October is Pregnancy and Infant Loss Awareness Month, a time to recognize pregnancies and babies lost too soon and the families whose lives have been changed by those experiences.
For someone who has experienced more than one miscarriage, grief can become intertwined with another difficult emotion: uncertainty. Why did this happen again? Is there an underlying cause? Should I be tested? And perhaps most importantly, when is it time to seek answers?
At the Fertility Institute of San Diego, recurrent pregnancy loss is approached through individualized evaluation rather than assumptions. Understanding what may be contributing to repeated losses can help patients make informed decisions about their next steps.
“After recurrent pregnancy loss, patients often come to us with two needs: they want to understand what may be happening, and they want to know what they can do next. Our role is to carefully evaluate their individual history and develop a plan based on what we find.”
Dr. Minoos Hosseinzadeh, Founder and Medical Director, Fertility Institute of San Diego
What Is Recurrent Pregnancy Loss?
Recurrent pregnancy loss, often abbreviated as RPL, generally refers to two or more pregnancy losses. Current reproductive medicine guidance recognizes that recurrent pregnancy loss can warrant evaluation after two losses rather than requiring patients to experience three miscarriages before seeking answers.
This is important because patients may encounter older information suggesting that recurrent miscarriage requires three consecutive losses before evaluation.
Pregnancy loss itself is relatively common. A single miscarriage does not necessarily indicate an underlying fertility problem. Repeated losses, however, may warrant a more comprehensive fertility evaluation.
One Loss vs. Recurrent Pregnancy Loss
One pregnancy loss
Often occurs sporadically and does not automatically indicate an underlying reproductive disorder.
Two or more pregnancy losses
May warrant evaluation for recognized factors associated with recurrent pregnancy loss.
Do You Have to Wait for Three Miscarriages Before Seeking Help?
No. Patients do not necessarily need to experience a third miscarriage before discussing recurrent pregnancy loss testing.
After two pregnancy losses, it may be appropriate to discuss a recurrent pregnancy loss evaluation with a reproductive endocrinologist. The appropriate timing can also depend on age, medical history, previous pregnancy history and other reproductive factors.
This distinction matters. Waiting for another loss simply because of an outdated numerical threshold may postpone a potentially useful evaluation.
“You do not have to assume that experiencing another miscarriage is the next step. After repeated pregnancy losses, we can review your history and discuss whether an evaluation is appropriate now.”
Dr. Minoos Hosseinzadeh
What Causes Recurrent Pregnancy Loss?
There is rarely one universal explanation for recurrent miscarriage. The reproductive process is biologically intricate, and several potential contributors may be considered.
Genetic and Chromosomal Factors
Chromosomal abnormalities within an embryo are a major cause of miscarriage. These abnormalities can occur sporadically during embryo development. In selected situations, genetic testing related to the pregnancy or parental chromosomes may provide useful information.
Uterine Factors
The anatomy of the uterus and uterine cavity may be evaluated for structural factors that could affect pregnancy. Depending on the patient’s history, a uterine cavity evaluation may investigate conditions such as congenital anomalies, polyps, fibroids or intrauterine adhesions.
Hormonal and Metabolic Factors
Certain endocrine conditions may be relevant to recurrent pregnancy loss. Evaluation can include clinically appropriate assessment of thyroid function and other hormonal or metabolic factors based on the patient’s individual circumstances.
Autoimmune and Clotting-Related Factors
Antiphospholipid syndrome is an acquired autoimmune condition with a recognized association with recurrent pregnancy loss. Testing should be clinically directed. Broad testing for inherited thrombophilias is not routinely recommended solely because someone has experienced recurrent pregnancy loss.
Maternal Age and Embryo Factors
Maternal age is an important consideration because embryo aneuploidy, an abnormal number of chromosomes, becomes more prevalent with increasing reproductive age. This can contribute to a higher risk of miscarriage.
Male Factors
Recurrent pregnancy loss evaluation should not automatically focus exclusively on the female partner. A reproductive specialist may review male medical and reproductive history as part of the couple’s broader assessment, while avoiding tests that are not supported for routine use.
What Can Be Investigated After Recurrent Pregnancy Loss?
A comprehensive fertility evaluation may examine several areas depending on the patient’s individual history:
- Genetic and chromosomal factors
- Uterine anatomy and the uterine cavity
- Hormonal and metabolic factors
- Antiphospholipid syndrome when clinically indicated
- Maternal age and embryo-related factors
- Relevant male reproductive factors
The objective is not to perform every available test. It is to determine which investigations are clinically meaningful for the individual patient.
What Does Recurrent Pregnancy Loss Testing Involve?
There is no single universal recurrent miscarriage testing panel appropriate for everyone.
A fertility evaluation typically begins with a detailed review of previous pregnancies, timing of losses, medical history, family history, age and prior fertility treatment. Based on those findings, additional evaluation may include uterine imaging, selected blood testing and genetic assessment when clinically appropriate.
Equally important is recognizing what not to test routinely. An evidence-based evaluation avoids indiscriminate testing when a test has not been demonstrated to improve clinical decision-making.
Can Recurrent Pregnancy Loss Be Treated?
Treatment depends on what the evaluation identifies.
For some patients, an anatomical, endocrine, genetic or autoimmune factor may influence the treatment plan. For others, no definitive cause is identified despite appropriate investigation.
An unexplained result does not mean that nothing can be done or that another pregnancy cannot succeed. Treatment may range from addressing an identified medical condition to monitored attempts at conception or assisted reproductive treatment.
When Are IVF and PGT-A Considered?
IVF may enter the discussion after recurrent miscarriage depending on age, reproductive history, fertility factors and the suspected cause of pregnancy loss.
Preimplantation genetic testing for aneuploidy, or PGT-A, evaluates embryos created through IVF for chromosomal copy-number abnormalities before embryo transfer.
However, PGT-A should not be presented as a guaranteed way to prevent miscarriage. Current evidence has not established that PGT-A universally reduces miscarriage or improves live birth rates for patients with recurrent pregnancy loss.
Instead, IVF and PGT-A should be discussed in the context of the individual patient’s circumstances, potential benefits, limitations and reproductive goals.
When IVF is clinically appropriate, Dr. Hosseinzadeh can also discuss how the Fertility Institute of San Diego’s Precision IVF approach may fit into an individualized treatment strategy.
Finding Answers With One-on-One Fertility Care in San Diego
Recurrent pregnancy loss can involve multiple overlapping factors. Continuity of care can therefore be particularly valuable.
At the Fertility Institute of San Diego in La Jolla, patients work directly with Dr. Minoos Hosseinzadeh, a double board-certified reproductive endocrinologist and Founder and Medical Director of the practice. From the initial fertility evaluation through treatment, the focus remains on one-on-one physician-led reproductive care.
For patients seeking recurrent pregnancy loss testing in San Diego, the objective is not simply to order more tests. It is to determine which questions are medically relevant and build a personalized fertility treatment strategy around the findings.
Frequently Asked Questions
How many miscarriages are considered recurrent pregnancy loss?
Recurrent pregnancy loss generally refers to two or more pregnancy losses. After repeated losses, it may be appropriate to discuss further evaluation with a reproductive endocrinologist.
Why do I keep having miscarriages?
Possible contributors include embryo chromosomal abnormalities, uterine factors, certain endocrine conditions, antiphospholipid syndrome and age-related factors. Sometimes, no definitive explanation is identified.
Is recurrent pregnancy loss the same as infertility?
Not necessarily. A person may be able to become pregnant but experience repeated pregnancy losses. However, recurrent pregnancy loss and infertility can coexist.
When should I see a fertility specialist after miscarriage?
One miscarriage does not generally require an extensive fertility workup. After two pregnancy losses, however, evaluation for recurrent pregnancy loss may be appropriate depending on your individual circumstances.
Can chromosome problems cause recurrent miscarriage?
Chromosomal abnormalities in an embryo can contribute to pregnancy loss. In selected cases, genetic evaluation may be considered as part of recurrent pregnancy loss testing.
Does age increase the risk of miscarriage?
Age can be an important factor because the prevalence of embryo chromosomal abnormalities increases with maternal age, which can contribute to miscarriage risk.
Can I have a successful pregnancy after recurrent miscarriages?
Yes. Experiencing recurrent pregnancy loss does not mean that a future successful pregnancy is impossible. Individual prognosis depends on factors including age, reproductive history and whether an underlying contributor is identified.
Can PGT-A prevent miscarriage?
PGT-A screens IVF embryos for chromosomal copy-number abnormalities, but it cannot prevent every miscarriage or address every potential cause of pregnancy loss. Whether PGT-A is appropriate should be determined individually.
When You Are Ready to Seek Answers
Pregnancy and Infant Loss Awareness Month gives us an opportunity to acknowledge loss, but patients experiencing recurrent pregnancy loss deserve more than awareness alone. They deserve thoughtful questions, evidence-based investigation and compassionate care.
Not every miscarriage can be explained. Not every patient requires the same testing. And not every path forward involves IVF. The appropriate next step begins with understanding your individual reproductive history.
If you’re ready to start your fertility journey, please book a complimentary virtual consultation with Dr. Hosseinzadeh to go over fertility options or any other reproductive healthcare questions,
