You were told to try again. Maybe you were told it was bad luck, or to wait until it happened a third time before anyone would look.

Here is what changed this year. In 2026, the American Society for Reproductive Medicine updated its definition of recurrent pregnancy loss for the first time since 2012. Two losses now meet the definition, not three, and a positive test that ended early counts. The old number kept women waiting for a third loss before the investigation even started.

Here is the part no one tells you. Meeting the definition gets you a workup. It does not guarantee the workup is complete. After two or more losses, up to half of couples are told the same word. Unexplained. The losses are real. What gets called a complete workup is the question.

This episode is the 9 specific things we most often find that are rarely checked before a woman is told her losses were unexplained or simply bad luck. Pull it up. Take notes. Bring it to your next appointment.

The 9 patterns:

1. Thyroid, the full panel and antibodies, not just TSH
2. Antiphospholipid antibodies, tested correctly
3. Chronic endometritis
4. The reproductive microbiome, vaginal and seminal
5. The gut, hidden gluten, and inflammation
6. Sperm DNA fragmentation
7. The male partner's full bloodwork
8. Blood sugar and metabolic patterns
9. The nervous system and progesterone

These are the areas that sit outside a standard miscarriage workup. A 2012 meta-analysis in Human Reproduction, pooling sixteen studies and nearly three thousand couples, found miscarriage rates rose with sperm DNA damage, with about twice the relative risk. Unexplained rarely means there is nothing to find. It usually means the search stopped at the karyotype, one antiphospholipid test, the anatomy, and a TSH.

For the full breakdown of every pattern, read the companion article, Recurrent Pregnancy Loss: The Functional Fertility Approach, at https://fabfertile.com/blogs/learn/recurrent-pregnancy-loss

WHAT YOUR CLINIC MISSED

The companion guide walks through all 9 of these patterns in more detail, so you can take it to your next appointment and ask the questions.

Email [email protected], subject line MISSED, and we will send you the guide.

FUNCTIONAL FERTILITY SECOND OPINION

A free 45-minute call where I review your labs, your history, your losses, and your partner's results with you. You leave knowing what your biology has been telling you and what your next decision could be.

Email [email protected], subject line FERTILE, or book here.

ABOUT THE HOST

I'm Sarah Clark, founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over one million downloads. My functional fertility team works with couples navigating low AMH and failed IVF, reviewing functional lab results, gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.

Sarah Clark, founder of Fab Fertile, host of Get Pregnant Naturally (1M+ downloads), and author of Fabulously Fertile.

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TIMESTAMPS

00:00 What "Unexplained" Means and What the 2026 Guideline Changed 01:30 Who's Reviewing Your Case at Fab Fertile 04:00 Thyroid: The Full Panel, Not Just TSH 05:50 Antiphospholipid Antibodies, Tested Correctly 06:30 Chronic Endometritis 07:30 The Reproductive Microbiome 08:30 The Gut, Hidden Gluten, and Inflammation 10:30 What Your Clinic Missed Guide 11:00 Sperm DNA Fragmentation 12:30 The Male Partner's Full Bloodwork 13:50 Blood Sugar and Metabolic Patterns 15:20 The Nervous System and Progesterone 16:30 What "Unexplained" Really Means 17:20 The Functional Fertility Second Opinion