What is recurrent pregnancy loss (RPL)? Diagnosis, risks and causes

By Marta Wais MD | August 22, 2026

On EP51 of My Fertility Podcast, we speak about pregnancy loss and recognize that it is an incredibly difficult and deeply personal experience, and when it happens repeatedly, the emotional toll can be overwhelming. Recurrent Pregnancy Loss (RPL) is a condition that affects many people, yet it is often misunderstood. This guide aims to provide a detailed, factual, and empathetic exploration of RPL, drawing upon the information provided by expert sources to help those affected navigate their journey with knowledge and support. We will cover:

  1. What is recurrent pregnancy loss?
  2. RPL statistics
  3. What causes recurrent pregnancy loss?
  4. How is recurrent pregnancy loss diagnosed?
  5. How can recurrent pregnancy loss be treated?
  6. The emotional impact of RPL
  7. The importance of seeking support

What is Recurrent Pregnancy Loss?

Recurrent Pregnancy Loss (RPL) has no universally agreed upon definition but it is generally defined as the loss of two or more clinical pregnancies. A clinical pregnancy is one that has been confirmed by ultrasound. RPL is distinct from infertility, as those affected can conceive but struggle to carry a pregnancy to term.

Recurrent Pregnancy Loss Statistics

  • RPL affects approximately 1-2% of couples trying to conceive.
  • Around 15-25% of all clinically recognized pregnancies end in miscarriage. Learn more about the topic of miscarriage causes.
  • In nearly 50% of RPL cases, no clear cause is identified despite thorough testing. (Source: ASRM)

Causes of Recurrent Pregnancy Loss

There are multiple potential causes of RPL, and sometimes, no single factor can be identified. Some of the known causes include:

  • Genetic Factors: Structural chromosomal abnormalities in either parent can contribute to pregnancy loss. A common condition is a balanced translocation, where chromosome segments are rearranged without missing genetic material but can lead to miscarriage when passed to the embryo.
  • Anatomical Issues: Uterine abnormalities, such as a septate uterus or fibroids, can interfere with implantation and fetal development.
  • Endocrine Disorders: Hormonal imbalances, such as uncontrolled diabetes or thyroid dysfunction, can impact pregnancy outcomes.
  • Immune and Blood Clotting Disorders: Conditions like Antiphospholipid Syndrome (APS) can lead to clotting issues that disrupt pregnancy. Studies suggest APS is responsible for up to 5-20% of recurrent miscarriages (Source: ASRM).
  • Lifestyle and Environmental Factors: Smoking, excessive alcohol consumption, and high levels of stress have been linked to higher rates of pregnancy loss.
  • Unexplained RPL: In nearly 50% of cases, no clear cause is identified despite thorough testing.

Diagnosis and Testing

A comprehensive evaluation is often necessary to determine the underlying cause of RPL. Standard tests include:

  • Genetic testing: Karyotyping of both parents and, possibly, testing of fetal tissue from a miscarriage.
  • Imaging studies: Ultrasounds, sonohysterograms (SHG), and MRI scans to detect uterine abnormalities.
  • Blood tests: To check for clotting disorders, autoimmune conditions, and hormonal imbalances.

Treatment Options

The approach to managing RPL depends on the identified cause. Some common treatments include:

  • Genetic counselling: If chromosomal abnormalities are found, genetic counselling may help guide future reproductive choices. Learn more about Genetics.
  • Surgical intervention: Correcting uterine abnormalities through surgery can improve pregnancy outcomes.
  • Medications: Hormone therapy, anticoagulants, or immunosuppressive drugs may be recommended depending on the condition.
  • Lifestyle modifications: Reducing stress, maintaining a healthy diet, and avoiding smoking and alcohol can improve the chances of a successful pregnancy.

The Emotional Impact of RPL

Experiencing multiple pregnancy losses can be devastating. The grief, frustration, and uncertainty that accompany RPL can be difficult to bear, and seeking support is crucial. Some strategies that may help include:

  • Support groups: Connecting with others who have experienced RPL can provide comfort and shared understanding.
  • Therapy and counseling: Speaking with a mental health professional can help process grief and develop coping strategies.
  • Open communication with partners: Maintaining an honest and supportive dialogue can strengthen relationships during this challenging time.

Seeking Professional Support

Finding a healthcare provider who is experienced in RPL can make a significant difference. Specialists such as reproductive endocrinologists can offer guidance, conduct thorough evaluations, and recommend personalized treatment plans.

Hope for the Future

While RPL is a challenging condition, many people go on to have successful pregnancies with the right support and medical care. Advancements in reproductive medicine continue to improve outcomes, offering hope to those affected.

If you or someone you love is experiencing RPL, know that you are not alone. There is support, understanding, and help available to guide you through this journey.

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Posted in Pregnancy Loss