Recurrent pregnancy loss
Recurrent pregnancy loss (RPL) describes repeated pregnancy losses and warrants a structured evaluation that looks for clinically useful causes while avoiding tests and treatments that have not been shown to improve outcomes.
At a glance
Quick facts
- ESHRE definition
- Loss of 2 or more pregnancies
- Possible factors
- Age, uterine, genetic, endocrine and antiphospholipid factors
- Often true
- No single cause is found
- Evaluation
- Targeted, not unlimited testing
- Treatment
- Cause-specific when evidence supports it
- Support
- Psychological and early-pregnancy support matter
Dr. Farida Sani
Fertility Physician · Clearview Hospital and Fertility
Reviewed for clinical accuracy, fertility context and patient-facing clarity.
Names & terminology
How this entity may be named or searched
- Recurrent pregnancy loss
- ESHRE considers RPL to be the loss of two or more pregnancies.
- Recurrent miscarriage
- A commonly used term; definitions can vary across organizations and health systems.
- Pregnancy loss
- Loss of a recognized pregnancy; terminology may differ by gestational age and jurisdiction.
- Antiphospholipid syndrome
- An autoimmune thrombotic condition that can be associated with recurrent pregnancy loss and has specific diagnostic criteria.
Structured entity profile
Clinical profile
Overview
ESHRE defines recurrent pregnancy loss as the loss of two or more pregnancies. Repeated losses can occur for several reasons, and in many patients no single explanation is found even after appropriate evaluation. The probability of another pregnancy outcome is influenced strongly by age and the individual reproductive history. [1]
RPL is not simply “infertility after miscarriage”. Many people with RPL conceive without difficulty but have trouble maintaining pregnancy. Evaluation therefore focuses on factors associated with pregnancy loss rather than repeating a generic infertility work-up without indication. [1]
Symptoms and warning signs
There is no symptom pattern between pregnancies that reliably identifies the cause of RPL. The key clinical information comes from the number and timing of losses, ultrasound or pathology findings when available, prior live births, menstrual and medical history, family history and features suggesting endocrine, uterine, genetic or thrombotic disease. [1]
SYMPTOM MATRIX
The pattern of losses matters more than a single symptom
History can determine which investigations are likely to be useful.
- Number of previous pregnancy losses
- Gestational age at each loss
- Prior live births
- Ultrasound findings from prior pregnancies
- Maternal age
- Known uterine anomaly
- Personal or family thrombotic history
- Thyroid or endocrine disease
- Chromosomal finding in a prior pregnancy
- Relevant family genetic history
- Heavy bleeding with dizziness or fainting
- Severe abdominal or shoulder pain
- Fever or signs of infection
- Concern for ectopic pregnancy in a new pregnancy
Acute symptoms during a pregnancy require assessment of the current pregnancy and are separate from the longer-term RPL evaluation.
Diagnosis
Evaluation should be evidence-led. Depending on the history, this can include assessment of uterine anatomy, antiphospholipid antibodies, thyroid function and selected genetic evaluation. Not every available blood test, immune panel or thrombophilia test is useful routinely, and testing should be linked to a result that could change management. [1]
Information from previous pregnancies can be important. Ultrasound reports, gestational age at loss and results of pregnancy-tissue genetic testing, when available, may help distinguish sporadic chromosomal loss from a recurring maternal, paternal or structural factor. The couple’s age and number of losses are also central to counselling about prognosis. [1]
Diagnostic pathway
Look for causes that change management
A focused RPL work-up uses the history of each loss to decide which investigations are justified.
Fertility assessment is usually most useful when relevant male and female factors are evaluated in parallel.
Why recurrent pregnancy loss can remain unexplained
Many early losses are related to chromosomal abnormalities that arise sporadically, while other patients have a persistent uterine, endocrine, genetic or antiphospholipid factor. Current tests cannot identify every mechanism of implantation and early placental development, so a thorough evaluation can still end without a single diagnosis. [1]
Treatment and management
Treatment depends on the finding. Antiphospholipid syndrome has a specific evidence-based treatment pathway; selected uterine abnormalities may require specialist discussion; thyroid or other endocrine disease should be managed appropriately; and genetic findings may lead to counselling about reproductive options. Empiric treatments without a supported indication should not be presented as proven therapy. [1]
When no cause is found, counselling should include the person’s age, pregnancy history and the fact that a future successful pregnancy may still be possible. Psychological support and access to early-pregnancy care can be important even when there is no medicine that specifically “treats” unexplained RPL. [1]
Treatment & care hub
Treat a demonstrated cause and support the next pregnancy
RPL care combines evidence-based investigation, targeted treatment and realistic prognosis.
Use diagnosis-specific treatment
Antiphospholipid syndrome is one of the recurrent-loss conditions with a defined evidence-based management pathway.
Refer findings that change reproductive planning
Structural or genetic findings can alter counselling and sometimes treatment.
Avoid unsupported treatment promises
When no cause is found, prognosis and supportive care are often more useful than unproven add-ons.
Plan early follow-up
Early access to assessment and continuity can reduce uncertainty and identify complications promptly.
Treatment is individualized according to diagnosis, age, reproductive goals and clinical context.
The psychological impact is part of the condition
Repeated pregnancy loss can produce grief, anxiety, fear in subsequent pregnancy and strain on relationships. ESHRE includes psychosocial care within RPL management. Support should not be framed as a substitute for medical evaluation, but as a parallel part of care. [1]
Evidence snapshot
Recurrent pregnancy loss affects a minority of couples but carries high personal impact
Definitions influence prevalence estimates, which is why the diagnostic threshold should always be stated.
Common questions
Frequently asked questions
ESHRE defines RPL as two or more pregnancy losses, although referral and testing thresholds can vary between health systems.
Not necessarily. Many people with RPL conceive readily but experience repeated loss after conception.
No. A substantial proportion of RPL remains unexplained even after evidence-based evaluation.
Depending on history, evaluation may include uterine anatomy, antiphospholipid syndrome, thyroid or other endocrine issues and selected genetic factors.
Yes. Prognosis depends on age and individual pregnancy history, and successful future pregnancy can occur even when the evaluation is unexplained.
Sources
This article is based on trusted medical sources and has undergone clinician review. It is not a substitute for personalized medical advice.
When documenting recurrent pregnancy loss, I distinguish intrauterine pregnancy losses from ectopic and molar pregnancies because those conditions follow different diagnostic and management pathways.