When this problem occurs, you just want to do whatever you can to help the couple who so desperately wants to have a child.
An evaluation is warranted after two consecutive miscarriages. What I look for is a reversible cause for the problem. Sometimes it is as simple as early pregnancy intervention with checking your progesterone level and supplementing appropriately with suppositories in the early stage of pregnancy. Many of my patients have conceived and carried to full term with such a simple intervention.
I do perform an extensive laboratory and radiology study of the couple. Luckily in most couples the work up is negative and the third time is often the charm. A face-to-face consultation to review the couple’s history is often the key to determining the problem before a single test is ordered. Listening to the patient is always the key to solving the problem; the tests are for confirmatory purposes only.