After experiencing many pregnancy losses, many people wonder about their future fertility. It can feel overwhelming, confusing, and isolating. These feelings are only made worse when you don’t know what is causing the miscarriages.

We talked with Cristina Vidal, RN to learn more. We also consulted the American Society for Reproductive Medicine’s (ASRM) Fact Sheets. Below, we share what we know about recurrent pregnancy loss, its potential causes, and more.

What is recurrent pregnancy loss?

Recurrent pregnancy loss (RPL) is defined by the spontaneous loss of two or more pregnancies. RPL is distinct from infertility. A variety of factors can cause RPL, and each case is unique. Please know that you can benefit from medical evaluation and psychological support. It’s very common to experience depression and anxiety after a pregnancy loss.

How common is recurrent pregnancy loss?

RPL affects as many as 1-5% of reproductive couples attempting to have children. It’s important to review each pregnancy loss to determine if there’s anything that needs to be evaluated or addressed for the individual or couple. 

What are the causes of RPL?

Unfortunately, for 50%–75% of couples, no cause is ever identified. Many of these unidentified cases are due to genetic issues. In particular, many early miscarriages happen because of chromosomal abnormalities that can occur during conception. In other words, these miscarriages occur because the embryo or fetus has an extra chromosome or a missing one. As a woman ages, her risk of experiencing a pregnancy loss due to a chromosomal abnormality increases.

Other possible causes of RPL are related to age, lifestyle, environmental exposures, sperm irregularities, uterine abnormalities, medical conditions, or an unexplained cause. Your doctor can help you understand what may be affecting your ability to carry a pregnancy to full term.

What happens after you experience recurrent pregnancy loss?

Cristina Vidal, RN, recommends that you get a comprehensive evaluation. Blood tests can help your doctor determine any conditions that may be affecting an ability to have a healthy baby. 

Your doctor may also order other diagnostic tests, such as an evaluation for uterine abnormalities, or refer you and your partner to other specialists. These specialists can collaborate to understand any contributing factors that lead to miscarriages. Specialty areas can include perinatal genetics, maternal-fetal medicine, hematology, immunology, urology, or endocrinology. 

Are there tests to discover the causes of RPL?

There are several tests that may provide helpful insight into cases of RPL. Your doctor may want to learn more about the uterine cavity. To do that, they may order a special x-ray (hysterosalpingogram), saline ultrasound (sonohysterogram), or a hysteroscopy. These tests may reveal that there is a problem with the shape of the uterus that is causing pregnancy loss and also see if any extra tissue, polyps, or fibroids need to be removed. 

There are tests that assess potential genetic causes of RPL. There is a special blood test, called a “karyotype,” that can study the chromosomes of conception partners. This test can help identify if partners have particular differences in the way their chromosomes are arranged. These differences can increase the risk for pregnancy loss — about 1-5% of individuals with RPL are identified with a chromosomal rearrangement that doesn’t impact their health but can affect their chances of achieving a healthy pregnancy.

Other blood tests can reveal if a woman has certain medical, immune, or blood-clotting conditions that might be causing RPL. Tissue from a pregnancy loss may also be tested for chromosomal differences, which is called “products of conception testing.” 

What are the treatment options for RPL? 

A variety of issues can cause RPL. There are also a variety of evidence-based treatment options available. 

Depending on the condition, medical or surgical treatment may lower the risk of future pregnancy loss. Certain conditions, such as uncontrolled diabetes, thyroid, and high levels of prolactin, will need medical treatment. Those who live with autoimmune and clotting conditions may be treated with a low dose of Heparin and/or Aspirin. Other conditions, such as fibroids or scar tissue, will need surgical treatment. 

There are also lifestyle changes you can make to maintain a healthy lifestyle. These include decreasing alcohol and caffeine consumption, refraining from using drugs, maintaining a healthy weight, regular exercise, taking prenatal vitamins with at least 400mcg of Folic Acid, and psychological support and counseling.

After conception, your doctor may need to closely watch you and your pregnancy. For a variety of reasons, some couples may choose to pursue egg/sperm donation and/or a gestational carrier. For more information, please see the ASRM fact sheet, Treatment of recurrent pregnancy loss, and consult with your doctor. 

Key takeaways

No matter the cause, we know that this process can be difficult and stressful. It is important to remember that there is hope. According to ASRM, “even after having 3 miscarriages, a woman has a 60%–80% chance of conceiving and carrying a full-term pregnancy.” With an evidence-based approach and supportive care, you and your partner can have a successful pregnancy. 

• The spontaneous loss of two or more pregnancies is known as recurrent pregnancy loss (RPL). RPL is distinct from infertility, and it can be caused by a variety of factors.
• If you are experiencing RPL, you will likely benefit from medical evaluation and psychological support. It is very common to experience depression and anxiety following a miscarriage.
• Even though 50%–75% of couples do not receive an explanation for their case of RPL, there are many diagnostic tests and treatments available. Consult with your doctor about the best approach. 
• According to the ASRM, even after having 3 miscarriages, a woman has a 60%–80% chance of conceiving and carrying a full-term pregnancy.

Resources consulted (and recommended!)

• ASRM’s What is recurrent pregnancy loss (RPL)?
• ASRM’s Treatment of recurrent pregnancy loss
• ASRM’s Preimplantation genetic testing 
• Stanford Medicine’s Recurrent Pregnancy Loss
• Stanford Medicine’s Recurrent Pregnancy Loss Research