Recurrent Pregnancy Loss (Recurrent Miscarriages)

Unfortunately, recurrent pregnancy loss (RPL) is a common problem. As many as one in 20 women experience recurrent miscarriages. 

At the Center for Reproductive Medicine and Fertility, we take a holistic approach to RPL, helping to meet both the physical and emotional needs of our patients and their partners. Our experts will perform a complete evaluation into the causes of recurrent pregnancy loss. We will also provide close, supportive care and regular monitoring during your next pregnancy. Our team is available in person and virtually.

What is recurrent pregnancy loss (or RPL)?

If you have experienced two or more miscarriages, this is considered recurrent pregnancy loss. We recommend that you consider reaching out to a specialist before you try to become pregnant again. Recurrent pregnancy loss increases your risk for having additional miscarriages, so it’s important to speak with your doctor about undergoing testing to identify any issues that may be impacting your ability to carry a healthy pregnancy.

Is recurrent pregnancy loss considered infertility?

Recurrent pregnancy loss is not the same as infertility. Infertility is not being able to get pregnant after trying to conceive for a year or longer. With recurrent pregnancy loss, you may be able to get pregnant, but you experience miscarriage.

However, don’t get discouraged. Even patients with three pregnancy losses have a 75% chance of having a live birth later on, research shows.

Causes, Prevention and Treatment for Recurrent Pregnancy Loss

What causes RPL?

Recurrent pregnancy loss can have a variety of causes including:

• Abnormalities in the uterus, such as a uterine septum, fibroids or retained pregnancy tissue
• Cervical insufficiency, which causes losses late in pregnancy
• Thyroid conditions, diabetes or high levels of the hormone prolactin
• Antiphospholipid antibody syndrome, a blood-clotting disorder
• Genetic conditions like chromosomal translocation, which is an abnormal arrangement of chromosomes
• Infections like chronic endometritis, an inflammation in the lining of the uterus

However, an exact cause for recurrent pregnancy loss — in other words, a specific answer to why it happens repeatedly — can be difficult to determine.

How can I prevent recurrent pregnancy loss?

Treatment plans for preventing future pregnancy losses depend on what is causing the recurrent miscarriages.

If you have:

• Fibroids, uterine septum, retained pregnancy tissue or other uterine abnormalities: Your doctor may recommend a minimally invasive procedure called a hysteroscopy to fix the structural abnormality or remove any retained tissue. A hysteroscopy can be performed vaginally (without surgical incisions) and does not require a hospital stay.
• Cervical insufficiency: Your doctor may recommend a surgery called transabdominal cervical cerclage. This procedure can provide additional support to your cervix as the fetus grows.
• A thyroid condition, diabetes or high levels of the hormone prolactin: Your gynecologist can refer you to a hormone specialist called an endocrinologist. This doctor can help you develop a plan to get your hormone levels under control.
• Antiphospholipid antibody syndrome: Taking a blood thinner and low-dose aspirin can improve your chances for a healthy pregnancy.
• Chromosomal translocation: Your doctor may recommend in vitro fertilization (IVF) and preimplantation genetic testing to improve your chances for a successful outcome.
• Endometritis: If you have an inflammatory condition like chronic endometritis, your doctor may recommend taking an antibiotic.
• Endometrial factor: Take progesterone supplements starting prior to pregnancy. If the cause of your recurrent pregnancy loss cannot be determined, your doctor may suggest that you take progesterone, a hormone that can support early pregnancy.
• Clotting factors: Your doctor will check your thrombophilia profile and work with a hematologist to recommend blood thinner.
• An unknown cause: Families often seek clinical evaluation to understand the cause of RPL. Unfortunately, for many patients, it may not be possible to identify an exact cause. Our team is actively leading evidence-based, NIH-funded research designed to improve the understanding of genetic causes of miscarriage.