losses, then add targeted testing when the findings or clinical history justify it. Canadian and U.S. recommendations differ on some details, so the final plan should follow your Ontario medical team.

Here are the main areas to discuss with your family physician, obstetrician, reproductive endocrinologist or pregnancy-loss clinic.

1. The details of each pregnancy and loss

Bring as much information as you have, even if the losses happened at different clinics.

Useful details include:

  • the first day of the last menstrual period and estimated gestational age

  • home and blood pregnancy-test dates

  • hCG and progesterone results, if measured

  • ultrasound reports

  • whether cardiac activity was ever seen

  • how the loss was managed

  • pathology or chromosome-testing results

  • symptoms or complications, including infection, severe bleeding or suspected ectopic pregnancy

  • medications used before and during the pregnancy

The timing and pattern of the losses help the physician decide which investigations are relevant.

2. Genetic testing of pregnancy tissue, when available

Chromosome testing of miscarriage tissue can sometimes show that a loss resulted from a sporadic chromosome error. The 2026 ASRM opinion recommends array-based chromosome evaluation of miscarriage tissue as a first step for patients with recurrent pregnancy loss.

This testing is not always available, may not be publicly covered, and cannot always produce a clear result. If tissue from a recent loss is available, ask whether testing is possible and what the result would—and would not—tell you. You should never feel that you need to experience another loss simply to obtain this information.

Parental chromosome testing may be considered in certain situations, such as when pregnancy-tissue testing finds an unbalanced chromosome rearrangement or when no tissue result is available. Genetic counselling is important before drawing conclusions from these tests.

3. The uterine cavity

The shape of the uterus and its cavity can be assessed for conditions such as a uterine septum, adhesions, polyps or fibroids that distort the cavity.

Depending on your history, your physician may discuss pelvic ultrasound, saline-infusion sonography, hysterosalpingography or hysteroscopy. These tests do different things; having had a routine pelvic ultrasound does not always mean the uterine cavity has been fully assessed.

Finding a fibroid does not automatically explain a miscarriage. Its location and effect on the uterine cavity are often more important than the simple fact that it exists.

4. Targeted blood testing

Bloodwork should be selected and interpreted in context. The Canadian SOGC and U.S. ASRM guidance differ on how broadly to screen, so an Ontario physician may reasonably follow a broader Canadian pathway than a U.S.-based checklist suggests. Questions may include:

  • Has thyroid function been assessed? SOGC includes TSH in the recurrent-loss endocrine evaluation, while ASRM targets testing according to symptoms, risk factors, a euploid miscarriage or the absence of pregnancy-tissue results.

  • Has glucose regulation been assessed with the test your physician considers appropriate? SOGC includes metabolic screening, while ASRM emphasizes HbA1c when diabetes risk factors or symptoms are present.

  • Has antiphospholipid-antibody testing been discussed? SOGC recommends screening patients with recurrent pregnancy loss, while ASRM limits routine testing to people meeting clinical criteria for antiphospholipid syndrome.

  • Has prolactin been assessed? SOGC includes it in the endocrine evaluation, while ASRM targets testing to symptoms such as irregular ovulation or nipple discharge.

Antiphospholipid syndrome, or APS, is a specific autoimmune clotting condition associated with pregnancy loss. Two losses alone do not diagnose APS. Diagnosis requires the appropriate clinical history and persistent laboratory findings. It should not be confused with broad, unvalidated “immune” testing.

5. The partner's history

Recurrent pregnancy loss is not solely an issue for the person who was pregnant. A review may include the sperm-contributing partner's age, health, medications, smoking or substance exposure, reproductive history and family history.

Routine semen analysis and sperm DNA fragmentation answer different questions. The 2026 ASRM guidance suggests that sperm DNA fragmentation testing may be considered in recurrent unexplained loss or when infertility is also present; an abnormal result may prompt reproductive-urology assessment. It is not automatically required for every couple.

For more partner-side context, read Male Fertility and Sperm Quality: What Acupuncture Can and Cannot Support Before IVF or IUI.

6. Health conditions, medications and preconception care

Review prescription medication, supplements and natural health products with the appropriate clinician. Do not stop a necessary medicine because you are trying to conceive, and do not start aspirin, progesterone, thyroid medication or an anticoagulant based only on online advice.

Existing conditions such as overt thyroid disease, diabetes, hypertension, autoimmune disease or antiphospholipid syndrome need condition-specific medical care. Smoking, alcohol, caffeine intake, nutrition and weight may also be discussed without implying that lifestyle caused the losses.

Which popular tests or treatments are not automatically recommended?

After repeated loss, it is understandable to want every available test. More testing, however, does not always produce a useful answer and can lead to cost, anxiety and treatments that have not been shown to help.

The 2026 ASRM guidance does not recommend routine use of:

  • inherited thrombophilia panels, including MTHFR testing, for recurrent pregnancy loss

  • broad immune or natural-killer-cell testing

  • endometrial receptivity testing

  • routine uterine or vaginal microbiome testing

  • routine ovarian-reserve testing solely to explain recurrent loss

  • aspirin or heparin for unexplained loss when antiphospholipid syndrome is absent

  • intralipids, IVIG or prednisone as empiric recurrent-loss treatments

This does not mean no patient ever needs specialized testing. It means the test should answer a clinical question and have the potential to change care.

Routine microbiome panels are not the same as an endometrial biopsy for chronic endometritis. In selected cases of otherwise unexplained recurrent loss, or when infertility is also present, your specialist may discuss whether an endometrial biopsy is relevant. This is not a universal screening test, and finding a possible cause does not automatically prove that a particular treatment will improve the next pregnancy outcome.

AMH and ovarian-reserve testing may still matter for broader fertility planning, but they answer a different question and do not identify the cause of recurrent pregnancy loss.

Should you take baby aspirin after two miscarriages?

Not without medical advice.

Low-dose aspirin and heparin have an established role for some patients with confirmed antiphospholipid syndrome. They are not universal miscarriage-prevention medicines. ASRM advises against empiric aspirin or anticoagulant treatment for unexplained recurrent pregnancy loss when APS is absent.

Aspirin can affect bleeding and may interact with other medications or health conditions. If it has been prescribed, follow the prescriber's instructions. If it has not, ask your physician whether there is a specific indication rather than self-starting it.

Do you need to wait before trying again?

There is no single waiting period that is right for everyone.

The immediate priorities are confirming that the pregnancy loss is complete, excluding ectopic pregnancy or infection, managing anemia or other complications, and allowing you to feel physically and emotionally ready. Your physician may also want to complete parts of the recurrent-loss evaluation before the next pregnancy.

Some people want to try again as soon as medically reasonable. Others need more time. Neither response is wrong.

Ask your medical provider:

  • Has the loss been confirmed as complete?

  • Does hCG need to be followed to a particular level?

  • Is there a reason to delay intercourse or conception after my specific treatment or procedure?

  • Should any testing be completed before the next attempt?

  • What should I do as soon as the next pregnancy test is positive?

You do not need to follow an arbitrary “three-month detox” rule from social media or complementary-medicine marketing.

Where may acupuncture fit after miscarriage?

Acupuncture does not diagnose or treat the causes of recurrent pregnancy loss. It cannot correct an embryo's chromosomes, identify a uterine abnormality, treat antiphospholipid syndrome or replace care for thyroid disease, diabetes, fertility treatment or pregnancy.

It also should not be advertised as a proven way to prevent miscarriage. High-quality evidence has not established that acupuncture prevents another miscarriage or guarantees that the next pregnancy will continue.

Acupuncture may still be considered as optional complementary care once you are medically stable. The goals should be specific and realistic, such as:

  • creating a structured space to decompress during a difficult period

  • supporting relaxation and sleep

  • addressing muscle tension or headaches when acupuncture is otherwise appropriate

  • reviewing cycle changes as menstruation resumes

  • helping you maintain a manageable self-care routine while medical evaluation proceeds

At a fertility-focused consultation, I review the dates and circumstances of the losses, current symptoms, cycle history, sleep, stress, digestion, medications, supplements and the medical follow-up already planned. If a symptom needs medical assessment first, acupuncture is postponed.

If you want a careful supportive plan built around your medical follow-up, book a fertility consultation in Aurora and bring the records you already have.

For more on combining treatment safely, read Can I Use Acupuncture or Chinese Herbs While Taking Fertility Medications?.

What acupuncture cannot promise after pregnancy loss

A responsible practitioner should not tell you that acupuncture will:

  • prevent another miscarriage

  • “hold” a pregnancy

  • correct embryo aneuploidy or improve embryo genetics

  • treat a clotting disorder or uterine structural problem

  • replace progesterone, aspirin, heparin, levothyroxine or another prescribed medicine

  • guarantee implantation, pregnancy or live birth

  • prove that stress, “cold uterus” or an energy imbalance caused the loss

Ontario's CTCMPAO advertising standard prohibits claims that acupuncture will increase a patient's chance of successful conception. The same honesty is especially important after miscarriage, when patients may be vulnerable to guilt and expensive promises.

Chinese herbs require a separate safety decision

Acupuncture and Chinese herbal medicine are not interchangeable. Herbs contain active ingredients and may interact with medication, affect bleeding, or become inappropriate when pregnancy is possible.

Do not automatically restart a formula used before the loss, borrow another person's formula, or continue a product after a positive pregnancy test without review. Any herbal plan should account for:

  • whether the miscarriage is medically complete

  • current bleeding and anemia

  • pregnancy possibility and contraception plans

  • prescription medicines and supplements

  • liver, kidney, clotting and other relevant conditions

  • the timing of fertility testing, IUI, IVF or embryo transfer

  • your fertility clinic's policy on herbs

Health Canada explains that an NPN identifies a natural health product authorized for sale in Canada when used according to its approved label. It does not prove that an individualized formula prevents miscarriage or is suitable in every stage of conception and pregnancy.

What if the next pregnancy test is positive?

Contact the physician, midwife or fertility clinic responsible for your early-pregnancy care and ask about the plan made for you. Depending on your history, that plan may include appropriately timed hCG testing, ultrasound or prescribed medication.

Do not change progesterone, thyroid medication, aspirin, heparin or other treatment because of a symptom, a home test, BBT changes or advice from an acupuncturist.

Acupuncture in early pregnancy may be considered as optional supportive care when you are medically stable, but the treatment must be modified for pregnancy. It is not a substitute for investigating bleeding, pain, dizziness or other concerning symptoms.

When medical care comes before acupuncture

If you are currently pregnant or recently experienced a loss, seek prompt medical advice for:

  • severe, one-sided or worsening abdominal or pelvic pain

  • shoulder-tip pain

  • fainting, marked dizziness, weakness or confusion

  • heavy bleeding, especially if you are soaking pads rapidly

  • fever, chills or foul-smelling discharge

  • shortness of breath or chest pain

  • persistent vomiting or inability to keep fluids down

  • worsening symptoms after medical or surgical management

These may indicate ectopic pregnancy, hemorrhage, infection, retained pregnancy tissue or another complication. Call 911 or go to an emergency department for severe symptoms.

What to bring to a recurrent-loss fertility consultation

You do not need a perfect binder. Screenshots and portal records are useful.

Bring or send:

  1. a timeline of every pregnancy and loss, including chemical pregnancies

  2. ultrasound, bloodwork, pathology and genetic-testing results

  3. your medication and supplement list

  4. menstrual-cycle information before and after the losses

  5. relevant diagnoses, procedures and family history

  6. your partner's available fertility or medical results

  7. the next steps already recommended by your physician or fertility clinic

  8. the supportive-care goals you want help with now

The purpose is not to replace a recurrent-pregnancy-loss clinic. It is to build complementary care around the medical plan you actually have.

If you have experienced two or more losses and want a careful, cycle-aware supportive plan, book a fertility consultation in Aurora and bring your available records.

Frequently asked questions

Do two chemical pregnancies count as recurrent pregnancy loss?

Under the 2025 SOGC guideline and 2026 ASRM opinion, pregnancies confirmed by urine or blood hCG can count even when they end before ultrasound confirmation. Discuss your complete history with your physician because documentation and local referral processes may vary.

Do the two miscarriages have to be consecutive?

No. Canada's updated definition includes non-consecutive losses. A live birth between losses does not erase the later need for an individualized review.

If you are trying to conceive after previously having a child, read Trying for Baby #2? Secondary Infertility and Fertility Acupuncture in Aurora.

Should I wait for a third miscarriage before asking for testing?

No. The updated Canadian definition recognizes recurrent pregnancy loss after two or more losses. The appropriate evaluation still depends on your age, pregnancy history, timing of the losses and other medical factors.

Does spotting mean low progesterone caused my miscarriages?

No. Spotting alone cannot diagnose low progesterone or establish the cause of a loss. Progesterone testing and treatment are context-dependent. Read Spotting Before Your Period When Trying to Conceive: Is Your Luteal Phase Too Short? for a more detailed explanation.

Can acupuncture prevent another miscarriage?

Current high-quality evidence does not establish that acupuncture prevents recurrent pregnancy loss. It may be used as optional supportive care for goals such as relaxation, sleep or muscle tension, but it should not replace investigation or prescribed treatment.

When can I start acupuncture after a miscarriage?

There is no universal number of days. First confirm that you are medically stable and that urgent complications have been excluded. Timing depends on bleeding, pain, the management method, anemia, infection risk and your clinician's instructions.

Can I take Chinese herbs while trying again?

Possibly, but only after an individualized medication and safety review. Pregnancy can occur before the first period after a loss, so herbs should be selected with pregnancy possibility in mind and reviewed again after a positive test.

Does recurrent pregnancy loss mean I need IVF?

No. Recurrent loss and infertility are different conditions, although they can occur together. IVF and genetic testing may be discussed in selected situations, but two losses do not automatically mean IVF is the best next step. For unexplained recurrent pregnancy loss, ASRM notes that prospective studies have not shown preimplantation genetic testing for aneuploidy (PGT-A) to reduce miscarriage or increase live birth. PGT for a structural chromosome rearrangement is a different, selected indication.

A practical next step in Aurora

After two miscarriages, you deserve more than “just relax” and more than a list of unproven add-ons. You deserve a clear medical review, honest information and support that does not blame you or promise what it cannot deliver.

I am Mike (Weijie) Xu, an Ontario Registered Acupuncturist and Registered Traditional Chinese Medicine Practitioner. At TCM Fertility in Aurora, I provide individualized, cycle-aware complementary care for people trying naturally or working with fertility clinics. I review your pregnancy-loss timeline and current medical plan before recommending acupuncture or herbal medicine.

If acupuncture is not the right next step, if herbs should be avoided, or if a symptom belongs with your physician first, I will say so.

Bring your records to a fertility consultation, or call 905-727-3029. If you are still organizing your history, begin with the free TCM Fertility self-assessment.

Clinic: 15165 Yonge St, Unit 2, Aurora, ON L4G 1M1
Serving: Aurora, Newmarket, Richmond Hill, Markham, Toronto and the Greater Toronto Area

About the author

Mike (Weijie) Xu, R.Ac., R.TCMP is an Ontario Registered Acupuncturist and Registered Traditional Chinese Medicine Practitioner. He holds bachelor's and master's degrees in herbal medicine from Nanjing University of Chinese Medicine in China, teaches Traditional Chinese Medicine, and serves as an education-program approval reviewer for the College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario. His Aurora practice provides individualized, cycle-aware complementary care alongside natural conception, IUI and IVF.

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