Recurrent Miscarriage: Finding the Reason Behind Repeated Pregnancy Loss

Recurrent pregnancy loss (RPL), also called recurrent miscarriage, is the loss of two or more pregnancies.

It affects around 5 in 100 couples trying to have a baby.

Recurrent miscarriage can often be evaluated and treated, but this requires a thorough RPL evaluation by doctors and specialists who have experience managing recurrent pregnancy loss.

At EPIA, we take a comprehensive approach to RPL, looking across multiple possible causes rather than treating every miscarriage in the same way.

Recurrent pregnancy loss means losing two or more pregnancies.

The losses do not have to happen one after another.

For example, if you have had one miscarriage, then a successful pregnancy, followed by another miscarriage, you can still be evaluated for recurrent pregnancy loss.

The important question is not just how many times you have miscarried, but why the pregnancies are not continuing.

Recurrent miscarriage can happen because of one underlying factor or a combination of several factors.

Sometimes, the embryo develops with a chromosomal abnormality.

The abnormality can be in the form of number of chromosomes in the embryo or a genetic anomaly inherited from either of the parents.

In such cases the body of the mother rejects the pregnancy as it considers it to not be good.

But, if chromosomal or genetic reasons lead to recurrent miscarriages then that requires further investigation and treatment.

• Miscarriages due to genetic and chromosomal loss usually occur in the first trimester of the pregnancy.
• Who is at the risk- Most likely couples who are above 30 but not limited.

The uterus needs to provide the right environment for a pregnancy to implant and continue developing.

Certain uterine conditions can interfere with this process.

These may include:

These may include:

These may include:

• Septate uterus
• Fibroids
• Polyps
• Other abnormalities of the uterus
• Abnormalities of the uterine cavity

The important part is to identify whether there is an abnormality that can be treated before another pregnancy.

Hormonal and metabolic conditions can also contribute to pregnancy loss.

These include:

• Thyroid disorders, including hypo- and hyperthyroidism
• Diabetes
• PCOS
• Prolactin abnormalities

When these conditions are present, they can affect the hormonal and metabolic environment required to support a pregnancy.

Pregnancy losses associated with these factors commonly occur in the first trimester, although the exact timing can vary from person to person.

If you already know that you have PCOS, diabetes or a thyroid condition, this is particularly important information for your RPL evaluation.

Blood-clotting and immune-related factors can also play a role in some cases of recurrent pregnancy loss.

One established condition associated with RPL is antiphospholipid syndrome (APS), an autoimmune condition that can affect pregnancy.

There are also other immune mechanisms that have been studied in recurrent pregnancy loss.

Pregnancy involves a complex interaction between the mother's immune system and the developing pregnancy. Because the embryo carries genetic material from both parents, the maternal immune system has to develop tolerance towards the pregnancy.

When immune mechanisms are abnormal, they may be investigated as part of an RPL assessment.

These factors do not have one fixed pattern of pregnancy loss. Depending on the underlying problem, losses can occur at different stages of pregnancy.

Age is an important factor in recurrent pregnancy loss, particularly because the likelihood of chromosomal abnormalities increases with age.

Other factors that may contribute to pregnancy loss include:

• Smoking
• Alcohol consumption
• Higher body weight
• Certain medical conditions
• Other lifestyle or environmental factors

These factors may not be the only reason behind RPL. They are considered alongside genetic, uterine, hormonal and other medical factors.

Recurrent miscarriage does not always have a single explanation.

There may be one underlying problem, several contributing factors, or an interaction between different factors.

That is why identifying the exact reason in your case requires looking at the complete picture.

If you have experienced recurrent miscarriage, you may have heard:

"We did the tests, but we couldn't find a reason."

For many couples, this can feel like there is nowhere else to look.

But an unexplained diagnosis can sometimes mean that the evaluation has not been able to identify the underlying factor.

Some causes of RPL are complex and require specialised investigation, particularly when standard testing has not provided an answer.

At EPIA, we take a broader approach.

Our RPL evaluation includes 99+ tests across six diagnostic axes, including detailed assessment of immune-related factors.

According to EPIA's clinical data, almost 70% of couples who came to EPIA after being told their pregnancy losses were unexplained were able to identify a possible reason for their losses.

The aim is to bring together every relevant piece of the puzzle and understand what may be happening in your particular case.

At EPIA, testing is designed around the possible causes discussed above.

Hormonal profiles help assess conditions such as:

• Thyroid abnormalities
• Prolactin abnormalities
• Diabetes and metabolic factors
• Other relevant hormonal conditions

This helps us investigate: hormonal and metabolic causes of RPL.

We assess the uterus and uterine cavity using investigations such as:

• Transvaginal ultrasound
• MRI, where required
• Hysteroscopy

This helps us investigate: septate uterus, fibroids, polyps and other structural or cavity-related abnormalities.

At EPIA, HLA and KIR typing may be used as part of our assessment of immune-related factors in selected RPL cases.

This helps us investigate: genetic and chromosomal factors that may increase the risk of pregnancy loss.

At EPIA, HLA and KIR typing may be used as part of our assessment of immune-related factors in selected RPL cases.

This helps us investigate: specific immune-related characteristics that EPIA considers as part of its RPL evaluation.

At EPIA, endometrial immune profiling may also form part of the evaluation where clinically appropriate.

This helps us investigate: the immune environment of the endometrium as part of the broader RPL assessment.

The objective is not simply to run a long list of tests.

It is to connect the test results back to your pregnancy history and identify the factors that may be relevant to your losses.

There is no single treatment for RPL. The treatment depends on what the evaluation finds.

In selected cases, IVF with preimplantation genetic testing (PGT) may be considered.

Embryos are created through IVF and tested before transfer. This can help identify embryos with certain chromosomal or genetic abnormalities, depending on the type of PGT being used.

This is different from a natural pregnancy, where there is no opportunity to test and select an embryo before implantation.

If a uterine abnormality is contributing to pregnancy loss, treatment may be recommended to correct the problem where appropriate.

This can include treatment for certain:

• Septate uterus
• Polyps
• Fibroids
• Intrauterine abnormalities

The underlying condition can be treated or optimised before and during pregnancy.

This may include appropriate management of thyroid disorders, diabetes, PCOS-related metabolic issues or other identified hormonal abnormalities.

At EPIA, treatment is individualised according to the immune-related findings and the patient's complete clinical history.

Depending on the case, EPIA may use immunomodulatory approaches such as LIT or IVIG as part of its treatment protocols.

These treatments should be discussed with an RPL specialist based on the individual's findings rather than used as a standard treatment for every patient with RPL.

Lifestyle factors are also addressed where relevant.

This may include changes related to:

• Smoking
• Alcohol
• Weight
• Nutrition
• Existing medical conditions

The treatment plan is built around why the losses are happening, rather than giving every patient the same treatment.

RPL requires experience, detailed investigation and a treatment plan built around the individual couple.

At EPIA, our RPL programme brings together:

40+ years of experience in reproductive medicine

A team with decades of experience managing complex reproductive and pregnancy-related cases.

1,500+ couples helped with RPL

More than 1,500 couples have been helped through their recurrent pregnancy loss journey at EPIA.

99+ tests across six diagnostic axes

A comprehensive diagnostic approach designed to look beyond the most obvious causes of pregnancy loss.

A comprehensive solution panel

Treatment options are planned according to the underlying findings rather than following a single RPL protocol.

Global specialist expertise

EPIA works with experts from across the world to support complex RPL cases where specialised expertise is required.

Two or more miscarriages deserve more than another pregnancy followed by another "let's see what happens."

Recurrent pregnancy loss can have different causes, and sometimes more than one factor may be involved.

The first step is to understand what may be happening in your case.

At EPIA, we bring together detailed testing, specialist expertise and individualised treatment to help couples move from repeated pregnancy loss to a clearer understanding of why it may be happening.