Senior Consultant, Medical Genetics, Artemis Hospitals, Gurgaon, India
Part 12 of 12 in Finding Answers in Recurrent Pregnancy Loss
Prognosis After Recurrent Pregnancy Loss: Why the Outlook Is Better Than Most Couples Expect
June 7, 2026
Prognosis after recurrent pregnancy loss depends on the number of prior losses and the woman's age, but Dr. Singh is clear that the numbers are more reassuring than most couples assume walking in. After one pregnancy loss, the statistical chance of a successful subsequent pregnancy is 80-90%. That figure decreases slightly with each additional loss.
But even after three pregnancy losses, the chance of a successful term pregnancy remains 65-70%, a message she repeats deliberately in counselling, because couples often arrive assuming the odds are far worse than they are. Combined with the fact that 40-50% of cases remain unexplained even after full workup, her broader point is that an unexplained cause doesn't mean an untreatable one: empirical management, psychological support, and this underlying favourable prognosis should guide the conversation, not just the diagnosis.
This guide is based on a live Jivo Masterclass — Dr. Kanika Singh taught doctors across Africa on June 7, 2026.
FROM THE LIVE Q&A
Dr. Agbogus Stanley
For patients with PCOS, how long should metformin be taken before conception and after conception?
Dr. Kanika Singh
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.
Frequently Asked Questions
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.
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.
What is the chance of a successful pregnancy after one prior pregnancy loss?▼
After one pregnancy loss, the statistical chance of a successful subsequent pregnancy is 80-90%.
Does the chance of success drop sharply after multiple losses?▼
The figure decreases slightly with each additional loss, but even after three pregnancy losses, the chance of a successful term pregnancy remains 65-70%.
What proportion of recurrent pregnancy loss cases remain unexplained after full workup?▼
40-50% of cases remain unexplained even after full workup.
Does an unexplained cause mean recurrent pregnancy loss cannot be managed?▼
No. An unexplained cause doesn't mean an untreatable one; empirical management, psychological support, and the underlying favourable prognosis should guide the conversation, not just the diagnosis.
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