Senior Consultant, Medical Genetics, Artemis Hospitals, Gurgaon, India
Series overview · 12 articles
Finding Answers in Recurrent Pregnancy Loss
June 7, 2026
Dr. Kanika Singh is Senior Consultant, Medical Genetics at Artemis Hospitals, Gurgaon. This guide is based on a live Jivo Masterclass where she walked doctors across Africa through why recurrent pregnancy loss happens (defined as two or more consecutive losses) and, critically, through the roughly 50-60% of cases where a real, identifiable cause can actually be found.
The series covers fetal chromosomal abnormalities and balanced parental translocation, single-gene causes behind recurring second-trimester losses, anatomical and endocrine factors, antiphospholipid antibody syndrome, sperm DNA fragmentation, the still-debated role of immunological testing, a practical trimester-by-trimester investigation framework, and pre-implantation genetic testing, closing with the reassuring prognosis data Dr. Singh shares with every couple she counsels.
This guide is based on a live Jivo Masterclass — Dr. Kanika Singh taught doctors across Africa on June 7, 2026.
Watch the full recording, or read the guide above.
FROM THE LIVE Q&A
Dr. Isaya
My question is about sperm collection. In my clinic I often see couples where the male is over 50 years old. What are the chances of getting good quality sperm, and what are the implications for implantation?
Dr. Kanika Singh
I will not be able to give you details about specific sperm selection procedures, as in our hospital this is a multidisciplinary process involving the IVF specialist and the andrology laboratory. But in terms of the genetic implications: above the age of 50, there is a high chance that sperm quality is reduced, and the sperm DNA fragmentation index is likely to be elevated. Unless we specifically test for it, we do not know the exact level, but even without testing, there is a significant chance that sperm DNA quality is impaired, which can result in recurrent pregnancy loss or implantation failure. Testing the sperm DNA fragmentation index in men above 50 with a history of recurrent pregnancy loss or implantation failure would be worthwhile.
Frequently Asked Questions
For patients with PCOS, how long should metformin be taken before conception and after conception?▼
Metformin should be started at least 2 to 3 months before conception. It is safe to continue in pregnancy and is generally continued through the first trimester and sometimes beyond. It should be monitored with GTT as well as regular HbA1c and blood sugar checks throughout.
My question is about sperm collection. In my clinic I often see couples where the male is over 50 years old. What are the chances of getting good quality sperm, and what are the implications for implantation?▼
I will not be able to give you details about specific sperm selection procedures, as in our hospital this is a multidisciplinary process involving the IVF specialist and the andrology laboratory. But in terms of the genetic implications: above the age of 50, there is a high chance that sperm quality is reduced, and the sperm DNA fragmentation index is likely to be elevated. Unless we specifically test for it, we do not know the exact level, but even without testing, there is a significant chance that sperm DNA quality is impaired, which can result in recurrent pregnancy loss or implantation failure. Testing the sperm DNA fragmentation index in men above 50 with a history of recurrent pregnancy loss or implantation failure would be worthwhile.
How is recurrent pregnancy loss defined?▼
Recurrent pregnancy loss is defined as two or more consecutive pregnancy losses.
In what proportion of recurrent pregnancy loss cases can a real cause be identified?▼
A real, identifiable cause can be found in roughly 50-60% of cases, leaving the remainder to be managed empirically.
What topics does this masterclass series on recurrent pregnancy loss cover?▼
The series covers fetal chromosomal abnormalities and balanced parental translocation, single-gene causes behind second-trimester losses, anatomical and endocrine factors, antiphospholipid antibody syndrome, sperm DNA fragmentation, the debated role of immunological testing, a trimester-by-trimester investigation framework, pre-implantation genetic testing, and prognosis.
Who is Dr. Kanika Singh?▼
Dr. Kanika Singh is Senior Consultant, Medical Genetics at Artemis Hospitals, Gurgaon.
In This Series: Finding Answers in Recurrent Pregnancy Loss
- 1.Finding Answers in Recurrent Pregnancy Loss
- 2.Fetal Chromosomal Abnormalities: The Leading Cause of First-Trimester Loss
- 3.Balanced Translocation: When a Genetically Normal Parent Passes on Recurrent Loss
- 4.Single-Gene Causes: Why Second-Trimester Losses Need a Different Genetic Workup
- 5.Anatomical Causes: Uterine Septum, Fibroids, and Cervical Incompetence
- 6.Antiphospholipid Antibody Syndrome: Diagnosis and Treatment
- 7.Endocrine Causes: Thyroid, PCOS, and Diabetes in Recurrent Pregnancy Loss
- 8.Sperm DNA Fragmentation: The Male Factor in Recurrent Pregnancy Loss
- 9.The Immunological Debate: NK Cells, TNF-Alpha, and IVIG Therapy
- 10.What to Test For: A Practical Investigation Framework by Trimester
- 11.Pre-Implantation Genetic Testing: PGT-A, PGT-M, PGT-SR and PGT-HLA Explained
- 12.Prognosis After Recurrent Pregnancy Loss: Why the Outlook Is Better Than Most Couples Expect