Part of our guide: Infertility

A miscarriage changes a lot. Some people want to get pregnant again soon, others first need some space. Both are okay.

This article covers what guidelines and studies say about the questions that come afterward: from the waiting time and the fall of the pregnancy hormone hCG to tests after several miscarriages and maternity protection in Germany, Austria, and Switzerland.

All numbers are averages for the groups studied. They do not predict how things will turn out for you, and they do not replace medical advice. If your pregnancy ended very early and was detected only by a test, also read our article on chemical pregnancy.

When is it okay to get pregnant again?

The recommendations contradict each other on this point:

Source Recommendation
AWMF 015-076 (DE, AT, CH), 2025 no waiting time if there are no individual reasons against it (statement 5.S13, expert consensus)
ACOG Practice Bulletin 200 (USA), reaffirmed 2025 no good-quality data for delaying
NICE NG126 (UK) no fixed interval, but information on when a new attempt is possible (1.2.1)
WHO, consultation 2005 at least 6 months after a miscarriage or abortion

As possible reasons to wait, the AWMF guideline names, for example, pending tests, the after-effects of surgery, or not being emotionally ready.

The WHO recommendation rests on a single study with data from public hospitals in Latin America, mainly Argentina and Uruguay. Spontaneous miscarriages and abortions could not be separated in it. The WHO itself notes that newer research exists.

Newer data do not argue for a long wait. A meta-analysis of 16 studies with 1,043,840 women found fewer repeat miscarriages with an interval of less than 6 months (relative risk 0.82; 95% CI 0.78 to 0.86) and fewer preterm births (0.79; 0.75 to 0.83). For stillbirth, low birth weight, and preeclampsia, there was no difference (Kangatharan 2017).

In the US EAGeR study of 1,083 women after one or two early losses, 53.2% of those who tried again within 3 months had a baby, compared with 36.1% of those who started later, without more complications (Schliep 2016; observational data from healthy women with regular cycles). In Norway, women with an interval of under 3 months less often had a baby that was small for gestational age (8.6% versus 10.1%) and less often had gestational diabetes (3.3% versus 4.5%) than those with 6 to 11 months (Tessema 2022, 49,058 births).

If you would still like to wait, you can use hormonal contraception right after a confirmed miscarriage. The often-given advice to abstain from vaginal intercourse for 1 to 2 weeks is not supported by studies, according to AWMF and ACOG.

After IVF or frozen embryo transfer: There is no guideline recommendation on the interval. In a cohort of 2,620 women after a biochemical or clinical loss, a new frozen embryo transfer within 6 months was not associated with worse outcomes than after 6 to 12 months (Yang W 2026). Your fertility practice sets the timing. For how the procedure works, see frozen embryo transfer.

Ovulation and the first period afterward

Even the first cycle can be fertile. In a small study of 18 women after a spontaneous miscarriage, all of them had their first ovulation before their first period, on average 29 days after the miscarriage, with a range of 13 to 103 days. One woman became pregnant in that cycle (Donnet 1990). If you do not want to get pregnant yet, it is therefore best to use contraception from the start.

The second half of the cycle was somewhat shorter in this first cycle than in the second (on average 12.9 instead of 14.4 days). By calculation, the first period therefore came on average about six weeks after the miscarriage (our own calculation, Donnet 1990). Because the timing of ovulation varied so much, this can differ considerably for you.

Bleeding and how long the miscarriage takes

Approach Duration of bleeding Success rate
surgical approx. 3 days 97%
medical (medication) 10 to 21 days 71% after 3 days, 84% after 8 days, with a repeat dose if needed
expectant 10 to 21 days 52% to 84% after 14 days, 66% to 91% after 6 weeks

Source: AWMF 015-076, table 9. Applies to clinical miscarriages, not to biochemical losses. With expectant management, the values depend on the type of miscarriage.

With expectant management, the miscarriage was complete after one week in 25% to 50% of women. After 2 weeks, it depends on the type: 84% for an incomplete miscarriage that has already begun, 59% for a missed miscarriage, and 52% for an empty gestational sac (blighted ovum) (AWMF 015-076, table 9). A follow-up check is usually done within 2 weeks. After medical treatment, the guideline recommends an ultrasound 7 to 14 days after the first dose of medication, with hCG measurements only as an alternative. If the bleeding continues, the pain gets worse, or you develop a fever, have it checked by a doctor. If the bleeding is very heavy or the pain is severe, get it checked immediately.

hCG after a miscarriage: table with study values

How quickly the pregnancy hormone falls depends mainly on the starting value. The values below come from studies and help you understand test results. Your own results are interpreted by the practice that ordered the tests.

A blood value above 5 IU/l points to a pregnancy. Urine tests turn positive only at about 20 to 50 IU/l, and a faintly positive test is easily read as negative. Serial values should come from the same lab using the same test (AWMF 015-076), because measurement systems sometimes give significantly different values (Desai 2014).

Starting hCG value (IU/l) Drop after 2 days: average / at least after 4 days after 7 days
250 48% / 35% 71% / 52% 86% / 66%
500 52% / 38% 75% / 59% 89% / 74%
1,000 55% / 42% 78% / 64% 91% / 79%
2,000 58% / 46% 81% / 68% 93% / 83%
3,000 59% / 48% 82% / 70% 94% / 85%
5,000 60% / 50% 83% / 73% 94% / 87%

Source: Butts et al. 2013. 443 women from three US centers with pain or bleeding and a pregnancy of unknown location (no gestational sac on ultrasound at first) that resolved without treatment; starting value up to 10,000 IU/l. “At least” is the 95th percentile: 95 out of 100 women had a drop at least that large. The AWMF guideline 015-076 adopts these minimum values as table 12.

Worked example (our own calculation from the table): With a starting value of 1,000 IU/l, the value after 2 days averaged about 450 IU/l and was at most about 580 IU/l in 95% of women. After 7 days, it averaged about 90 IU/l and was at most about 210 IU/l in 95%.

The data do not come from miscarriages confirmed on ultrasound or from IVF treatments. An older analysis by the same research group (Barnhart 2004, also pregnancies of unknown location: 710 later miscarriages in 1,543 women) reports lower minimum drops: In about 95% of women, hCG fell by at least 21% to 35% in 2 days and by at least 60% to 84% in 7 days, depending on the starting value. These are minimum values, not typical values. According to the authors, a slower fall points to retained tissue or an ectopic pregnancy.

What the British NICE guideline recommends depending on the course

Situation Approach according to NICE NG126
hCG falls by more than 50% in 48 hours (pregnancy of unknown location) the pregnancy is probably not continuing; urine test 14 days after the second measurement, and if it is positive, evaluation within 24 hours (1.8.8)
drop of less than 50% or rise of less than 63% in 48 hours evaluation within 24 hours (1.8.9)
after expectant management (once bleeding and pain have subsided after 7 to 14 days) or medical management urine test 3 weeks after the miscarriage, and if it is positive, further evaluation (1.10.5, 1.11.7)

A falling value does not rule out an ectopic pregnancy. 71% of women with an ectopic pregnancy have an atypical hCG course, and 8% to 14% of pregnancies of unknown location turn out to be an ectopic pregnancy (AWMF 015-076). If you have pain or heavy bleeding, get examined by a doctor immediately.

When is hCG negative again?

There are no systematic studies on this for spontaneous miscarriages, only small studies after an abortion, mostly with high starting values. After vacuum aspiration in the first or second trimester, it took 13 women an average of 37.5 days (± 6.4) for hCG to fall below 2 IU/l (Marrs 1979). A urine test with a detection limit of 1,000 IU/l was usually negative within 2 weeks; a positive test after 4 weeks pointed to an incomplete miscarriage or retained tissue (van der Lugt 1985, 28 women). This cannot be applied to very early losses with low values.

How hCG rises after an embryo transfer in an intact pregnancy is shown in the hCG table in the IVF Due Date Calculator.

How high is the risk of another miscarriage?

According to the AWMF guideline, an early pregnancy loss affects at least 10% to 15% of clinically recognized pregnancies, and about 80% of all miscarriages occur in the first trimester. In Germany, Austria, and Switzerland, miscarriages are not recorded statistically. About half of first-trimester miscarriages are due to a chromosomal abnormality of the embryo (AWMF 015-050, ACOG; ASRM: 50% to 60%).

Maternal age Share of miscarriages
under 20 15.8%
20 to 24 11.3%
25 to 29 9.8%
30 to 34 10.8%
35 to 39 16.7%
40 to 44 32.2%
45 and older 53.6%

Source: Magnus et al. 2019, table 1. All pregnancies recorded in Norwegian health registries from 2009 to 2013 (421,201), excluding ectopic pregnancies; miscarriages from week 6 to before week 20 of pregnancy, adjusted for induced abortions. Very early losses without contact with specialist care are missing. Overall 12.8%, lowest at age 27 (9.5%).

History Next pregnancy ended in miscarriage Odds ratio, age-adjusted (95% CI)
first pregnancy 11.6% reference group
1 miscarriage immediately before 19.8% 1.54 (1.48 to 1.60)
2 miscarriages in a row 27.7% 2.21 (2.03 to 2.41)
3 or more in a row 41.9% 3.97 (3.29 to 4.78)

Source: Magnus et al. 2019, table 3. Percentages exclude induced abortions from the denominator.

Read the other way around: After a miscarriage, about 80% of the next pregnancies did not end in a miscarriage (our own calculation). Regardless of earlier miscarriages, in Germany after IVF or ICSI in the fresh cycles 2019 to 2023, 21.7% (IVF) and 21.4% (ICSI) of clinical pregnancies ended in a miscarriage (German IVF Registry, Deutsches IVF-Register, D.I.R.). They are not directly comparable with the Norwegian values. You can find values for every year of age from 35 to 45 under Getting pregnant over 40.

How good are the chances afterward?

According to the available data, a miscarriage does not make you more fertile. In a Norwegian cohort of 48,537 planned pregnancies, the chance of becoming pregnant in a given month dropped slightly: to 0.83 times after one miscarriage, 0.79 times after two, and 0.74 times after three or more (Arge 2022).

Many women have a baby even after several miscarriages. In a Danish specialty clinic, 66.7% of 987 women with recurrent miscarriage had a baby within 5 years (Lund 2012). According to ASRM, 50% to 80% succeed at the next attempt, even without special treatment. The chance decreases with age:

Age, after 3 miscarriages Live birth in the next pregnancy
25 to 29 approx. 75%
30 to 34 approx. 70%
35 to 39 approx. 55%
40 to 44 approx. 32%

Source: AWMF 015-050, table 10, after Kolte et al. 2021 (Denmark 1977 to 2017, 2,722,441 pregnancies). Taken from a graph in the original study, hence “approx.”

Recurrent miscarriage: when does the term apply?

Source Definition Do biochemical losses count?
AWMF 015-050, version 2.0, May 2026 (DE, AT, CH) follows the WHO: 3 or more consecutive miscarriages before week 20 of pregnancy not expressly addressed
ESHRE 2022 (Europe) 2 or more pregnancy losses, excluding ectopic and molar pregnancies yes, hCG detection is enough
ASRM 2026 (USA) 2 or more spontaneous losses before 22 weeks, not necessarily consecutive yes
SOGC 2025 (Canada) 2 or more losses, also if not consecutive yes
ICMART glossary 2025 2 or more clinical pregnancies that end before 22 completed weeks of pregnancy no

About 1% to 3% of all couples are affected, according to the AWMF guideline, and up to 5% by the definition of two miscarriages. There is a reason why even very early losses can count: Among 587 women with unexplained recurrent miscarriage, each earlier loss that was never seen on ultrasound reduced the chance of a live birth about as much as a clinical miscarriage (relative risk 0.90 versus 0.87; Kolte 2014).

Which tests are recommended

The German-language guideline recommends looking for causes after three consecutive miscarriages (“shall”) and, in justified cases, already after two (“should,” recommendations 2.E1 and 2.E2). A meta-analysis cited in the guideline found uterine malformations and antiphospholipid syndrome just as common after two miscarriages as after three. ESHRE advises testing for antiphospholipid antibodies after two losses already. From the second miscarriage on, ASRM offers chromosome analysis of the pregnancy tissue as a first step.

Gynecologist in a calm conversation with a patient

Test AWMF 015-050
Chromosomes of both partners, if no chromosome result from the miscarriages is available shall
Chromosome analysis of the pregnancy tissue should
3D ultrasound and/or hysteroscopy shall
Antiphospholipid antibodies, twice at least 12 weeks apart shall
TSH before pregnancy shall
Vitamin D before pregnancy statement
with PCOS: hormonal and metabolic disorders shall
Partner: counseling about an extended semen analysis with DNA fragmentation shall
hereditary thrombophilia without risk of thrombosis shall not
immunological tests such as NK cells outside of studies should not
microbiome testing outside of studies shall not

Antiphospholipid antibodies are found in 11% to 15% of women with recurrent miscarriage (AWMF 015-050), and congenital uterine malformations in 13.3% versus 5.5% in the general population (ASRM). In about 4% to 5% of couples with two or more miscarriages, one partner carries a balanced chromosomal change (AWMF 015-050).

ESHRE sets some different priorities: The pregnancy tissue is not examined routinely, and the parents' chromosomes only after an individual risk assessment. The uterus should be assessed in all women.

You can find a practice for the evaluation in the clinic directory. The Fertility Clinic Finder helps you sort out the next steps.

Treatments: what the evidence supports

There are signs of a benefit mainly in two situations: heparin with aspirin in confirmed antiphospholipid syndrome and, with a small effect from subgroup analyses, vaginal progesterone for bleeding after earlier miscarriages.

Progesterone

Study Who was treated Live birth
PROMISE 2015 836 women with unexplained recurrent miscarriage, vaginal progesterone 400 mg twice daily until week 12 of pregnancy 65.8% versus 63.3% with placebo (RR 1.04; 0.94 to 1.15), no confirmed benefit
PRISM 2019 4,153 women with bleeding in early pregnancy, 400 mg twice daily until week 16 of pregnancy 75% versus 72% live births at 34 weeks of pregnancy or later (RR 1.03; 1.00 to 1.07; P = 0.08)
PRISM, subgroup Bleeding and at least 1 earlier miscarriage (1,800 women) 75% versus 70% (RR 1.09; 1.03 to 1.15)
PRISM, subgroup Bleeding and at least 3 earlier miscarriages (285 women) 72% versus 57% (RR 1.28; 1.08 to 1.51)
Cochrane analysis 2021 (Devall) Network analysis, 7 studies with 5,682 women in total, various progestogens vaginal micronized progesterone for bleeding and at least 1 earlier miscarriage: RR 1.08 (1.02 to 1.15; subgroup from 2 studies with a total of 4,090 women, predominantly PRISM); for recurrent miscarriage: RR 1.04 (0.95 to 1.15; 1 study with 826 women, PROMISE)
Cochrane analysis 2025 (Haas) Women with unexplained recurrent miscarriage, without bleeding and without IVF pregnancies; live birth from 5 studies with 1,063 women RR 1.04 (0.96 to 1.12), probably little or no effect

The subgroups are partial analyses: “at least 1” was formed only after the fact, “at least 3” was planned in advance but small (Coomarasamy 2020).

The AWMF guideline recommends vaginal progesterone until week 16 of pregnancy for recurrent miscarriage and threatened miscarriage (“should”); for unexplained recurrent miscarriage, progesterone or a synthetic progestogen may be given in the first trimester (“may”). NICE recommends 400 mg twice daily for bleeding and an earlier miscarriage once the pregnancy is confirmed in the uterus by ultrasound, continuing until 16 completed weeks of pregnancy when a heartbeat has been detected. ESHRE sees a possible benefit with three or more losses and bleeding (conditional recommendation); for a luteal phase defect, it considers the evidence insufficient. ASRM considers vaginal progesterone in early pregnancy, for bleeding and/or unexplained recurrent miscarriage, an option after shared decision-making. It lists giving it as early as the second half of the cycle under possible benefit with limited or conflicting evidence. It considers the PRISM subgroups uncertain because several comparisons were calculated without statistical correction. The Canadian SOGC considers progesterone possibly helpful, mainly when it is started in the second half of the cycle.

For recurrent miscarriage without bleeding, the guidelines therefore do not agree: The AWMF guideline says “may,” ASRM considers it an option, ESHRE sees a possible benefit only together with bleeding, and the 2025 Cochrane analysis finds probably little or no effect.

Approval: Progesterone and dydrogesterone are prescription-only in Germany (Prescription Drug Ordinance, Arzneimittelverschreibungsverordnung, AMVV, Annex 1). None of the German prescribing information documents reviewed names miscarriage as an indication: Vaginal micronized progesterone (200 mg) is approved there only for support of the luteal phase during fertility treatment (up to week 12 of pregnancy at most) and for the prevention of preterm birth with a shortened cervix, and a missed miscarriage is a contraindication. For miscarriage, it is therefore off-label, that is, outside the approval. The same applies to the synthetic progestogen dydrogesterone, whose prescribing information names only cycle irregularities due to progesterone deficiency and hormone replacement therapy. According to the AWMF guideline, synthetic progestogens may be associated with a higher risk of hypospadias (a malformation of the opening of the urethra) (odds ratio 3.7; 2.3 to 6.0).

17-hydroxyprogesterone caproate (17-OHPC) is not an option. The approvals have been suspended EU-wide since 2024 because of a possible cancer risk in people who were exposed to it in the womb and because of a lack of efficacy (German Federal Institute for Drugs and Medical Devices, BfArM). The AWMF guideline still names the drug without mentioning this.

More on progesterone, luteal phase defect, and the studies: luteal phase defect.

Heparin and aspirin only for antiphospholipid syndrome

Low-molecular-weight heparin (LMWH) and low-dose acetylsalicylic acid (aspirin) are recommended by the guidelines only for confirmed antiphospholipid syndrome (APS). In that case, the AWMF guideline provides for aspirin until 34+0 weeks of pregnancy plus LMWH until at least 6 weeks after birth (“shall”): in obstetric APS at a preventive dose starting with a positive pregnancy test, in thrombotic APS at a therapeutic dose. Under the combination, the live birth rate is up to 70%. ESHRE recommends the combination for APS and three or more losses (conditional), for two losses only in studies. For ASRM, it is standard.

For unexplained miscarriages, ALIFE (364 women) showed no benefit: 54.5% live births with aspirin plus heparin, 50.8% with aspirin alone, 57.0% with placebo. With inherited thrombophilia, in ALIFE2 (326 women), 72% with LMWH and 71% with standard care had a baby. The AWMF guideline advises against it in both cases, and ESHRE does so for unexplained losses (strong recommendation). For preventing miscarriage, LMWH and aspirin are off-label in Germany.

Thyroid and other measures

With a TSH above 4 mU/l before pregnancy, levothyroxine may be given according to the AWMF guideline. ESHRE advises against treating women with normal thyroid function and thyroid antibodies.

According to the AWMF guideline, the following are not recommended: glucocorticoids without an autoimmune disease, immunoglobulins, lipid infusions, lymphocyte immunization, TNF-alpha blockers, and G-CSF. Genetic testing of embryos (PGT-A or PGT-SR) does not increase the live birth rate in couples who conceive naturally. What is recommended, by contrast, is vitamin D3 (2,000 to 4,000 IU daily) for a confirmed deficiency, a normal body weight, quitting smoking, avoiding alcohol, and psychosocial support. For chronic inflammation of the uterine lining with CD138 detection, antibiotics may be given.

Maternity protection, protection against dismissal, and sick leave

This section applies to Germany, Austria, and Switzerland.

Germany

Since June 1, 2025, maternity protection has also applied after a miscarriage from week 13 of pregnancy. § 3 para. 5 of the Maternity Protection Act (Mutterschutzgesetz, MuSchG) reads:

“In the event of a miscarriage, the employer may not employ a woman, unless she expressly declares that she is willing to work, 1. until the end of two weeks in the case of a miscarriage from the 13th week of pregnancy or 2. until the end of six weeks in the case of a miscarriage from the 17th week of pregnancy or 3. until the end of eight weeks in the case of a miscarriage from the 20th week of pregnancy. She may revoke her declaration under sentence 1 at any time with effect for the future. Paragraphs 1 to 3 do not apply.”

According to the Family Portal of the German federal government (Familienportal des Bundes), the protection period applies if you have informed your employer and do not expressly want to keep working. Weeks are counted from the first day of the last period, so week 13 begins at 12+0 weeks of pregnancy (our own derivation). Legally, a miscarriage is a loss without signs of life under 500 g and before week 24 of pregnancy. During the protection period, maternity allowance (Mutterschaftsgeld) is paid: People with statutory health insurance receive at most €13 per calendar day from their health insurance fund, and the employer pays the rest as a supplement (§ 24i of Book V of the Social Code, SGB V). Since January 1, 2026, proof is the medical “certificate of a miscarriage, preterm birth, or disability of the child” (form 9). Self-employed people are not covered.

Protection against dismissal: After a miscarriage after the twelfth week of pregnancy, dismissal is not permitted until four months have passed (§ 17 para. 1 no. 2 of the Maternity Protection Act). This applies if the employer knows about the miscarriage or if you tell them about it within two weeks after receiving a notice of dismissal.

Sick leave: Before week 13 of pregnancy, there is no maternity protection. If you cannot work, your doctor will put you on sick leave. The employer then continues to pay your wages for up to six weeks, followed by sickness benefit (Krankengeld). You are entitled to continued pay if the employment relationship has existed without interruption for at least four weeks (§ 3 paras. 1 and 3 of the Continued Remuneration Act, Entgeltfortzahlungsgesetz, EFZG).

Austria

There is no maternity protection period after a miscarriage, but there are four weeks of protection against dismissal. § 10 para. 1a of the Austrian Maternity Protection Act 1979 (Mutterschutzgesetz 1979), in force since January 1, 2016:

“A dismissal is legally invalid up to four weeks after a miscarriage has occurred. At the employer's request, the employee must present a medical certificate of the miscarriage.”

Whether a loss counts as a miscarriage or a stillbirth is decided solely by weight; there is no limit in weeks of pregnancy. According to § 8 para. 1 item 2 of the Austrian Midwives Act (Hebammengesetz), a fetus counts as stillborn “if none of the signs listed under item 1 can be recognized and it has a birth weight of at least 500 grams.” At a lower weight, it is a miscarriage (item 3). Since September 1, 2024, there has been an entitlement to midwife care after a miscarriage occurring after the 18th week of pregnancy.

Switzerland

In the case of a stillbirth, maternity allowance is paid only if the pregnancy lasted at least 23 weeks (from 23 0/7), proven by a medical certificate (Circular on maternity allowance, KS MSEAE, margin no. 1043). A loss before that does not give rise to an entitlement. In the case of incapacity to work, the employer continues to pay the wage for a limited time if the employment relationship has lasted more than three months or was entered into for more than three months (Art. 324a of the Code of Obligations, Obligationenrecht, OR). After the probation period, Art. 336c of the Code of Obligations protects against dismissal during illness through no fault of the employee (30 to 180 days, depending on the year of service) as well as “during pregnancy and in the 16 weeks after childbirth.” Whether a miscarriage before week 23 counts as childbirth is not stated in the law. If in doubt, get legal advice on employment law.

Support after the loss

You are allowed to grieve this pregnancy, no matter how early it ended. And you do not have to decide anything until you are ready.

The guideline on recurrent miscarriage recommends offering psychosocial support (AWMF 015-050). Ask your gynecologist's office or fertility practice about psychosocial counseling, for you and for your partner.

Hand with a butterfly and a young plant in warm evening light

If a new pregnancy takes longer, our guide to infertility explains which steps make sense then.

Frequently asked questions

How long should you wait after a miscarriage before getting pregnant again?

According to the German-language guideline, you do not have to wait if there are no reasons against it, such as pending tests or not being emotionally ready (AWMF 015-076). The WHO advises 6 months but relies on a single study. A meta-analysis found fewer repeat miscarriages with a shorter interval (RR 0.82; Kangatharan 2017).

Are you more fertile after a miscarriage?

The data are inconsistent. In a Norwegian cohort, the chance per month dropped slightly after one miscarriage, to 0.83 times (Arge 2022). In a Chinese study of 518 women with daily urine tests, the chance of conception in the following cycle was higher after very early losses (odds ratio 2.6), but so was the risk of another early loss (2.4) (Wang 2003). This does not show that women are more fertile afterward.

When does ovulation come after a miscarriage?

In a small study of 18 women, the first ovulation came on average 29 days after the miscarriage, with a range of 13 to 103 days, and in all of them before the first period (Donnet 1990).

How quickly does hCG fall after a miscarriage?

In women whose pregnancy of unknown location resolved without treatment, hCG fell by 48% to 60% on average in 2 days and by 86% to 94% in 7 days, depending on the starting value (Butts 2013). 95% had a drop of at least 35% to 50% after 2 days (AWMF 015-076, table 12). Slower courses should be evaluated by a doctor (NICE NG126).

When is a pregnancy test negative again after a miscarriage?

There are no systematic studies for spontaneous miscarriages. After an abortion by vacuum aspiration, it took just over 5 weeks on average for hCG to fall below 2 IU/l in a very small study (Marrs 1979). After expectant or medical management, NICE recommends a urine test 3 weeks after the miscarriage; if it is positive, further evaluation follows.

How high is the risk of having another miscarriage after a miscarriage?

In Norway, 19.8% of the next pregnancies after a miscarriage ended in another miscarriage, 27.7% after two in a row, and 41.9% after three or more (Magnus 2019).

After how many miscarriages are tests done?

The German-language guideline recommends an evaluation after three consecutive miscarriages and, in justified cases, after two (AWMF 015-050). ESHRE, ASRM, and SOGC speak of recurrent miscarriage from two losses.

Does progesterone help after a miscarriage?

For unexplained recurrent miscarriage (3 or more, ages 18 to 39), vaginal progesterone, given preventively starting with a positive pregnancy test, brought no confirmed benefit (PROMISE: 65.8% versus 63.3% live births). The 2025 Cochrane analysis sees probably little or no effect in recurrent miscarriage. For bleeding and at least one earlier miscarriage, the live birth rate rose slightly (Cochrane 2021: RR 1.08, mostly data from PRISM). The guidelines do not agree. In Germany, this use is off-label, and the drugs are prescription-only.

Is there maternity protection after a miscarriage?

In Germany, since June 1, 2025, from week 13 of pregnancy: 2 weeks, from week 17 of pregnancy 6 weeks, and from week 20 of pregnancy 8 weeks, if you inform your employer and do not expressly want to keep working (§ 3 para. 5 of the Maternity Protection Act). Austria has no protection period but four weeks of protection against dismissal. In Switzerland, maternity allowance is available only from 23 completed weeks of pregnancy.

Sources

Guidelines and professional societies

Studies and registries

Medicines

Laws and authorities

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About this article

Fertilio Editorial Team

The Fertilio Editorial Team researches fertility topics using specialist sources such as the German IVF Registry (Deutsches IVF-Register, D.I.R.), medical guidelines, and statutes. The sources are listed at the end of each article. The content does not replace medical advice.