Recurrent pregnancy loss (RPL), defined as 2 or more clinical losses, is one of the most challenging conditions we see as infertility specialists.
One of the first difficulties is when patients have already had many losses before having additional testing done.
While RPL was previously defined as 3 or more losses, it is now routine to pursue testing for 2 or more miscarriages.
The next challenge is how to define a pregnancy loss. A positive pregnancy test that quickly turns negative is classified as a biochemical pregnancy loss, as opposed to losses that happen when a patient is further along in the pregnancy.
There are various causes of RPL, including genetic, uterine/structural, hormonal, and due to underlying diagnoses, such as thyroid disease, diabetes, and autoimmune etiologies.
Ultimately the most common cause is “aneuploidy” which is defined as abnormal chromosome number in the fetus.
Aneuploidy typically increases with advanced maternal age but can happen to younger patients as well. The best way to diagnose this is via chromosomal testing of the pregnancy tissue, which often is not performed for a first (or even second) loss.
Over 50% of the time the cause of the miscarriages remains unknown.
We focus on testing so we can look for conditions where treatment has shown improved outcomes and higher chance of live birth.
Routine testing typically includes an evaluation of the uterus and blood tests for the patient (and partner if applicable).
A focused fertility workup can also be helpful to ensure there are no other underlying issues and to assess ovarian reserve, to give better context to timeline.
We strive to offer our patients the best possible support, especially to those who are experiencing pregnancy loss. Your provider and clinical team, as well as our fertility counselors, are here to support you throughout your experience here at SRM.
A consultation with a fertility specialist is the best first starting point to review history and determine what tests and treatments should be considered.