Introduction
Pregnancy brings anticipation, excitement and dreams of the future. But for some couples, the journey to parenthood is interrupted by repeated heartbreak.
Recurrent pregnancy loss (RPL) is when a woman has two or more miscarriages in a row. It affects about 1–2% of women. It is not only a medical challenge but also an emotional burden, often surrounded by confusion and unanswered questions.
While one miscarriage can occur without a clear explanation and is sadly common, repeated losses often indicate an underlying issue that can be addressed with the right medical guidance. This article aims to explore the key causes, diagnostic approaches and treatment strategies for recurrent miscarriages, helping couples better understand their options and hold on to hope.
What Is Recurrent Pregnancy Loss?
Recurrent pregnancy loss (RPL), also referred to as habitual abortion, is clinically defined as two or more consecutive pregnancy losses before 20 weeks of gestation. Miscarriage itself is common, with approximately 10–20% of pregnancies ending in early loss, but when it happens repeatedly, it’s time to look deeper.
Pregnancy loss may happen due to multiple reasons, some related to the fetus, others due to the mother’s health or environment. Importantly, each case of RPL is unique and a comprehensive evaluation is essential to determine the exact cause and recommend targeted treatment.
Main Causes of Recurrent Pregnancy Loss
1. Chromosomal Abnormalities
Genetic factors are a leading cause of early pregnancy loss. About 50–60% of miscarriages in the first trimester happen because of chromosomal problems in the embryo. These issues often arise from random mistakes during cell division.
In cases of RPL, one or both partners may be carriers of a balanced chromosomal translocation a condition where parts of chromosomes are rearranged, but all genetic material is present. While the parent is healthy, this can result in an embryo with missing or extra genetic material, leading to miscarriage.
Diagnostic Tool:
- Karyotyping (chromosome analysis) of both partners helps identify these abnormalities.
Treatment Options:
- Preimplantation Genetic Testing (PGT) during IVF can screen embryos to select genetically normal ones for transfer.
2. Uterine Abnormalities
A structurally abnormal uterus may prevent a fertilized embryo from implanting properly or growing to term. Common structural issues include:
- Septate uterus: A fibrous band dividing the uterus partially or fully.
- Bicornuate uterus: A heart-shaped uterus with two horns.
- Intrauterine adhesions (Asherman’s Syndrome): Scar tissue from previous surgeries or infections.
Diagnostic Tool:
- 3D ultrasound, hysteroscopy, or MRI for detailed visualization.
Treatment Options:
- Corrective surgery, like hysteroscopic metroplasty, can significantly improve chances of a successful pregnancy.
3. Antiphospholipid Antibody (APLA) Syndrome
APLA syndrome is an autoimmune condition where the body produces antibodies that increase the risk of blood clots. These clots can interfere with the placental blood flow, leading to miscarriage.
Diagnostic Tests:
- Lupus anticoagulant
- Anticardiolipin antibody
- Beta-2 glycoprotein I antibody
Treatment Options:
- Combination of low-dose aspirin and heparin throughout pregnancy has shown excellent outcomes for affected women.
4. Thrombophilia and Blood Clotting Disorders
Some women have inherited conditions that make their blood clot more easily. These disorders, known as thrombophilias, can also cause complications in pregnancy by disrupting blood flow to the placenta.
Common Tests:
- Protein C and Protein S levels
- Factor V Leiden mutation
- Prothrombin gene mutation
Treatment:
- Anticoagulation therapy under the supervision of a specialist.
5. Hormonal and Endocrine Disorders
Conditions like uncontrolled diabetes, thyroid dysfunction, or polycystic ovary syndrome (PCOS) can affect hormone balance, uterine lining and ovulation factors crucial for maintaining a healthy pregnancy.
Testing:
- Thyroid function tests, blood sugar levels, LH/FSH ratio and prolactin levels
Management:
- Strict control of blood sugar, correcting thyroid hormone levels and treating PCOS with lifestyle changes and medications.
6. Lifestyle and Environmental Factors
Certain lifestyle habits and environmental exposures can increase miscarriage risk:
- Smoking, excessive alcohol, or drug use
- High caffeine intake
- Obesity or being significantly underweight
- Exposure to environmental toxins or radiation
Recommendations:
- Adopt a healthy diet, regular exercise and eliminate harmful substances.
Diagnosis: What to Expect
When RPL is suspected, doctors will typically perform:
- Detailed medical and pregnancy history
- Blood tests for immune, genetic and hormonal evaluation
- Imaging tests like 3D ultrasound or hysteroscopy
- Genetic screening of products of conception, if available
This thorough approach helps identify the root cause and guides personalized treatment strategies.
Treatment and Management of Recurrent Pregnancy Loss
Treatment depends entirely on the identified cause. In many cases, even when no specific cause is found (idiopathic RPL), empirical treatments such as progesterone supplementation, lifestyle modification, or close monitoring in early pregnancy may still improve outcomes.
Examples of treatment approaches:
- Surgery for uterine abnormalities
- Blood thinners for APLA syndrome or thrombophilia
- IVF with genetic testing
- Hormonal regulation for endocrine disorders
- Supportive care and early monitoring
Importantly, psychological support and counseling are essential throughout the process to help couples cope with the emotional toll of repeated losses.
Conclusion:
Recurrent pregnancy loss is a complex but manageable condition. With today’s medical advancements, thorough evaluation and tailored treatment, many couples who experience repeated miscarriages can go on to have healthy pregnancies. If you’re navigating this journey, know that you’re not alone and that answers, support and hope are within reach.
At Supreme Hospital, we believe effective management grounded in compassion and integrity is key to delivering exceptional patient care. Our leadership approach combines clinical excellence with ethical values to ensure every decision supports healing and humanity.
Most experts define RPL as two or more consecutive miscarriages, though some use three as the threshold. Evaluation is often recommended after two.
Yes. Many causes of RPL are treatable or manageable. Once a diagnosis is made, appropriate interventions significantly improve the chance of a successful pregnancy.
In about 50% of cases, no clear cause is identified. However, even in unexplained RPL, many women go on to have healthy pregnancies with supportive care.
Yes. As maternal age increases, the risk of chromosomal abnormalities in eggs also rises, contributing to miscarriage risk. Women over 35 may require more specialized fertility evaluation.
