Latest / Finally Get Pregnant Naturally: Holistic Fertility Support To Conceive Naturally and Stay Pregnant After Miscarriage / #253 | The Recurrent Miscarriage Testing Update You NEED to Know for Your Fertility and Ability to Stay Pregnant (Plus the Gaps That Could Still Be Holding You Back)
Transcript
- 0:01Katie: What you need to know about the updates to miscarriage testing and how that will impact your fertility goals.
- 0:09Welcome to the Finally Get Pregnant Naturally podcast, the podcast helping women identify the real reasons you haven't conceived or stayed pregnant so you and your partner can finally grow the family of your dreams.
- 0:22I'm your host, Dr.
- 0:24Katie Wood.
- 0:25Let's dive in, shall we?
- 0:27Katie: Three things you'll walk away with from today's episode: what the ASRM 2026 guideline update actually changed and why you may now qualify for a workup if you've had a miscarriage, what the updated conventional workup covers and why some
- 0:46Katie: cases still come back without a clear answer, where the functional approach begins when the conventional one ends.
- 0:56Katie: So it just came out that the ASRM 2026 guidelines had updated.
- 1:05Katie: So for years, the standard in conventional medicine was that a full recurrent pregnancy loss workup was not initiated until after three consecutive losses.
- 1:19Katie: Three, right?
- 1:21Katie: They required a woman, a couple, a family to go through three consecutive losses before ever being willing and able to investigate that further.
- 1:36Katie: I just It just sounds inhumane to me.
- 1:40Katie: Which meant that if you had two devastating miscarriages, you were often sent home and told to just try again and hope for the best, that you had not yet qualified for answers at that time.
- 1:54Katie: So the American Society for Reproductive Medicine, or ASRM, published an updated committee opinion in 2026 that has changed this.
- 2:04Katie: The new definition of recurrent pregnancy loss is two or more losses, and critically, those losses no longer need to be consecutive.
- 2:15Katie: Two losses at any point in your reproductive history now qualifies you for a full investigation, and I should probably retract the word full, to be honest.
- 2:26Katie: It qualifies you for an investigation.
- 2:30Katie: Biochemical losses or pregnancies confirmed by a positive test but lost before a successful ultrasound are also now included in that count.
- 2:42Katie: So this is meaningful.
- 2:44Katie: If you have had two losses and you were previously told you needed to wait, bring this update to your next appointment.
- 2:51Katie: You now meet the clinical threshold for evaluation.
- 2:55Katie: Advocate for yourself.
- 2:57Katie: Push for it if you still have no answers.
- 3:00Katie: Okay?
- 3:01Katie: So let's go over what the conventional workup covers.
- 3:06Katie: So what does the updated conventional RPL or recurrent pregnancy loss workup actually look at?
- 3:15Katie: The guidelines recommend chromosome analysis of miscarried tissue as the first step.
- 3:20Katie: This is a significant addition that helps identify whether a loss was due to a chromosomal abnormality in the embryo, which does account for roughly 50% of first trimester losses.
- 3:33Katie: Beyond that, the workup includes uterine anatomy assessment for everyone, antiphospholipid antibody testing, thyroid screening with TSH, and other evaluations for those who meet clinical criteria.
- 3:50Katie: So these are real and important tests.
- 3:52Katie: Finding an antiphospholipid syndrome, a uterine septum, or overt thyroid dysfunction changes management meaningfully and can improve outcomes.
- 4:04Katie: This workup matters, and you deserve access to it.
- 4:08Katie: But here is what I need you to understand.
- 4:12Katie: Even after a complete conventional workup, a significant portion of RPL cases come back without a clear explanation, somewhere in the range of 50% or more when all losses are euploid.
- 4:28Katie: The guideline acknowledges this directly.
- 4:31Katie: For the woman who completes every recommended test and still has no answer, the conventional investigation has really reached its boundary, and that is not a failure on your part That is the edge of what the conventional framework was
- 4:48Katie: designed to find.
- 4:50Katie: Because here's the thing about fertility testing, conventional or functional, every single result is just one star, one piece of the puzzle, one piece of the full picture.
- 5:04Katie: One star never tells the whole story, and what I want to give you today is the constellation, the fuller picture of what can be contributing to loss that no single test and no single guideline is really designed to
- 5:22Katie: capture on its own.
- 5:24Katie: So let's talk about where the functional approach can pick things up.
- 5:29Katie: And I wanna be clear about something before I go any further.
- 5:33Katie: What I'm about to share is not within the ASRM guidelines.
- 5:36Katie: The conventional guideline is built on randomized controlled trial evidence, or RCT.
- 5:44Katie: And for areas where that evidence is limited or conflicting, it will not include in their recommendations.
- 5:52Katie: What functional medicine does is operate in the space that conventional guidelines cannot yet fully address, looking at root cause contributors that have biological plausibility and emerging research, even if large-scale RCTs are not yet available.
- 6:11Katie: So that distinction matters, and I wanna point it out because you deserve to know the difference between what has been validated in large trials and what represents a root cause whole body approach and clinical perspective.
- 6:25Katie: Both have a place.
- 6:27Katie: They're just different frameworks.
- 6:30Katie: And I like to think of functional medicine, the functional approach that I take with my clients is leaving no stone unturned.
- 6:39Katie: Whereas in conventional medicine, there are definitely some stones that are not even being, looked at at all So here is what I'm looking at in my clients, especially with a history of loss.
- 6:53Katie: Gut health and systemic inflammation.
- 6:56Katie: The conventional workup does not assess the guts-- does not assess the gut, but gut dysbiosis is a huge driver of systemic inflammation.
- 7:06Katie: It can disrupt estrogen metabolism, impairs nutrient absorption, and contributes to immune dysfunction, all of which have biological relevance to implantation and early pregnancy.
- 7:18Katie: This is not in the guideline, but it is in my functional root cause framework.
- 7:24Katie: And for the woman with unexplained loss, it is absolutely worth exploring.
- 7:29Katie: And then we have the vaginal and uterine microbiome.
- 7:32Katie: So full transparency here, the 2026 guideline does not recommend routine microbiome testing, partly because a recent high-quality trial showed no benefit of antibiotic treatment for chronic endometritis in RPL patients specifically.
- 7:50Katie: But the guideline's conclusion on treatment does not mean that the microbiome is irrelevant to the uterine environment.
- 7:58Katie: It means the research on how to act on those findings is still evolving.
- 8:04Katie: From a functional perspective, the vaginal microbiome has emerging associations with implantation success and pregnancy maintenance, and that is just something I simply could not ignore for my clients.
- 8:17Katie: I assess it with clients not as a proven standalone treatment protocol, but as a part of understanding the full picture with the honest caveat that what we find informs a broader personalized root cause approach, not a one-size-fits-all antibiotic
- 8:34Katie: course.
- 8:35Katie: And just a really quick side note, I had a client come to me who had had a total of five losses with one successful pregnancy within that timeframe, and her doctor did give her treatment for ureaplasma, which is
- 8:52Katie: a pathogen that has been found to have fertility implications.
- 8:57Katie: She still had a loss after that.
- 9:00Katie: We ran a vaginal microbiome testing.
- 9:02Katie: She had a, a ton of dysbiosis, a few different pathogens that are not fertility-friendly, and no healthy lactobacillus at all.
- 9:13Katie: Once we treated that and worked on the other things that we do, she got pregnant.
- 9:19Katie: She stayed pregnant, and she just had her baby girl this past spring.
- 9:23Katie: God will only really know what it was.
- 9:25Katie: Did that play a part?
- 9:27Katie: I absolutely think so And then we have the full thyroid picture beyond TSH.
- 9:33Katie: The guideline recommends TSH screening and does not recommend routine thyroid antibody testing because RCTs have not shown that treating euthyroid women with elevated antibodies improves outcomes.
- 9:46Katie: What I still assess functionally is the full thyroid picture, including antibodies, not because I'm going to treat antibodies in isolation, but because the full picture tells me how the thyroid system is actually functioning and whether there are other
- 10:01Katie: drivers to address.
- 10:03Katie: Subclinical thyroid dysfunction that sits within the conventional normal range, not optimal, but outside of the optimal fertility range is something I absolutely want to see.
- 10:14Katie: This is a clinical judgment call, not a guideline recommendation, and being transparent about that distinction is part of how I serve my clients well from a functional perspective.
- 10:26Katie: And then we have our HPA axis and cortisol.
- 10:29Katie: Chronic stress and HPA dysregulation can suppress progesterone, impair implantation, and create an internal environment that is less hospitable to early pregnancy.
- 10:40Katie: This is never, ever assessed in conventional RPL care.
- 10:46Katie: A comprehensive hormone panel like the Dutch test maps this picture in ways that a standalone workup does not.
- 10:53Katie: It does not replace conventional testing, but it adds a layer that the guideline is just not designed to address.
- 11:01Katie: And then we have nutrient status, like vitamin D, B12, folate, zinc, magnesium, just to name a few.
- 11:07Katie: Deficiencies in these nutrients have direct biological impacts on egg quality, progesterone production, immune regulation, and embryo development.
- 11:17Katie: A standard workup will not assess most if any of these.
- 11:21Katie: A functional nutrient panel will.
- 11:23Katie: And in women experiencing recurrent loss, depletion is far more common than conventional care may give that credit for.
- 11:32Katie: Last but not least, we have sperm DNA fragmentation, which surprisingly this one is actually in the updated guideline.
- 11:40Katie: It is now recommended to consider sperm DNA fragmentation testing in unexplained RPL.
- 11:47Katie: This is worth naming explicitly because male factor is so often left out of the conversation, and two or more losses is a couple's diagnosis.
- 11:57Katie: It's not just a female one.
- 12:00Katie: So I'm just super excited to talk about something that I have been building behind the scenes.
- 12:08Katie: It's getting even closer to being ready, and it was made for exactly you The woman that this episode is speaking to.
- 12:18Katie: You have done the conventional workup, you've gotten incomplete answers, and you're ready to go deeper.
- 12:25Katie: I'm not quite ready to share everything yet, but I will say this: It is going to give you access to the kind of root cause investigation we talked about in a way that has never been available before without
- 12:40Katie: directly working with a practitioner.
- 12:42Katie: If you are not already following this podcast, go do that right now.
- 12:47Katie: And if you are following, stay close, because what is coming is absolutely worth the wait for you.
- 12:54Katie: So to recap, the ASRM updated its definition, two or more losses, no longer needing to be consecutive, now qualifies you for a full RPL workup, including chromosome testing, uterine anatomy, and evaluation such as an APS panel, thyroid, and
- 13:11Katie: sperm DNA fragmentation in certain circumstances.
- 13:14Katie: That is progress, and you deserve access to it.
- 13:18Katie: But when the conventional workup comes back without answers, and it does for a significant number of couples, that does not have to be the end of the road for you.
- 13:27Katie: It is where a functional root cause investigation begins.
- 13:31Katie: The guidelines goalpost moved.
- 13:34Katie: Make sure your investigation moves with them.
- 13:38Katie: And if you need someone to go further, I'm absolutely here for that.
- 13:42Katie: I just wanna thank you so much for listening to this episode.
- 13:44Katie: I hope you have a wonderful day, and I'll see you on our next episode, released every Tuesday and Thursday.
- 13:50Are you ready to finally discover why you haven't been able to get or stay pregnant?
- 13:55The Ultimate Fertility Blueprint is a quick, insightful quiz designed to reveal your overall capacity to conceive and help you discover potential root causes and areas to address to improve your fertility so you can finally get and stay pregnant.
- 14:13You'll find the link in the show notes.
- 14:15As a quick reminder and disclaimer, this podcast is for educational purposes only and is not a substitute for medical advice.
- 14:23Always consult your doctor or healthcare provider before starting any new supplement or protocol, especially if you're actively trying to conceive or undergoing treatment.