Dealing with recurrent pregnancy loss

Two or more consecutive pregnancy losses qualifies for the diagnosis of recurrent pregnancy loss. The medical workup looks for what may be treatable – and finds something in roughly half of cases. The other half remain unexplained. The emotional work is parallel and important. Both deserve attention.

The medical workup

A complete recurrent-loss evaluation typically includes: parental karyotyping (looking for chromosomal rearrangements), thyroid function, antiphospholipid antibody screen, factor V Leiden and other thrombophilia tests, hysteroscopy or saline-infusion sonography for cavity assessment, glucose tolerance, and chronic endometritis screen. Each is targeted; not every test is necessary for every patient.

What gets found, and what changes

The most common findings: antiphospholipid syndrome (treated with heparin and aspirin in subsequent pregnancies), thyroid dysfunction (treated with thyroid hormone), and uterine factors (treated surgically if appropriate). Where one of these is found, treatment substantially improves the next pregnancy outcome. Where the workup is negative – in roughly half of cases – the diagnosis is “unexplained recurrent loss,” which still has a roughly 60 to 70 percent next-pregnancy success rate with supportive care alone.

The emotional weight

Recurrent loss is one of the most isolating experiences in fertility care. People around you may not know what to say. You may grieve differently from your partner. The cumulative weight builds across losses in a way single losses do not. Most reproductive medicine centres now have counselling resources or referral relationships; using them is reasonable, not weak.

Where IVF with PGT-A becomes part of the conversation

Where losses are documented chromosomally abnormal, PGT-A (testing embryos for chromosomal number) can reduce the likelihood of another aneuploid pregnancy. It is not a guaranteed solution, but in repeated chromosomally-abnormal losses, it changes probabilities meaningfully.

Questions worth asking your doctor

• Have we completed a full recurrent-loss workup, or are there second-tier tests we have not yet done?
• If our workup is unexplained, what is our realistic next-pregnancy success rate?
• Would IVF with PGT-A change our outcomes, given what we know?
• What additional support is available – counselling, follow-up, monitoring in the next pregnancy?

This essay is educational. Every patient’s situation is different – the right plan is shaped in conversation with a fertility specialist who knows the full picture.