Recurrent Pregnancy Loss: Causes, Evaluation, and Treatment Options

Dear patients, experiencing two or more pregnancy losses is one of the most emotionally and physically exhausting journeys a couple can face. I recognise that mix of hope, exhaustion, and the silent question — "Why us?" — in the eyes of so many couples who walk through our clinic doors. What I want you to know is this: a significant proportion of recurrent pregnancy losses have identifiable causes, and with the right evaluation, most of them can be treated. I want to walk you through this process with complete transparency.

What Is Recurrent Pregnancy Loss?

The European Society of Human Reproduction and Embryology (ESHRE) defines recurrent pregnancy loss (RPL) as the loss of two or more clinically confirmed pregnancies. This threshold was recently revised downward from three to two, enabling couples to seek a thorough evaluation earlier in their journey. Approximately 1–2 in every 100 couples are affected — you are far from alone.

What Causes It? Key Factors

Multiple factors may contribute to recurrent pregnancy loss, sometimes in combination. The causes I encounter most frequently include:

• Chromosomal and Genetic Factors: Structural chromosomal abnormalities in one parent — such as a balanced translocation — are among the most commonly identified genetic causes. Numerical chromosomal errors (aneuploidy) in the embryo itself are also frequent, and often arise randomly.
• Uterine Anomalies: A uterine septum, submucosal fibroid, polyp, or intrauterine adhesions (Asherman's syndrome) can impair embryo implantation. Most of these issues can be diagnosed and corrected during the same hysteroscopy procedure.
• Thrombophilia (Clotting Disorders): Antiphospholipid syndrome (APS) and other clotting disorders can cause thrombosis in placental vessels, triggering pregnancy loss. This group typically responds very well to treatment.
• Endocrine Disorders: Uncontrolled thyroid disease, Polycystic Ovary Syndrome (PCOS), and diabetes are hormonal conditions that may compromise the continuation of a pregnancy.
• Immunological Factors: Impaired maternal immune tolerance toward the embryo is an active area of research; diagnostic and treatment protocols continue to be refined.
• Unexplained Causes: After thorough evaluation, no definitive cause is found in approximately half of all couples. Even within this group, live birth rates in subsequent pregnancies remain encouraging.

What Does the Diagnostic Workup Include?

At my clinic, couples with recurrent pregnancy loss receive a systematic, comprehensive evaluation:

• Parental karyotype analysis (chromosomal mapping) for both partners
• Ultrasound and hysteroscopy for detailed uterine cavity assessment
• Antiphospholipid antibody testing and extended thrombophilia screening
• Hormonal panel: thyroid function, fasting insulin, prolactin
• Preimplantation Genetic Testing (PGT-A) when indicated, to screen embryos for chromosomal health before transfer during IVF

What Are the Treatment Options?

For every couple, I create a personalised treatment plan tailored to their specific findings:

• When antiphospholipid syndrome is identified, a combination of low-molecular-weight heparin and low-dose aspirin significantly improves pregnancy outcomes.
• Uterine pathology is corrected via minimally invasive hysteroscopic surgery — diagnosis and treatment are often accomplished in the same procedure.
• Hormonal disorders are brought under control with targeted medical therapy before conception is attempted.
• Where one parent carries a balanced chromosomal translocation, IVF combined with PGT-A allows selection and transfer of chromosomally healthy embryos.
• Even for couples with unexplained RPL, close pregnancy monitoring, psychological support, and lifestyle optimisation — maintaining a healthy weight, stopping smoking, taking folic acid — can meaningfully increase live birth rates.

There Is Always Hope

Research consistently shows that the majority of couples who have experienced recurrent pregnancy loss go on to have a healthy baby with appropriate management. Even among couples for whom no definitive cause is identified, ESHRE data indicate live birth rates above 60% in subsequent pregnancies. Please remember: you are not alone in this journey, and you have a dedicated, experienced team walking alongside you every step of the way.