Recurrent Pregnancy Loss — Investigation and IVF Considerations

Recurrent pregnancy loss (RPL) — typically defined as 2 or more consecutive losses — requires systematic investigation. IVF with PGT may help in selected cases. This page covers the evaluation and management framework.

1. Defining RPL

ESHRE 2022: 2 or more pregnancy losses (clinical or non-visualised). Some definitions require 3 consecutive losses. Investigation indicated after 2 losses given emotional and time impact. Most pregnancies after RPL are successful — diagnosis triggers workup and reassurance.

2. Causes of RPL

Genetic — parental balanced translocations (3–5%), embryonic aneuploidy (most common single factor). Anatomic — uterine septum, submucous fibroids, adhesions. Endocrine — diabetes, thyroid disease, PCOS. Immune — antiphospholipid syndrome. Thrombotic — inherited thrombophilias. Infection rarely. Often unexplained even after thorough workup.

3. Standard RPL workup

Parental karyotype. Anatomic assessment (saline-infusion sonography, hysteroscopy). Antiphospholipid antibodies (anticardiolipin, anti-beta2-glycoprotein, lupus anticoagulant) — confirmed positive on two occasions. Thyroid function and antibodies. Diabetes screening. POSEIDON consensus criteria for further testing. Selected thrombophilia testing.

4. Genetic considerations

Parental karyotype abnormalities in 3–5 percent of RPL. Balanced translocations may produce unbalanced embryos. PGT-SR (structural rearrangement) possible. Sporadic embryonic aneuploidy increases with maternal age and accounts for most pregnancy losses overall.

5. PGT-A role in RPL

Reduces miscarriage rate per transfer in RPL patients by selecting euploid embryos. Particularly valuable in older patients (over 38) where aneuploidy rates are very high. Not proven to increase overall live birth rate. Selective use based on patient profile.

6. Treatment of identified factors

Antiphospholipid syndrome — aspirin + heparin in pregnancy substantially improves outcomes. Uterine septum — hysteroscopic resection. Submucous fibroids — hysteroscopic resection. Thyroid optimisation. Diabetes optimisation. Inherited thrombophilias — anticoagulation in selected cases. Smoking cessation. Weight optimisation.

7. Unexplained RPL

50 percent of RPL remains unexplained after thorough workup. Reassurance — most couples ultimately have successful pregnancies. Empirical interventions (progesterone supplementation, aspirin) — limited evidence in unexplained RPL. Supportive care during subsequent pregnancies. Mental health support during loss recovery.

8. IVF for RPL — when

Confirmed PGT indication (parental translocation, advanced age with multiple losses, multiple unexplained losses). Coexisting infertility. Failed natural conception attempts during workup. Most RPL couples conceive naturally with appropriate management — IVF not always required.

Frequently Asked Questions

Individualised IVF and fertility planning with honest, evidence-based counselling — and realistic expectations from the very first consultation.

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Dr. Priyadatt Patel

Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead

MS OBGyn · Pregnancy Care · Advanced Gynaecological Ultrasound · Fertility Preservation

ESHRE / ESGE / AAGL / ASRM guideline-aligned practice. 3D Karl Storz precision technique. Fertility-preservation-first philosophy. Evidence-based decisions, honest counselling, long-term outcomes orientation.