By the third loss you know the routine. Which corridor, which chair, the particular way the room goes quiet a half-second before anyone says anything. Somewhere in a folder there's a record of everything that has been checked in her body — thyroid, clotting, uterine cavity, chromosomes, hormones on day three and again on day twenty-one. It is a thick folder. And in most couples facing recurrent miscarriage there is a second person whose file is almost empty. He drove her to every one of those appointments. Nobody has ever asked him for anything except a lift home.
There was an official reason for that, and this year the official reason changed. In 2026 the American Society for Reproductive Medicine published a new committee opinion on recurrent pregnancy loss. It replaces the previous one, which had stood, unrevised, since 2012. Fourteen years. Buried in the middle of the new document is a short passage about him — what might be worth testing, what it might mean, and, stated more plainly than you'd expect from a body like that, how little anyone can promise about it.
What recurrent miscarriage means, and why the number matters
The 2026 document defines it as the spontaneous loss of two or more pregnancies, confirmed by a urine or blood hCG test, excluding molar and ectopic pregnancies, before twenty-two weeks. Two. Not three. That distinction is worth carrying to an appointment, because plenty of practices still run on the older three-loss threshold, and the gap between those two numbers is an entire pregnancy spent waiting to qualify for a conversation. If you've had two, you are inside the definition of recurrent miscarriage as the field currently writes it, and you can ask for the workup rather than waiting to earn it.
What that workup looks at is mostly her. Some of that is sound — the guideline is clear that the single most common reason an early pregnancy ends is a genetically abnormal embryo, and a good deal of the female evaluation exists to catch the treatable exceptions. But there are two people in the room and there always were. Until this year the standard document had close to nothing to say about the second one.
The sentence in the new guideline about him
Here is what it says, in full, because the wording is the whole story: "Sperm DNA fragmentation testing may be considered in patients with otherwise unexplained recurrent miscarriage or recurrent miscarriage and concomitant infertility. Further research is necessary to determine if treatment improves pregnancy outcomes."
Read that twice. Both halves are doing work. The first half opens a door that was shut for fourteen years. The second half tells you that nobody knows what's on the other side of it. That is a hedge, and the committee's own chair has said publicly that it's a hedge — while adding, fairly, that at least it put the male evaluation into the document at all. I'd rather have the hedge than the silence. But you should know you're being handed a maybe, not an answer, and anyone who sells you that test as the solution to recurrent miscarriage is going further than the guideline does.
The line that should have been the headline
A few sentences earlier there's something more immediately useful, and it went almost entirely unreported: "standard semen analysis parameters do not appear to be predictive of RPL."
Meaning the ordinary test — the cup, the locked room, the count and the motility and the shape — is not the test for this. A man can hand back a perfectly normal semen analysis and it tells you close to nothing about recurrent miscarriage. Which matters, because an enormous number of couples have already been through exactly that, been told his results were fine, and reasonably concluded that his side was settled. It wasn't settled. It was measured with the wrong instrument.
DNA fragmentation is a different question altogether. A semen analysis counts sperm and watches how they swim; it's a headcount and a fitness test. Fragmentation looks inside — at breaks in the genetic material each one is carrying. A sperm with damaged DNA can look completely ordinary under a microscope, swim perfectly well, and fertilise an egg. The problem, if there is one, shows up later, in what the embryo has to work with. That's why a normal count reassures a couple facing recurrent miscarriage about a question they weren't actually asking.
What the evidence on recurrent miscarriage and sperm DNA actually says
This is the part where most articles about recurrent miscarriage pick a side. I'm not going to, because the literature hasn't.
On one side: the guideline cites two recent meta-analyses finding that male partners of women with recurrent pregnancy loss have higher sperm DNA fragmentation than partners of fertile controls, with a mean difference of eleven to twelve percent on the fragmentation score. It cites a third meta-analysis reporting a higher rate of subsequent miscarriage in couples with high fragmentation compared to low, with a relative risk of 2.16 — confidence interval 1.54 to 3.03. Those are real findings from pooled data, and taken alone they make a decent case that recurrent miscarriage has a paternal component we've been ignoring.
On the other side: in 2025 a group published a study of 1,485 men undergoing fertility evaluation — 634 from couples with recurrent pregnancy loss, 851 without. If the association were strong, this is where it should have shown up. It didn't. Median fragmentation index in the loss group: 11.9 percent. In the control group: 11.9 percent. The same number. The proportion of men above the 30 percent threshold was 6.3 versus 5.2 percent, which is noise. Adjusted odds ratio per one percent rise in fragmentation: 1.01, and not statistically significant. The authors' own summary is one sentence long — they found no significant relationship between sperm DNA fragmentation and the risk of recurrent pregnancy loss.
So the honest position on recurrent miscarriage and sperm DNA today is that pooled analyses find a signal and the largest recent single cohort doesn't. That's not a scandal. That's what an unsettled question looks like from inside, and it usually resolves in a direction nobody predicted. What it does mean is that the confident version of this story — damaged sperm is the hidden cause of your losses — is being told well ahead of the evidence, and it's being told to people who are exhausted and will pay for hope.
The guideline is blunter about treatment than any wellness article about recurrent miscarriage will be. Varicocele repair, testicular sperm extraction, sperm selection, quitting smoking, ejaculating more often, general lifestyle work — several of these do lower fragmentation scores. And then: "there are no well-controlled published studies that demonstrate whether treatment of elevated SDF decreases the risk of RPL." You can move the number. Nobody has shown that moving the number moves the outcome.
What to ask for after recurrent miscarriage, and what not to expect from it
None of that is a reason to skip the test. It's a reason to know what you're buying. If your recurrent miscarriage is otherwise unexplained, fragmentation testing is now something you can raise without being treated as though you've been reading forums at two in the morning — it's in the document, by name. Ask what threshold that lab uses, because they differ, and a result means very little without one. Expect a few hundred dollars and expect your insurer to be unenthusiastic.
The more valuable line in the guideline is what comes after an abnormal result: it may prompt urologic consultation, with the goal of finding factors or interventions that could affect fragmentation. That's the real move. Not the number itself — the referral it triggers, and the fact that somebody finally examines the man properly. A varicocele found that way is worth finding regardless of what it does or doesn't do for recurrent miscarriage.
The man in the corridor
There's a second reason to want him inside the recurrent miscarriage workup, and it has nothing to do with sperm.
In 2022 researchers at an Irish tertiary hospital sat down with men whose partners had been through two or more consecutive first-trimester losses. Five men, some interviews running past two hours. It's a small study and the authors say so themselves — five participants, one hospital, first-trimester losses only, and they note plainly how hard men are to recruit for this kind of research, which is its own finding. What the five described was consistent. They felt in the way. Staff spoke to their partners and around them. One man's summary of being processed through the system was that you're just a number, again, like a factory. Another said something I haven't been able to put down since: lads really struggle with what their role is.
They also described doing the thing men in this situation almost always do — deciding, silently, that their job was to hold her up, and shelving whatever they were carrying to do it. The researchers use the term disenfranchised grief: loss that the people around you don't recognise as yours to have. Nobody sent him a card. Nobody rang to see how he was. He went back to work on the Monday and was asked how his wife was doing, which is a kind question that quietly tells a man where he stands. That's the view of recurrent miscarriage from the passenger seat, and almost nobody describes it.
The 2026 guideline, to its credit, now says this outright. It records that women experiencing recurrent miscarriage face significant psychological consequences — depression roughly five times higher — and then adds that male partners are also at significant risk of those symptoms, and that both men and women reported limited social support. That sentence has been true for as long as there have been miscarriages. This is the first time it's been in the document.
What recurrent miscarriage does to a nervous system
I want to be careful here, because this is the exact point where my end of the wellness world starts saying things it can't support. Stress did not cause your losses. There is no evidence that it did, the guideline doesn't suggest it, and I'm not going to hand anybody that particular weight to carry on top of everything else.
What is true is narrower and worth naming anyway. After two or three losses, the next pregnancy arrives already occupied. A person who has been through recurrent miscarriage doesn't get the ordinary version of a positive test; they get the one where the body starts bracing on the same afternoon. Every twinge gets interrogated. Bathroom trips become verdicts. Some couples stop telling anyone, which sounds like protection and works like isolation. The bracing isn't a malfunction — it's a nervous system doing precisely what it's built to do after it has learned that this specific hope ends badly. Your body isn't broken. It's bracing.
Nervous-system work — breath, sleep, actual rest, not performing fine for your relatives — won't prevent a miscarriage, and I won't pretend it will. What it can do is make the waiting survivable, and make it likelier that the two of you come out the other side still facing each other. That's a smaller promise than the internet will make you. It's the one I can keep.
The number nobody repeats
There's a figure in the 2026 guideline that deserves far more circulation than the sperm paragraph, and I'll leave it here rather than in the middle where it would get lost. Among patients with recurrent pregnancy loss, somewhere between fifty and eighty percent go on to succeed in their next attempt with no specific intervention at all.
Fifty to eighty. That's not a supplement company's number or a coach's number. It's in the same document, written by the same committee, in the same careful language as everything else. It doesn't say why, and it isn't a promise to anybody in particular. It does mean that the most likely outcome after recurrent miscarriage — the boring, statistically ordinary outcome — is the one nobody in a waiting room dares say aloud.
So: get the workup at two losses, not three. Know that his normal semen analysis answered a different question. Ask about fragmentation testing if your losses are unexplained, and hold the result loosely, because the science is genuinely unfinished and the honest people admit it. And stop treating recurrent miscarriage as something happening to one body while the other one drives. Two people lost those pregnancies. Only one of them has been asked how she's doing.
References:
• ASRM Practice Committee (2026). "Recurrent pregnancy loss: a committee opinion." Fertility and Sterility 2026;125:1023–41 — asrm.org/practice-guidance/practice-committee-documents/recurrent-pregnancy-loss-a-committee-opinion-2026/
• Yao G, Dou X, Chen X, Qi H, Chen J, Wu P, Li J, Liang S, Han Z, Bai S, Hu X (2025). "Association between sperm DNA fragmentation index and recurrent pregnancy loss: results from 1485 participants undergoing fertility evaluation." Frontiers in Endocrinology 15:1493186.
. • Harty T, Trench M, Keegan O, O'Donoghue K, Nuzum D (2022). "The experiences of men following recurrent miscarriage in an Irish tertiary hospital: A qualitative analysis." Health Expectations 25(3)
