This page explains how Recurrent Pregnancy Loss (RPL) relates to IVF treatment. All information is educational. Talk to your reproductive endocrinologist about how this condition may affect your specific situation and treatment plan.
What is Recurrent Pregnancy Loss?
Recurrent pregnancy loss (RPL) is defined as two or more pregnancy losses before 20 weeks of gestation. It affects approximately 1 to 2 percent of couples trying to conceive. RPL is distinct from infertility, though it often intersects with fertility treatment. A thorough evaluation is recommended after two or more losses to look for treatable contributing factors.
How common is it?
RPL affects approximately 1 to 2 percent of couples trying to conceive. After three or more losses, the prevalence is around 0.5 to 1 percent. Many people with RPL are able to carry a pregnancy to term with appropriate evaluation, treatment, and support.
How RPL affects IVF
For people with RPL pursuing IVF, the goal shifts from achieving a positive pregnancy test to sustaining a healthy pregnancy. Preimplantation genetic testing (PGT-A) is often used to select chromosomally normal embryos for transfer, since chromosomal abnormalities account for a significant portion of early losses. Additional evaluation of the uterine cavity, clotting factors, and immunological markers may guide the protocol.
Typical IVF approach
IVF with PGT-A to screen embryos for chromosomal abnormalities before transfer. Uterine evaluation (hysteroscopy or saline infusion sonogram) to identify structural issues such as polyps, fibroids, or uterine anomalies. Thrombophilia panel and immunological testing in some cases. Luteal phase support with progesterone. Some clinics add low-dose aspirin or heparin for specific clotting conditions.
Factors that support success
- PGT-A testing significantly reduces the risk of transferring chromosomally abnormal embryos that may result in loss
- Identifying and treating uterine structural issues before transfer
- Addressing any thrombophilia or antiphospholipid syndrome if diagnosed
- Optimizing thyroid function, which is associated with pregnancy loss if undertreated
- Psychological support throughout treatment, given the compounding grief of prior losses
Your emotional experience matters
The medical side of infertility is only part of the story. Here is what many people in the IVF community want you to know about the emotional side of this diagnosis.
- Each loss carries its own grief, and that grief does not diminish with subsequent pregnancies. It often intensifies.
- The anxiety of a subsequent pregnancy after RPL can be profound. It is very common to find it difficult to feel hopeful or attached early in a new cycle.
- You may feel alone in this because pregnancy loss is still not spoken about openly enough. You are not alone. This grief is real and it is carried by far more people than you might imagine.
- It is okay to need more support than you think you should. RPL is a complex medical and emotional experience, and seeking help is not weakness.
- Survival strategies that worked for others may not work for you, and that is okay. Your path through this is yours.
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What causes recurrent pregnancy loss?
In approximately 50 to 60 percent of cases, recurrent pregnancy loss is caused by chromosomal abnormalities in the embryo. Other causes include uterine structural issues (fibroids, polyps, uterine septum), antiphospholipid syndrome (a clotting disorder), thyroid conditions, and in rare cases, chromosomal abnormalities in one or both parents. In a significant percentage of couples, no cause is identified even after a full evaluation.
Will PGT-A testing prevent future losses?
PGT-A (preimplantation genetic testing for aneuploidy) can identify embryos with chromosomal abnormalities before transfer, which reduces the risk of transferring an embryo likely to result in a loss. However, PGT-A does not eliminate all causes of pregnancy loss. It is most helpful when chromosomal abnormality is a contributing factor, which is the case in many RPL patients.
How many losses should happen before I seek evaluation?
ASRM guidelines recommend offering evaluation after two clinical pregnancy losses. You do not need to wait for three. If you have experienced two losses, it is reasonable to ask your doctor about an RPL workup, which includes uterine imaging, blood tests for clotting and immune factors, and in some cases genetic testing of both partners.
Is it normal to feel anxious during a pregnancy after RPL?
It is extremely common and entirely understandable to experience significant anxiety during a subsequent pregnancy after losses. The clinical term is "pregnancy after loss anxiety," and it is well documented. Many people find it helpful to work with a therapist during this time, and some clinics offer more frequent monitoring for patients with RPL to help reduce uncertainty where possible.
Medical disclaimer: This page provides general educational information only. It is not medical advice and should not replace guidance from your doctor, nurse, or reproductive endocrinologist. Every person's treatment is unique. Always consult your care team before making any decisions about your medications or treatment plan.
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About the author
Viv
BSc, Patient Advocate
Founder, TrackMyIVF
I built TrackMyIVF because I needed it during my own journey. Every feature comes from real experience.