Important change to RANZCOG miscarriage guidelines - and why it matters
TW: This blog post discusses miscarriage and early pregnancy loss. If this is something you're not ready to read about today, please take care of your heart and come back to it if or when you're ready. Sending you all my love x
If you or someone you love has experienced a miscarriage, you will understand just how heavy and complex the journey to conceiving can feel. Often, the hardest part is feeling like you're walking it alone, with more questions than answers.
But today, I want to share something important. Something that feels like a step forward.
You may have recently seen that the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has updated its recommendations when it comes to miscarriage and ectopic pregnancy. And the change deserves our attention.
So, what’s new?
RANZCOG now recommends that anyone who experiences two miscarriages, whether consecutive or not, should be offered further medical investigations to explore potential underlying causes.
Yes, two. Not three. Not consecutive. Just two.
This change is long overdue. But it’s an important one.
Because for too long, people experiencing loss have been told to “just try again,” often without any investigations or support until they've had to endure three or more devastating losses. That’s not okay. And this update signals a shift in the way the medical system is beginning to treat miscarriage - not as something to brush aside, but as a deeply personal, valid loss that deserves answers and care.
What testing can I ask for after two miscarriages?
Under the updated guidelines, your doctor can now arrange further investigations, such as:
Antiphospholipid antibody screening to check for autoimmune conditions linked to blood clotting.
Thyroid testing (TSH and TPO antibodies).
Uterine imaging to assess the physical structure of the uterus.
These are really valuable starting points. But unfortunately, they still might not tell the whole story.
There’s more we can (and should) explore.
There are still critical nutrients and hormones that are often overlooked, despite their well-known roles in supporting fertility and a healthy pregnancy.
These tests include:
Vitamin D - due to our lifestyle, vitamin D deficiency is common and can impact fertility and pregnancy outcomes
Active thyroid hormones (T3 and T4) - to assess the function of your thyroid, you need a full panel including T3 and T4 (even if TSH is ‘normal’). Conditions such as hypothyroidism are linked to an increased risk of miscarriage.
Comprehensive hormone panel – FSH, LH, oestrogen, progesterone, prolactin, testosterone and SHBG. These tests must be done on day 2 of your period for an accurate representation of what’s going on with your hormones.
Vitamin B12 and homocysteine – important for cell division, implantation, and egg health.
Sperm DNA testing – assessing your partner’s sperm is important as they contribute 50% of the DNA and poor quality is associated with miscarriage.
As a fertility nutritionist working in this space every day, I've seen just how much insight these tests can offer when trying to understand the root causes behind recurrent pregnancy loss and unexplained infertility.
So, what’s my take?
These updated guidelines are a positive step, and I’m so glad to see the system starting to shift. But at the same time, it’s important to know: they're still just guidelines, and they may not always be applied consistently across clinics or doctors.
That's why it's so essential to stay informed and confident in your ability to advocate for yourself. If you've experienced miscarriage, especially more than once, and you feel something's being missed or overlooked, you have every right to request deeper testing and support.
You know your body better than anyone.
And if you need support in that process, I’m here.
Whether you're grieving a recent loss, navigating the uncertainty of trying again, or just looking to understand what’s going on beneath the surface, you don’t have to go through it alone.
You can reach out anytime or book a free discovery call with me. Let’s explore what’s next, together.
