Recurrent Pregnancy Loss and Recurrent Miscarriage Naturopath in Ottawa

Partners forming a heart shape with their hands over a pregnant belly, representing support for a new pregnancy after recurrent pregnancy loss in Ottawa

By Dr. Harsimranjeet Singh Bhatia, ND · Last reviewed October 2026

The quick summary: Dr. Harsimranjeet Singh Bhatia, ND is a naturopathic doctor in Ottawa who has focused on fertility for over ten years, with a clinical focus on integrative support for recurrent pregnancy loss (RPL), the loss of two or more pregnancies. Care looks at metabolic health, inflammation, thyroid and nutrient status, the reproductive microbiome, diet and lifestyle, and the male partner's sperm health, including sperm DNA fragmentation, along with emotional support for both partners. He works alongside your family doctor, fertility clinic or recurrent pregnancy loss specialist, supports patients before conception and through pregnancy, can prescribe progesterone when it is indicated, and sees patients in person at 2599 Carling Avenue in Ottawa or virtually anywhere in Ontario.

Recurrent pregnancy loss at a glance

The European Society of Human Reproduction and Embryology (ESHRE) defines RPL as the loss of two or more pregnancies, whether or not they were consecutive, and includes very early losses confirmed only by a pregnancy test (chemical pregnancies). Other guidelines, including the American Society for Reproductive Medicine's, include only clinical pregnancies confirmed on ultrasound, which is why patients are sometimes given different answers (ESHRE, 2022; ASRM, 2020).
RPL affects roughly 1 to 3% of couples, depending on which losses are included in the definition (ESHRE, 2022).
There is no direct evidence that stress causes pregnancy loss, but emotional wellbeing matters, so we offer practical stress management tools as part of caring for you as a whole person (ESHRE, 2022).
Male partners in couples with RPL have higher sperm DNA fragmentation on average, and sperm DNA fragmentation testing can now be considered as part of the workup (Fertility and Sterility, 2019; ESHRE, 2022).
Nearly one in three women meet the criteria for post traumatic stress one month after an early pregnancy loss, so emotional care is part of good care (American Journal of Obstetrics and Gynecology, 2020).
Preparation is planned over at least three months, and support can continue through pregnancy.

What is recurrent pregnancy loss?

Recurrent pregnancy loss means losing two or more pregnancies before viability. The ESHRE guideline includes losses after natural conception and after fertility treatment such as IUI or IVF, as well as very early losses confirmed only by a pregnancy test (chemical pregnancies). The American Society for Reproductive Medicine defines RPL using clinical pregnancies only, meaning pregnancies confirmed on ultrasound, and some physicians follow that definition, so you may hear different answers about whether chemical pregnancies are part of the diagnosis. Every loss is real, and whichever definition your care team uses, a history of very early losses is still worth sharing with them. Ectopic and molar pregnancies, while just as devastating, are not included in the definition of RPL because they have different causes and care. You will also hear the term recurrent miscarriage, which is used when every loss has been confirmed as a miscarriage. In everyday conversation, the two terms are often used interchangeably.

Miscarriage is common. About 15% of recognised pregnancies end in miscarriage, but repeated losses are much less common: about 1.9% of women have had two miscarriages and 0.7% have had three or more (The Lancet, 2021). You do not need to wait for a third loss before asking for an assessment. Current guidance supports looking for answers after two.

What causes recurrent miscarriage?

A single miscarriage is most often caused by a chromosomal problem in the embryo, and this becomes more common with age. When losses repeat, other factors become more important. These include antiphospholipid syndrome, thyroid conditions, differences in the shape of the uterus or adenomyosis (see our endometriosis and adenomyosis page), a chromosome change in either parent, sperm DNA damage, and lifestyle factors such as smoking, alcohol and body weight. For many couples, no single cause is found, which can be one of the hardest parts.

If you have been told that stress caused your loss, please know that the guideline is clear: stress is associated with RPL, but there is no direct evidence that it causes pregnancy loss. It is not your fault. Emotional wellbeing is still critical, and we offer stress management tools and support as part of caring for you as a whole person.

Factors we look at beyond the core workup

Research has linked recurrent loss with several broader health factors. In one study, insulin resistance was about three times as common in women with RPL as in matched women without it. Celiac disease is more common in women with recurrent miscarriage, and people with celiac disease have a higher risk of miscarriage. Low vitamin D, iron deficiency, inflammation and thyroid autoimmunity also matter for fertility and pregnancy health. Some of these are not part of the routine RPL workup in the guideline, so we explain why each test is being considered and only run it when it is relevant to you.

Who is a recurrent miscarriage specialist in Ottawa?

Care for recurrent loss usually involves a team, and knowing who does what can save you months. Your family doctor or nurse practitioner often starts the investigations. A gynaecologist, a reproductive endocrinologist (REI) at a fertility clinic, or a dedicated recurrent pregnancy loss specialist arranges the core medical investigations, such as antiphospholipid antibody testing, chromosome testing (karyotyping) and pelvic ultrasound, and manages medical treatments such as blood thinning medication when antiphospholipid syndrome is found. In a new pregnancy, your obstetric care provider monitors you more closely.

Where a naturopathic doctor fits

As a naturopathic doctor, Dr. Harsimranjeet Singh Bhatia, ND is not a medical specialist (NDs may maintain areas of focus but cannot specialize as per regulatory guidelines) and does not replace the specialists described above. His practice has a clinical focus on integrative support for people with RPL, working alongside your medical team. His care addresses the factors that respond to day-to-day care, including metabolic health, inflammation, thyroid and nutrient status, diet and lifestyle, the reproductive microbiome and the male partner's sperm health, using every evidence informed strategy available. You do not need a referral to see a naturopathic doctor in Ontario. He works alongside your physicians, and with your consent he can send a written summary letter to your family doctor, fertility clinic or RPL clinic on request.

What testing does a naturopathic doctor order for recurrent pregnancy loss?

When it is clinically appropriate, Dr. Singh can requisition blood work that is commonly used to assess and monitor RPL and overall pregnancy health. This includes TSH and thyroid peroxidase (TPO) antibodies, prolactin, A1c, fasting glucose and insulin, vitamin D, a detailed iron panel, B12, homocysteine, CRP, celiac screening, and ANA when indicated. For the male partner, he can requisition a semen analysis and sperm DNA fragmentation (DFI) testing.

Antiphospholipid antibody testing, karyotyping and pelvic ultrasound are arranged through your physician or RPL clinic. If you already have recent results, we review those first rather than repeat them.

Sperm DNA fragmentation and the male partner

Recurrent loss is not only about the person carrying the pregnancy. A meta-analysis of 13 studies found that male partners in couples with RPL had significantly higher sperm DNA fragmentation than partners in couples without RPL. The 2022 ESHRE guideline recommends assessing the male partner's lifestyle, including age, smoking, alcohol, exercise and body weight, and says sperm DNA fragmentation testing can be considered.

Assessing, diagnosing and treating male factor concerns, particularly elevated DFI, is a core focus of our practice. Sperm selection techniques in the IVF lab, such as sperm washing, can help choose sperm on the day of treatment, but they do not change the health of the sperm being produced. Our focus is improving baseline sperm health over the roughly three months it takes sperm to develop, through nutrition, lifestyle and evidence informed supplements, which complements whatever your clinic offers. A Cochrane review found that antioxidant supplements in men with subfertility may improve live birth rates, although the evidence is still low certainty. Learn more about male fertility testing and treatment.

Thyroid health and recurrent miscarriage

ESHRE recommends checking TSH and TPO antibodies in everyone with RPL. Overt hypothyroidism should be treated, and the decision to treat subclinical hypothyroidism is made case-by-case, because the evidence is mixed. For people with normal thyroid function and positive antibodies, large trials found that thyroid hormone did not improve live birth rates, so it is not recommended for that group.

We use integrative therapies and nutrition to support people with elevated thyroid antibodies. A meta-analysis found that supplementing one trace mineral lowered thyroid antibody levels, although an effect on pregnancy outcomes has not been shown. We monitor thyroid markers before conception and through pregnancy. When levels are not where they should be, we review them with your physician. Levothyroxine (such as Synthroid) is the preferred thyroid hormone, and any decision to start or adjust it is made together with your healthcare team. Learn more about our thyroid support.

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What does a naturopathic doctor do for recurrent pregnancy loss?

We cannot promise a particular outcome, and no single supplement prevents miscarriage. What we can do is find and address the factors within reach, so your next pregnancy starts from the strongest possible foundation. Depending on your history and results, your plan may include:

Clinical nutrition and diet and lifestyle support for blood sugar, inflammation, body weight, sleep, alcohol and smoking
Evidence informed nutraceuticals and botanical medicine, chosen with safety reviews, interaction checks and monitoring, and only when they are suitable for conception and pregnancy
Support for the reproductive and gut microbiome, including diet and selected evidence informed selection of particular strains of probiotics/prebiotics where appropriate
Mood support for anxiety and depressive symptoms, and mindfulness based coaching
Fertility acupuncture for stress regulation and wellbeing
Assessment and treatment for the male partner

Why at least three months of preparation is important

The final stages of egg development and the full cycle of sperm production each take about three months. That window also gives time to get results back, correct deficiencies such as low iron or vitamin D, and put a plan in place with your medical team. If you have just found out you are pregnant, you do not need to wait. We also support people from the first positive test onward.

What does the research show for nutrients and supplements?

Research on nutrients and recurrent loss is modest but real, and it works best as part of a coordinated plan. Because form, dose and timing matter, and because some products are not suitable in pregnancy or interact with medications, every recommendation is individualized and reviewed for safety. This is one of the most common reasons patients book: to stop guessing with supplements bought online.

Vitamin D

A 2022 meta-analysis found that women with vitamin D deficiency had about twice the odds of miscarriage, although the quality of the evidence was low and it is not yet clear whether supplementing lowers that risk. The ESHRE guideline notes that vitamin D supplementation before conception can be considered and is safe. Your level and the right approach are best reviewed with a knowledgeable fertility focused naturopathic doctor.

Iron

Iron deficiency is common in people trying to conceive and in pregnancy. How well iron is absorbed depends on the form, the dose and how often it is taken, and one trial showed that the dosing schedule alone can change absorption considerably. We review the best formulation and dose for absorption and tolerance, and we monitor your iron panel to confirm you reach and keep iron sufficiency.

Antioxidants, CoQ10 and omega-3s

Oxidative stress is one of the pathways studied in recurrent loss. In one controlled trial in women with unexplained RPL, adding N-acetylcysteine (NAC) to folic acid was associated with higher rates of ongoing pregnancy and live birth than folic acid alone, although this was a single, small study. CoQ10 and omega-3 fatty acids have been studied mainly for egg and sperm quality, and research specific to recurrent loss is still limited. Folic acid is recommended before conception to prevent neural tube defects, but it has not been shown on its own to prevent loss in unexplained RPL.

The reproductive microbiome

The bacteria of the vagina and uterus are an emerging area of research in recurrent loss. A 2022 study found that a vaginal microbiome low in Lactobacillus, together with local inflammation, was more common in miscarriages of chromosomally normal pregnancies. ESHRE notes that this research is still early. We support the reproductive and gut microflora through diet and selected probiotics/prebiotics using evidence informed selection of specific strains and doses where appropriate, alongside the testing and care your physician provides.

Can you prescribe progesterone to help prevent miscarriage?

Yes. Dr. Singh holds hormone prescribing rights in Ontario and prescribes progesterone for patients in Ontario with a history of pregnancy loss when it is indicated. If progesterone is the main reason you are reaching out, you are welcome to book. We will review your history and your current pregnancy together, and if progesterone is a good fit for you, it can be prescribed and coordinated with your physician or obstetric care provider.

The research shows who is most likely to benefit. In the large PRISM trial, women with bleeding in early pregnancy who had one or more previous miscarriages had a modestly higher live birth rate with vaginal micronized progesterone, 75% compared with 70% on placebo. The benefit was greater for those with three or more previous miscarriages, 72% compared with 57%. The ESHRE guideline supports progesterone for people with three or more losses who have bleeding in a new pregnancy, and it does not recommend progesterone for unexplained RPL in general when there is no bleeding.

Because the benefit depends on your history, progesterone is assessed individually rather than started automatically, so it is used where it is most likely to help. Learn more about bioidentical hormone therapy.

Parents reading a picture book with their smiling young daughter, representing growing a family after recurrent miscarriage

Support in early pregnancy and beyond

A new pregnancy after loss brings hope and often a lot of fear. We support patients through the first trimester and the rest of pregnancy, monitoring relevant thyroid, nutrient and hormone markers, and metabolic markers such as A1c and glucose for people with a history of insulin resistance or prediabetes. A history of recurrent miscarriage is also linked with a higher risk of some later pregnancy complications, so we coordinate with your obstetric care provider and flag anything that needs their attention.

Losses after IVF, chemical pregnancies and recurrent implantation failure

Losses after IVF or IUI are included in the ESHRE definition of RPL, and very early chemical pregnancies are included by ESHRE but not by every guideline. However they are classified, each one is a real loss and deserves the same care and attention. Recurrent implantation failure (RIF) is different: it describes repeated transfers of embryos considered viable that do not lead to a positive pregnancy test. RIF is investigated by your fertility clinic, and ESHRE's good practice recommendations on RIF discuss reviewing lifestyle, thyroid function and the male partner's semen analysis. We support people with RIF using the same integrative approach, including metabolic health, thyroid, the microbiome and the male partner. See also our IVF support and unexplained infertility pages.

Emotional support after recurrent pregnancy loss

Each loss is a real loss, and repeated losses can compound grief. In a large study, nearly one in three women met the criteria for post-traumatic stress one month after an early pregnancy loss, and many also had anxiety or depression. Partners grieve too, and the ESHRE guideline notes that the kind of support people need may differ between partners. We support mood and treat anxiety and depressive symptoms as part of care, coach patients through mindfulness based exercises, and make space for partners. Free peer support is also available across Ontario through the Pregnancy and Infant Loss (PAIL) Network.

"There is nothing more challenging I have come across in practice than the pain and heartbreak of recurrent loss. My role is to help find answers where they exist, give each pregnancy the best support possible, care for the emotional wellbeing of my patients and their partners, and advocate within the wider care team whenever more support is needed. No one should have to walk this path alone."

Dr. Harsimranjeet Singh Bhatia, ND

What happens at your first visit, and what does it cost?

Your first visit is 60 minutes. We review your pregnancy history, previous investigations, cycle history, medications and supplements, lifestyle, and your goals and timeline, then build a prioritized plan with clear next steps. Your partner is assessed in a separate consultation so their plan is just as personalized. Follow up visits track progress, review new results and adjust the plan, including during pregnancy.

Current fees for each appointment type are shown when you choose a time on the online booking page. We do not direct bill, but you receive a receipt to submit to your insurer, and most extended health plans cover visits with a naturopathic doctor. New patient appointments often book several weeks ahead, so it helps to book early.

Where do we see patients?

In person appointments are at NutriChem Clinic, 2599 Carling Avenue, Ottawa, which is easy to reach from Westboro, Carlingwood, Nepean, Kanata, Stittsville, Barrhaven, Orléans and downtown Ottawa. Virtual appointments are available anywhere in Ontario and Quebec, including Toronto, Kingston, Hamilton, London, Kitchener Waterloo, Gatineau and Montreal.

Frequently asked questions

How many miscarriages before I should be tested?

The ESHRE guideline supports considering a diagnosis of recurrent pregnancy loss, and starting relevant assessments, after two losses. You do not need to wait for a third.

Can recurrent miscarriage happen even if all my tests are normal?

Yes. For many couples, no single cause is found. This is called unexplained RPL, and many people with unexplained losses still go on to have a successful pregnancy. Your outlook depends mainly on your age and your full pregnancy history, and supportive care can help in the meantime.

Can sperm quality affect miscarriage risk?

Research links higher sperm DNA fragmentation with recurrent pregnancy loss, and ESHRE now says testing can be considered. Sperm health can often be improved over about three months, which is why we assess and treat male partners.

How long should we wait to try again after a miscarriage?

A meta-analysis of nearly one million women found that conceiving within six months of a miscarriage was not linked with a higher risk of another loss. The right timing depends on your physical recovery, your emotional readiness and any investigations underway, so check with your physician.

Can I start care if I am already pregnant?

Yes. We support people who have just found out they are pregnant, as well as those preparing for a future pregnancy.

Can you prescribe progesterone?

Yes. Dr. Singh can prescribe progesterone for patients in Ontario when it is indicated, after reviewing your pregnancy history and your current pregnancy. Research shows the clearest benefit for people with previous losses who have bleeding in a new pregnancy, and the decision is made with you and coordinated with your physician.

Do you work with fertility clinics and RPL clinics?

Yes. We work alongside your family doctor, fertility clinic, RPL clinic and obstetric care provider, and with your consent we can send a written summary of your plan.

Do I need a referral, and is it covered by insurance?

No referral is needed in Ontario. Most extended health plans cover visits with a naturopathic doctor up to a yearly maximum. We do not direct bill, and you receive a receipt to submit to your insurer.

About Dr. H. Singh, ND

Dr. Harsimranjeet Singh Bhatia, ND is an award winning naturopathic doctor in Ottawa who has focused on reproductive and hormonal health for over ten years. He has presented Grand Rounds to physicians at The Ottawa Hospital's Department of Obstetrics, Gynecology and Newborn Care and to physicians at the largest fertility clinic in Eastern Ontario, and he works collaboratively with fertility clinics and family physicians. He received the 2026 Emerging Leader Award from the Ontario Association of Naturopathic Doctors and was named Naturopath of the Year by Faces Magazine Ottawa from 2021-2024. He holds a BSc from the University of Guelph and graduated from the Canadian College of Naturopathic Medicine.