What are the common causes of recurrent pregnancy loss?

What are the common causes of recurrent pregnancy loss?  

Experiencing more than one miscarriage is a heartbreaking experience. Recurrent pregnancy loss (RPL) is typically defined as two or more consecutive miscarriages and it is something we evaluate and treat regularly. 

The most important message we share with our patients is that recurrent pregnancy loss is not your fault and, in many cases, there are answers and options. 

It has long been recognized that genetic abnormalities in the embryo are one of the primary causes of early pregnancy loss — a fact that still remains true today. However, advances in reproductive medicine and technology have enabled us to better investigate and understand additional contributing factors. 

1. Chromosomal Abnormalities  

One of the most common causes of repeated miscarriage is chromosomal abnormalities in the embryo. As eggs and sperm combine, errors can occur that prevent normal development of the embryo. In some cases, one partner may carry a chromosomal rearrangement that increases the risk of miscarriage. 

How we evaluate: 

• Genetic testing 
• Parental karyotype testing 
• IVF with preimplantation genetic testing (PGT-A) when appropriate 

2. Uterine Abnormalities  

Structural differences in the uterus can interfere with implantation or early pregnancy development. These  differences may include abnormalities regarding the uterine septum, fibroids or polyps, scar tissue, and endometrium anatomy and function. 

Many of these conditions are treatable with minimally invasive procedures. 

3. Immunological Issues  

Immunological conditions are increasingly recognized as an important cause of recurrent pregnancy loss, as immune system issues can interfere with implantation and early fetal development. At the CHR, we often conduct comprehensive testing to identify underlying immunological issues before initiating fertility treatment.  

Some strategies may include the use of certain steroids to modulate immune responses, low-dose (“baby”) aspirin to help address inflammatory processes, and endometrial biopsies to evaluate the uterine lining for signs of inflammation. Optimizing and treating these conditions prior to pregnancy can help improve the chances of a successful outcome. 

4. Egg Quality  

As maternal age increases, especially after 35 and more so after 40, a woman’s egg quality declines. This can lead to a higher rate of chromosomal abnormalities in embryos and therefore, miscarriage.  

In these cases, the issue at hand is usually a genetic one rather than a structural one. 

Moving Forward  

If you’ve experienced two or more miscarriages, we encourage scheduling a fertility assessment. Our goal is to help you by identifying the causes, optimizing your reproductive health, and creating an individualized plan to help you move forward with confidence and support. 

To schedule a consult with one of our doctors at the CHR, call 845-444-3650.