Recurrent Pregnancy Loss
Recurrent pregnancy loss (RPL) occurs when a woman has two or more miscarriages. While experiencing pregnancy loss can be difficult, evaluation and treatment can help guide your path forward to a healthy, full-term pregnancy. The fertility specialists at University Hospitals provide individualized care to help you understand what may be causing miscarriage and explore treatment options tailored to you.
Schedule Your Fertility Consultation
A consultation can help determine what evaluation or treatment approaches for recurrent pregnancy loss may be appropriate for your care plan.
To schedule, call 216-765-3352.
Quick Facts About Recurrent Pregnancy Loss
- Recurrent pregnancy loss is commonly defined as two or more pregnancy losses, or miscarriages.
- Many cases are related to chromosomal or genetic factors.
- Evaluation may include testing of the uterus, hormones and genetic factors.
- Identifying the cause may help guide treatment options.
- Treatment varies based on the underlying cause and individual health and fertility factors.
- Fertility specialists provide guidance to support evaluation and care planning.
What Is Recurrent Pregnancy Loss?
Recurrent pregnancy loss is defined as two or more miscarriages. A single miscarriage is relatively common, occurring in approximately 10 – 15 percent of all pregnancies. Recurrent pregnancy loss occurs less frequently. Recurrent pregnancy loss may happen at different stages of early pregnancy. It can happen very early, before a heartbeat is detected, or after a heartbeat has been confirmed. Regardless of when it happens, recurrent pregnancy loss may be a treatable condition, and an evaluation with a fertility specialist can help identify contributing factors.
Recurrent pregnancy loss is not caused by factors like exercise, stress or sexual activity during early pregnancy. Instead, it typically results from specific medical, genetic or structural factors that can at times be identified and addressed. Importantly, not all cases have an immediately identifiable cause. In some situations, evaluation may not reveal a clear explanation, which is referred to as unexplained recurrent pregnancy loss.
What Causes Recurrent Pregnancy Loss?
The causes of RPL vary between individuals. Multiple factors may be involved in some cases, and evaluation is essential to assess what may be contributing to your losses. Your fertility specialist will recommend appropriate testing based on your medical history and specific circumstances.
- Genetic and Chromosomal Factors
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Chromosomal abnormalities are the most common cause of recurrent pregnancy loss. Random errors in egg or sperm can result in embryos with missing or extra chromosomes. These chromosomal abnormalities prevent normal fetal development and typically result in miscarriage. The risk of chromosomal abnormalities increases with a woman’s age, which impacts egg quality.
- Uterine Factors
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Structural differences in the uterus can affect implantation or pregnancy development. Examples include a uterine septum (a wall dividing the uterus), fibroids, scar tissue or other differences in a woman’s anatomy. Some women may be born with structural differences, while others develop them over time. Imaging can identify these conditions, and some may be treated surgically to improve pregnancy outcomes.
- Hormonal and Endocrine Conditions
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Hormonal imbalances can contribute to pregnancy loss. For example, thyroid disorders — either an overactive or underactive thyroid — can affect pregnancy viability. Abnormal prolactin levels may also interfere with the hormonal support needed to maintain early pregnancy. Additionally, diabetes and uncontrolled glucose levels may contribute to miscarriage. These conditions can usually be identified through blood testing and managed with medication.
- Immune-Related Conditions
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Certain immune system conditions may increase miscarriage risk. One autoimmune condition, antiphospholipid syndrome (APS) causes the body to produce antibodies that increase blood clotting, potentially affecting blood flow to the placenta. Other immune-related factors may also contribute to recurrent miscarriages in some women.
- Other or Unexplained Causes
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Environmental or lifestyle factors such as smoking, excessive alcohol use or certain environmental exposures may increase miscarriage risk. Additionally, in some cases, no specific cause is identified despite thorough evaluation. This is called unexplained recurrent pregnancy loss.
When Should You Seek Evaluation?
Evaluation for recurrent pregnancy loss is often recommended after two consecutive miscarriages. However, earlier evaluation may be considered based on your age, medical history or other circumstances. If you’re 35 or older, or if you have a known medical condition that might affect pregnancy, your doctor may recommend evaluation after one miscarriage.
If you’ve experienced recurrent pregnancy loss, an early consultation with a fertility specialist is important. The sooner you seek evaluation, the sooner you can understand what may be contributing to your miscarriages and begin exploring treatment options.
How Is Recurrent Pregnancy Loss Evaluated?
Evaluation for RPL involves a thorough review of your medical history and diagnostic tests to identify possible underlying causes. Not all women with RPL require every test – your fertility specialist will recommend appropriate testing based on your individual circumstances.
After testing is complete, your care team will review results and discuss findings and treatment options with you.
Step One: Medical History Review
Your fertility specialist will review your complete medical and pregnancy history, including the timing of your prior pregnancies and the point in pregnancy when the losses occurred. Understanding the pattern of your miscarriages – whether they occur consistently at the same stage or vary – provides important information that can help guide treatment.
Step Two: Genetic Testing
Genetic testing may include chromosomal analysis of both parents to identify if either parent carries a chromosomal difference that could be passed to a fetus. This testing helps determine whether genetic factors are contributing to recurrent pregnancy loss.
Step Three: Uterine Evaluation
Imaging such as transvaginal ultrasound or hysterosalpingography (HSG), which provides a view of your uterus and fallopian tubes, is used to evaluate your uterus and identify any structural abnormalities that might affect pregnancy. If needed, additional imaging or hysteroscopy to visualize inside the uterus may be recommended.
Step Four: Hormonal Testing
Blood tests assess hormone levels including thyroid function and prolactin. Thyroid disorders and prolactin abnormalities can interfere with early pregnancy and result in miscarriage. These hormonal conditions are easily identified and treated.
Step Five: Immune and Blood Testing
Blood tests screen for antiphospholipid syndrome and other immune-related factors that may increase miscarriage risk. Depending on your history and findings, additional immune testing may be recommended.
Treatment Options for Recurrent Pregnancy Loss
Treatment for recurrent pregnancy loss depends on the underlying cause identified during evaluation. Not all cases require the same approach. Some women may need a single intervention, while others may benefit from a combination of treatments. Individualized care is essential to address your specific situation and maximize the chances of a successful pregnancy.
- Treatment Based on an Identified Cause
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When an evaluation identifies a specific cause of RPL, treatment is planned to target that underlying cause. For example, if hormonal abnormalities are identified, hormone therapy such as thyroid medication or prolactin-lowering medications may be recommended. If a structural abnormality is identified in the uterus, surgical correction may be recommended to improve implantation and pregnancy outcomes.
- Medications for Immune Conditions
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If antiphospholipid syndrome or another immune-related condition is diagnosed, treatment may include anticoagulants (blood thinners) or other therapies to reduce clotting risk and support early pregnancy. These medications are taken for a specific time period during pregnancy.
- Genetic Considerations and IVF with Testing
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In certain cases, particularly when genetic factors are identified or when other treatments have not been successful, in vitro fertilization (IVF) combined with preimplantation genetic testing (PGT) may be considered. PGT allows screening of embryos for chromosomal abnormalities before transfer, potentially reducing the risk of pregnancy loss.
- Supportive Care and Monitoring
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Close monitoring in early pregnancy is often recommended after recurrent losses. Early ultrasound and follow-up visits allow your care team to confirm normal pregnancy development and provide reassurance. Some women benefit from more frequent monitoring or additional support during early pregnancy.
Recurrent Pregnancy Loss and Fertility Planning
Recurrent pregnancy loss is part of broader fertility care planning. Understanding the cause and available treatments helps you and your fertility specialist develop a strategy moving forward.
Your fertility specialist will work with you to create an individualized plan based on your diagnosis, age, overall fertility and goals. This plan may include treatment for identified causes, close monitoring in early pregnancy or other supportive measures. Multiple options may be considered, and your care team will discuss what approach is most appropriate for your situation.
The goal of fertility planning after recurrent pregnancy loss is not just to achieve pregnancy, but to support a healthy, viable pregnancy. With appropriate diagnosis and treatment, many women who have experienced recurrent pregnancy loss go on to have successful pregnancies.
Emotional and Support Considerations
Experiencing recurrent pregnancy loss can be emotionally challenging. Repeated losses may bring grief, frustration, anxiety about future pregnancies and questions about whether pregnancy is possible. These emotions are completely valid and normal.
Support is available. Speaking with a fertility counselor or therapist can help you process your emotions, address anxiety about future pregnancies and develop coping strategies as you move through evaluation and treatment. Additionally, connecting with others who have experienced similar losses – whether through support groups or online communities – can provide validation and perspective.
Bereavement Program for Pregnancy Loss
University Hospitals also offers a parent bereavement program that gives support to families that are dealing with miscarriage/pregnancy loss, stillbirth or death of an infant or child. Our team can provide personalized recommendations and resources to help families navigate the grieving process.
Learn more about parent bereavement support at UH or contact us for help accessing individualized resources:
Email: HEAL@UHhospitals.org
Call: 440-569-6550
With Pregnancy Loss, Support Is Available
What to Know About Fertility at Every Age
The Path to Parenthood: Support for Your Fertility Journey
Frequently Asked Questions About Recurrent Pregnancy Loss
- What is recurrent pregnancy loss?
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Recurrent pregnancy loss is defined as two or more miscarriages. While a single miscarriage is common, recurrent pregnancy loss occurs less frequently and typically warrants evaluation to identify possible underlying causes and guide treatment.
- What causes recurrent pregnancy loss?
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Recurrent pregnancy loss may be caused by several factors including chromosomal abnormalities (the most common cause), structural abnormalities in the uterus, hormonal imbalances such as thyroid disorders, immune-related conditions like antiphospholipid syndrome or other factors that may not be immediately identified. Evaluation by a fertility specialist can help determine what may be contributing to your losses.
- When should I see a doctor after multiple pregnancy losses?
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Evaluation for recurrent pregnancy loss is typically recommended after two consecutive miscarriages. However, if you’re 35 or older or have a known medical condition that might affect pregnancy, your fertility specialist may recommend evaluation after one pregnancy loss. Early consultation is important so you can begin exploring potential causes and treatment options.
- How is recurrent pregnancy loss diagnosed?
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Diagnosis involves a comprehensive evaluation including medical history review, genetic testing of both parents, imaging to assess uterine anatomy, hormonal testing to check thyroid and prolactin levels, and immune and blood testing to screen for conditions like antiphospholipid syndrome. Your fertility specialist will recommend specific tests based on your individual circumstances.
- What treatments are available for recurrent pregnancy loss?
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Treatment depends on the underlying cause identified during evaluation. Options may include hormone therapy for hormonal imbalances, surgical correction for structural abnormalities, anticoagulants or other therapies for immune conditions, close monitoring in early pregnancy or, in some cases, IVF with genetic testing of embryos. Your fertility specialist will recommend an approach tailored to your specific diagnosis.
- Can recurrent pregnancy loss be prevented?
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Prevention depends on identifying and treating the underlying cause. For example, treating thyroid disorders or hormonal imbalances may prevent future losses. However, if no specific cause is identified, prevention focuses on close monitoring in early pregnancy and supportive care. Your fertility specialist can discuss what prevention strategies may be appropriate for your situation.
- Can I have a successful pregnancy after recurrent pregnancy loss?
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Yes. Many women who have experienced recurrent pregnancy loss go on to have successful pregnancies with appropriate diagnosis and treatment. The key is identifying the underlying cause through evaluation and pursuing targeted treatment. With individualized care and support, pregnancy after recurrent loss is achievable for many women. Even without intervention, many women go on to have healthy pregnancies and live births after recurrent pregnancy loss.
Learn More and Next Steps
Your fertility care may involve additional treatments and services. Explore these resources to understand your full range of care options.
- In Vitro Fertilization (IVF) – IVF may be recommended in certain cases of RPL, particularly when combined with genetic testing of embryos. Learn about IVF and how it works.
- Preimplantation Genetic Testing (PGT) – PGT screens embryos for chromosomal abnormalities before they are transferred to the uterus, which may reduce miscarriage risk in some cases. Learn more about PGT.
- Fertility Center Hub – Access all fertility services and resources at UH.
Schedule a Fertility Consultation
Understanding your recurrent pregnancy loss and exploring treatment options is an important step forward. University Hospitals provides comprehensive fertility care with experienced reproductive endocrinologists who can evaluate your individual situation and help you create a personalized treatment plan.
Ready to discuss recurrent pregnancy loss and your fertility options?
A consultation can help determine what evaluation or treatment approaches for recurrent pregnancy loss may be appropriate for your care plan.
To schedule, call 216-765-3352.