Recurrent Pregnancy Loss
Overview
Recurrent pregnancy loss, or RPL, is defined as three or more miscarriages before 20 weeks of pregnancy. The risk of a single miscarriage ranges from 15 percent to 50 percent or more per pregnancy, depending on the woman's age.
About 1 percent of couples experience RPL, which is an emotionally challenging experience.
Our approach to recurrent pregnancy loss
UCSF's reproductive endocrinologists specialize in helping women and couples with RPL. We provide thorough fertility evaluations to uncover the cause of RPL, when possible, as well as proven approaches to preventing future miscarriages.
We recognize the emotional toll that RPL can take on our patients. We closely monitor all subsequent pregnancies, providing care and support during what is often an anxiety-provoking time. Our team psychologist is available to provide additional support.
Awards & recognition
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Among the top hospitals in the nation
Causes
With a thorough fertility evaluation, we are able to identify the cause of recurrent pregnancy loss (RPL) in 50 percent of couples. Potential causes are described below.
Chromosomal cause
In approximately 4 percent of couples who experience RPL, one or both partners will have an abnormality of chromosome structure.
Anatomical abnormalities
Abnormalities of the uterine cavity account for about 15 percent of RPL cases. Abnormalities may include a uterine septum (an abnormally-shaped cavity), scar tissue within the uterus, polyps or fibroids.
Immunological causes
About 15 percent of couples with RPL have circulating antibodies that interfere with the proper function of the placenta, the tissue that supports the pregnancy. Blood tests can identify a set of these antibodies and, if found, the diagnosis of anti-phospholipid antibody syndrome (APS) can be made.
Blood clotting disorders (thrombophilias)
Some women with RPL have inherited disorders that make them more prone to clots in their blood vessels. The link between thrombophilas and miscarriage is strongest for women experiencing losses in the late first trimester or second trimester.
Hormonal abnormalities
Women with uncontrolled diabetes mellitus and uncorrected thyroid gland dysfunction have a greater risk of miscarriage.
Fetal chromosomal anomalies
As many as 70 percent of all miscarriages are due to abnormalities of the number of chromosomes in the fetus. Although this problem gets more common as women age, it occurs across all age groups. This type of miscarriage is often referred to as "random miscarriage."
Unexplained RPL
As many as 50 percent of RPL cases have no identified cause. Unexplained RPL can be very frustrating for couples. However, many studies have found that with continued attempts at conception and no additional interventions, the chances for a future live birth remain quite good for couples with unexplained recurrent pregnancy loss. Depending on age, these couples' chances for a live birth in future pregnancies range from 50 percent to 80 percent.
Treatments
The treatment for recurrent pregnancy loss (RPL) depends on what's causing the condition.
Chromosomal cause
In cases where an abnormality of chromosome structure is causing RPL, one possible therapy is in vitro fertilization (IVF), with biopsy and chromosomal evaluation of each embryo, called pre-implantation genetic diagnosis.
Anatomical abnormalities
Diagnostic tests such as hysterosalpingograms, saline sonohysterograms and hysteroscopy (an endoscopic inspection of the uterus) can be used to evaluate the uterine cavity. Many abnormalities within the uterine cavity can be corrected with minor surgery.
Immunological causes
Anti-phospholipid antibody syndrome (APS) has been shown to respond to treatment with blood thinning medications.
Blood clotting disorders (thrombophilias)
Currently, there is no evidence that blood thinning medications can prevent miscarriage, although studies are ongoing.
Hormonal abnormalities
In cases of uncontrolled diabetes or thyroid gland dysfunction, correcting the hormonal imbalances is recommended.
Unproven tests and treatments
In the search for a solution for RPL, several tests and therapies have been used that are not proven to be helpful. These include:
- Maternal antibodies directed against paternal cells
- Chemicals toxic to embryo development (embryotoxic factors)
- Intravenous immunoglobulin (IVIG)
- White blood cell (leukocyte) immunization
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
More treatment info
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In Vitro Fertilization (IVF)
Procedures to achieve IVF pregnancy have become increasingly simpler, safer and more successful than in the past.
Learn more -
Pre-Implantation Genetic Diagnosis
The laboratory procedure is combined with in vitro fertilization to reduce the risk of passing along inherited conditions.
Learn more
