Recurrent Pregnancy Loss: Causes, Testing, and Hope for the Future

By Dr. Anshika Lekhi | MBBS, DGO, Fellowship in Reproductive Medicine, The Fertilife, Gurgaon

Recurrent pregnancy loss takes more out of a couple emotionally than almost any other fertility challenge. With infertility the difficulty sits in getting pregnant at all. Recurrent pregnancy loss means getting there again and again and losing it each time. Every loss carries its own grief, and the waiting between attempts is a particular kind of suffering on top of that. At The Fertilife our Recurrent Pregnancy Loss program is built on one principle: anybody who has been through multiple losses deserves a thorough investigation, not a reassurance that "it often happens naturally" and a suggestion to go and try again.

Recurrent pregnancy loss (RPL) is clinically defined as the loss of three or more pregnancies before 20 weeks of gestation. Some guidelines now bring two consecutive losses in, given what two failures mean emotionally and clinically. Around 50% of recurrent pregnancy losses remain unexplained even after thorough investigation, so for a good share of couples no single correctable cause turns up. That is not the same as nothing being able to be done.

What Causes Recurrent Pregnancy Loss?

Chromosomal Abnormalities

Chromosomal abnormality in the embryo is what sits behind most individual miscarriages. In recurrent pregnancy loss, the pattern across the losses can point to one or both partners carrying a chromosomal rearrangement, a balanced translocation say, which pushes up the likelihood of chromosomally abnormal embryos. Parental karyotyping picks that up and is a standard part of our investigation.

Uterine Structural Abnormalities

Anatomical problems inside the uterus can stop a developing pregnancy implanting fully or keep it from being sustained:

• A uterine septum, meaning a partition within the uterine cavity, and one of the most treatable causes of recurrent loss there is

• Submucosal fibroids distorting the cavity

• Intrauterine adhesions (Asherman's syndrome)

• Cervical incompetence, which typically shows up as second-trimester losses

A hysteroscopy puts eyes directly on the uterine cavity and reads these more reliably than ultrasound on its own.

Immune and Thrombophilic Causes

Antiphospholipid syndrome (APS) is an autoimmune condition that raises the risk of blood clots in the placental vessels, and that causes pregnancy loss. It is one of the few identifiable and treatable causes going, managed through anticoagulation therapy during pregnancy. A Female Fertility Assessment for recurrent pregnancy loss always takes in antiphospholipid antibody testing.

Other thrombophilias, meaning inherited clotting disorders, may be implicated too, though their association with pregnancy loss rests on weaker evidence than the APS association does.

Hormonal Factors

• Thyroid dysfunction, underactive and overactive both, goes with increased miscarriage risk and is easily treated once somebody finds it

• Poorly controlled diabetes

• Raised prolactin levels working on the hormonal environment of early pregnancy

Male-Factor Contribution

The male partner's part in recurrent pregnancy loss gets underinvestigated all the time. Raised sperm DNA fragmentation has been associated with early pregnancy loss even where fertilisation and initial development look entirely normal. Sperm DNA testing should be carried out in cases of recurrent pregnancy loss, recurrent IVF failure, and unexplained infertility, because it reads a factor standard semen analysis misses.

What Does Our Investigation Include?

What Are the Treatment Options?

Treatment turns entirely on the cause identified. Find a uterine septum and hysteroscopic resection is straightforward, and it often improves outcomes dramatically. Confirm antiphospholipid syndrome and low-dose aspirin with low-molecular-weight heparin during pregnancy is standard management. Find raised sperm DNA fragmentation and protocol adjustments in IVF come into play, the use of testicular sperm or antioxidant supplementation among them.

The Role of IVF Treatment

IVF Treatment with preimplantation genetic testing (PGT-A) screens embryos for chromosomal abnormalities before transfer, which goes straight at the commonest cause of pregnancy loss there is. For couples where parental chromosomal rearrangements have been identified, or where multiple losses have happened with no cause found, PGT-A alongside IVF Treatment offers a targeted approach that natural conception cannot.

Moving Forward With Support

No couple should be facing repeated pregnancy loss without answers. Our Recurrent Pregnancy Loss program at The Fertilife runs a structured investigation, gives you a clear explanation of the findings, and builds a treatment pathway around what the evidence shows rather than around a generic protocol. Alongside the clinical management, a Female Fertility Assessment and psychological support come as part of the process, because recurrent pregnancy loss asks for care of the body and the mind both. Visit thefertilife.in to arrange a consultation.

This article is for general educational purposes and is not a substitute for personalised medical advice from your fertility specialist or embryologist.