Recurrent Pregnancy Loss
Hope Healing Happiness
in Fertility Care
Intrauterine Insemination (IUI) is a type of fertility treatment where specially prepared sperm is placed directly into a woman’s uterus using a thin catheter.
Recurrent Pregnancy Loss
What is Recurrent Pregnancy Loss (RPL) ?
Recurrent pregnancy loss (also known as recurrent miscarriage or habitual abortion) refers to the loss of two or more clinically recognized pregnancies, most often before 20 weeks of gestation. Definitions vary—some medical bodies use three or more consecutive losses, while others (like ASRM) define it as two or more.
When is It Considered ?
- The World Health Organization (WHO) defines it as three or more consecutive miscarriages before the 20th week.
- Meanwhile, the American Society for Reproductive Medicine (ASRM) considers two or more consecutive losses enough to warrant evaluation and treatment.
- This condition affects approximately 1–3% of couples trying to conceive.
Causes for RPL
Nearly half of recurrent miscarriages remain unexplained, even after thorough evaluation.
When the cause is identified, contributing factors can include:
Genetic and Chromosomal Issues
- Chromosomal problems in the embryo (e.g. trisomy) are common causes, especially with increasing maternal age.
- Balanced translocations in a parent—an uncommon but possible inherited cause—are seen in about 2–5% of cases.
Uterine or Anatomical Abnormalities
- Structural issues like a septate uterus, fibroids, polyps or scarring affect around 10–15% of women with recurrent miscarriage.
Endocrine, Metabolic, and Immune Conditions
- Disorders such as thyroid disease, diabetes, or luteal phase defects can contribute .
- Immune-related causes include antiphospholipid syndrome (APS) (~15% of cases) and anti-thyroid autoantibodies .
Thrombophilias (Blood Clotting Disorders)
- Clotting disorders like Factor V Leiden may account for 49–65% of miscarriages in some studies, though most women with these disorders have normal pregnancies .
Infections and Lifestyle Factors
- Some infections (e.g. syphilis, CMV, malaria) may raise miscarriage risk, but direct links to recurrent cases are unclear.
- Lifestyle factors such as smoking, excessive caffeine, alcohol, obesity, stress, or exposure to toxins may play a role .
How is it Diagnosed ?
When RPL is suspected, doctors may recommend:
Medical and Pregnancy History Review
- Examining the number of losses, maternal age, previous live births, and pregnancy details .
Genetic Testing
- Karyotyping both parents and possibly miscarriage tissue to detect chromosomal abnormalities .
Imaging and Uterine Evaluation
- Ultrasounds, MRI, hysteroscopy, or sonohysterography may help reveal structural issues .
Blood Tests for Health and Immune Factors
- Testing for hormone imbalances (thyroid, glucose), autoimmune conditions (APS), and thrombophilia .
Even after these evaluations, about 50% of cases remain unexplained .
Step Process
Treatment Options
Treatment aligns with the identified causes:
Step 1 : Genetic Counseling and PGT
- Couples with chromosomal translocations may benefit from Preimplantation Genetic Testing during IVF .
Step 2 : Surgical Intervention
- Correcting uterine structural issues via hysteroscopic surgery may improve outcomes .
Step 3 : Medical Management
- Treating underlying thyroid or metabolic disorders, and using medications like aspirin/heparin for APS or thrombophilia .
Step 4 : Assisted Reproductive Technologies (ART)
- IVF combined with genetic screening (PGT) can help select healthy embryos .
Step 5 : Supportive and Lifestyle Care
- Addressing modifiable factors like weight, smoking, caffeine, stress, and providing emotional support or counseling .
Psychological Impact
- Recurrent loss is emotionally exhausting—many people experience grief, depression, anxiety, and feelings of isolation .
- Support can include therapy, support groups, or help from mental health professionals—and sharing experiences can foster healing .
Proghy Pragnancy Possible ?NOSIS : Is a Health
- Most couples—even without a clear diagnosis—can eventually have a successful pregnancy: success rates can reach 60–70% for unexplained cases .
- Risk of future loss increases with more previous miscarriages and advancing maternal age. For instance, women aged 25–29 have a ~40% recurrent risk after 3 losses, which rises with age .