Losing a pregnancy once is painful. Losing two or three, or more, is an experience that can erode hope in ways that are difficult to describe. If you have been through recurrent pregnancy loss, you may have been told that the losses were "just bad luck," or that you should "keep trying." You deserve more than that. You deserve answers, or at least a real attempt to find them.
Recurrent pregnancy loss (RPL) is defined as two or more pregnancy losses and affects a meaningful subset of people trying to conceive. It is not simply a series of random misfortunes. In many cases, an identifiable cause or a combination of contributing factors can be found through thorough evaluation. And when a cause is found, there are often effective treatment strategies that can meaningfully improve outcomes.
At Hanabusa IVF, patients who come in after recurrent losses receive a comprehensive workup, not a reassurance that things will probably work out. The "One Size Doesn't Fit All" philosophy means that each patient's history is examined on its own terms, and the care plan reflects what is actually going on in that individual case.
What Is Recurrent Pregnancy Loss?
Recurrent pregnancy loss is traditionally defined as two or more clinical pregnancy losses, losses confirmed by ultrasound or pathology, not just a failed test. Some organizations define it as three or more losses, but the clinical community has increasingly recognized that two losses warrant thorough evaluation, especially in patients over 35 or those with a history of difficulty conceiving.
RPL is distinct from infertility, though the two can coexist. Some patients with RPL have no difficulty getting pregnant; they simply cannot sustain a pregnancy. Others have both difficulty conceiving and difficulty maintaining pregnancies once achieved. The evaluation and treatment approach differs somewhat depending on which situation applies.
Common Causes of Recurrent Pregnancy Loss
Chromosomal Abnormalities in the Embryo
The most common cause of individual pregnancy losses, and a significant factor in RPL, is chromosomal abnormality in the embryo. Embryos with the wrong number of chromosomes typically cannot develop to term. As discussed in detail in Hanabusa IVF's recurrent pregnancy loss care overview, chromosomal errors become more common with advancing maternal age, which is why RPL rates increase for patients in their late thirties and forties.
In IVF cycles, preimplantation genetic testing for aneuploidy (PGT-A) can identify chromosomally normal embryos before transfer, significantly reducing the risk of chromosomally driven pregnancy loss.
Uterine Structural Abnormalities
The shape and structure of the uterus affect implantation and the ability to sustain a pregnancy. Uterine septums (a wall of tissue dividing the uterine cavity), submucosal fibroids, polyps, and intrauterine adhesions (Asherman's syndrome) can all interfere with implantation or early pregnancy development. These can often be identified on imaging, transvaginal ultrasound, saline infusion sonography (SIS), or hysteroscopy, and in many cases, surgically corrected.
Thrombophilias and Clotting Disorders
Certain inherited or acquired clotting disorders can affect placental blood flow and contribute to pregnancy loss, particularly in the second trimester. Antiphospholipid syndrome (APS), an autoimmune condition that increases the risk of clotting, is among the most well-established thrombophilic causes of RPL. Testing for APS and inherited thrombophilias is a standard part of the RPL workup at Hanabusa IVF.
Hormonal and Endocrine Factors
Thyroid dysfunction, poorly controlled blood sugar, elevated prolactin, and luteal phase insufficiency (inadequate progesterone support after ovulation) have all been associated with pregnancy loss. Endocrine evaluation is an important component of the RPL workup and can identify correctable contributors.
Immunological and Inflammatory Factors
The relationship between the immune system and early pregnancy is complex. An overactive or dysregulated immune response to the implanting embryo may contribute to losses in some patients. This is an area of active research, and while some treatments (such as low-dose aspirin or progesterone supplementation) have established evidence, others remain investigational. At Hanabusa IVF, the immunological evaluation is calibrated to what the evidence supports, not to an approach that over-promises.
Parental Chromosomal Abnormalities
In approximately 2–5% of couples with RPL, one partner carries a chromosomal structural rearrangement (such as a balanced translocation) that does not affect them personally but leads to chromosomally unbalanced embryos. A blood karyotype of both partners is a standard part of the RPL evaluation and can identify this cause. When found, PGT-SR testing of embryos can help identify balanced or normal embryos for transfer.
"When a patient comes to me after two or three losses, the first thing I want to do is look carefully at their history and their testing. In many cases, there are identifiable factors that have been overlooked or incompletely evaluated. Finding those factors does not always lead to an easy fix, but it usually leads to a better plan."
— Dr. Diana LeBlanc, a Fertility Specialist at Hanabusa IVF
The RPL Evaluation at Hanabusa IVF
A thorough RPL workup typically includes:
- Uterine evaluation: Transvaginal ultrasound, SIS, or hysteroscopy to assess uterine anatomy
- Genetic evaluation: Karyotype of both partners; if products of conception are available from prior losses, chromosomal analysis of the pregnancy tissue
- Hormonal panel: Thyroid function, prolactin, fasting blood sugar, progesterone
- Thrombophilia panel: Antiphospholipid antibodies (including lupus anticoagulant and anticardiolipin), inherited clotting factor evaluations
- Ovarian reserve testing: AMH and antral follicle count, particularly relevant when IVF with PGT-A is being considered
Not every patient requires every test, and the evaluation is designed around the individual's specific history, age, and prior testing.
Treatment Strategies for Recurrent Pregnancy Loss
Treatment follows the cause, which is precisely why the evaluation matters. For patients with no identified cause after a thorough workup (a scenario called unexplained RPL), empiric strategies, such as progesterone supplementation, low-dose aspirin, or folic acid, may be used, though with honest acknowledgment of what the evidence supports.
For patients where IVF with PGT-A is appropriate, particularly those with age-related aneuploidy risk, parental chromosomal rearrangements, or prior losses where chromosomal testing pointed to embryo abnormality, the ability to select chromosomally normal embryos for transfer represents one of the most meaningful advances in RPL management.
"Recurrent pregnancy loss is one of the areas where the difference between a thorough evaluation and a cursory one really matters. A patient who has been told 'try again' without evaluation may have a treatable cause that keeps being missed. I want every RPL patient at Hanabusa to feel that we have genuinely looked."
— Dr. Lyndon Chang, Medical Director at Hanabusa IVF
Frequently Asked Questions
How many miscarriages define recurrent pregnancy loss?
Most definitions use two or more clinical pregnancy losses. Some guidelines still require three, but the clinical community increasingly recommends evaluation after two losses, particularly for patients over 35. If you have had two pregnancy losses, you do not need to wait for a third before seeking a thorough workup.
What causes recurrent miscarriage?
The most common cause of recurrent miscarriage is chromosomal abnormality in the embryo, which becomes more frequent with age. Other causes include uterine structural problems, thrombophilias like antiphospholipid syndrome, hormonal imbalances, parental chromosomal rearrangements, and immunological factors. In some cases, no single cause is identified, which is called unexplained RPL.
Can IVF help with recurrent pregnancy loss?
For patients whose losses are driven by chromosomal abnormalities in embryos, IVF with PGT-A allows selection of chromosomally normal embryos before transfer, which significantly reduces the rate of chromosomally driven pregnancy loss. IVF is not the answer for every patient with RPL, but for the right candidates, it can meaningfully change the outcome trajectory.
Is recurrent pregnancy loss my fault?
In the overwhelming majority of cases, recurrent pregnancy loss is not caused by anything you did or did not do. Most early pregnancy losses result from chromosomal abnormalities in the embryo, a biological occurrence outside anyone's control. Blaming yourself is a natural response to grief, but it is not supported by the medicine.
What should I do after a recurrent pregnancy loss diagnosis?
Seek an evaluation from a fertility specialist who will take a thorough, individualized approach, not a reassurance that it will probably work out next time. A proper workup identifies potential causes and informs a real plan. Hanabusa IVF provides this kind of evaluation and individualized care.
A Thorough Approach to a Devastating Experience
Recurrent pregnancy loss deserves a serious, systematic, and compassionate response. At Hanabusa IVF, patients navigating RPL receive a complete evaluation, an honest conversation about what is known and unknown, and a care plan built around their specific history, not a generic reassurance.
If you have experienced two or more pregnancy losses and want answers, a consultation at Hanabusa IVF is where that conversation begins.
