What Causes Miscarriage? A Fertility Doctor's Full Breakdown

Pregnancy loss affects 15–25% of clinically recognized pregnancies, yet so many people are left without answers — or without hope. In this solo episode, Dr. Sasha Hakman breaks down everything you need to know about miscarriage and recurrent pregnancy loss: the five major causes, how each one is diagnosed, what treatment actually looks like, and which lifestyle factors are (and aren't) worth worrying about. If you've experienced a loss and are searching for answers, this episode is for you — and remember, it is not your fault.

In this episode, we cover:

Why miscarriage is so common, and how the definition of "recurrent pregnancy loss" has evolved to include biochemical losses

Bucket 1 — Genetic/Chromosomal causes: why random chromosomal errors (like trisomy 16 and Turner syndrome) account for up to 75% of losses, the U-shaped age-risk curve, and when to test for balanced translocations via karyotype

Bucket 2 — Anatomic causes: uterine septums, scar tissue (Asherman syndrome), fibroids, polyps, adenomyosis, and how they're diagnosed via saline infusion sonogram or HSG

Bucket 3 — Immune/Autoimmune causes: antiphospholipid syndrome (APS), the antibodies involved, and why diagnostic criteria may lag behind clinical reality

Bucket 4 — Endocrine causes: thyroid dysfunction, high prolactin, insulin resistance/diabetes, PCOS, and luteal phase defects

The "5th bucket": unexplained pregnancy loss — and additional testing some REs order beyond ASRM guidelines (clotting disorders, chronic endometritis, vaginal microbiome)

Treatment options by diagnosis, including PGT-SR, Lovenox + baby aspirin for APS, metformin, and surgical correction of uterine abnormalities

Modifiable risk factors: smoking, alcohol, caffeine (the real data), weight/GLP-1 agonists, sleep, sedentary behavior, and why stress is often unfairly blamed

The encouraging stats: a 70% live birth rate in the pregnancy following a loss, and how high-touch prenatal care can improve outcomes

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