Recurrent pregnancy loss (RPL) management at Femcare Fertility, Kalyani Nagar, Pune involves systematic investigation of genetic, anatomical, immunological, hormonal and thrombophilic causes of repeated miscarriage, followed by a targeted treatment plan by Dr. Sayali Chavan Shitole. Consultation: ₹500.
Losing a pregnancy once is heartbreaking. Losing two, three, or more pregnancies in succession is a grief that cannot be adequately described to anyone who has not lived through it. The uncertainty is often worse than the loss itself - the question of why this keeps happening and whether it will ever change.
Recurrent pregnancy loss (RPL) is defined as two or more clinical pregnancy losses. At Femcare Fertility in Kalyani Nagar, Pune, Dr. Sayali Chavan Shitole takes a systematic, evidence-based approach to investigating RPL - running a thorough panel of tests to identify treatable causes and designing a management plan that addresses what is actually found.
Approximately 50-60% of all miscarriages are caused by chromosomal errors in the embryo, most of which occur by chance and are not inherited. However, in a small proportion of couples with RPL, one partner carries a chromosomal rearrangement (translocation) that increases the frequency of abnormal embryos. A karyotype test of both partners identifies this.
For couples with recurrent losses due to chromosomal factors, Preimplantation Genetic Testing for Aneuploidies (PGT-A) during an IVF cycle can screen embryos before transfer, significantly reducing the miscarriage rate.
Uterine septum - a fibrous wall dividing the cavity, the most correctable anatomical cause of RPL
Intrauterine adhesions (Asherman's syndrome) - scarring from previous uterine procedures
Submucosal fibroids or polyps - growths protruding into the cavity that disrupt implantation
Congenital uterine anomalies - bicornuate or unicornuate uterus
Antiphospholipid Syndrome (APS) is the most important treatable immunological cause of RPL. Women with APS have antibodies that cause abnormal clotting, affecting blood flow through the placenta. The treatment - low-dose aspirin and heparin throughout pregnancy - reduces miscarriage risk substantially.
Inherited thrombophilias (Factor V Leiden, Prothrombin gene mutation, MTHFR variants) are also investigated, though their role in RPL is more debated. Dr. Sayali discusses the evidence honestly before recommending treatment.
Uncontrolled thyroid disease, uncontrolled diabetes and poorly managed PCOS (particularly elevated LH and insulin resistance) are associated with increased miscarriage rates. Optimising these conditions before and during early pregnancy reduces risk.
Even after a thorough evaluation, approximately 50% of RPL cases remain unexplained. This is frustrating, but not hopeless - many couples with unexplained RPL do eventually carry a successful pregnancy and supportive care (close monitoring, early progesterone supplementation and frequent reassurance scans) has been shown to improve outcomes.
Karyotype of both partners
Antiphospholipid antibodies: anticardiolipin and anti-beta-2-glycoprotein-1 antibodies, lupus anticoagulant
Inherited thrombophilia screen
Thyroid function (TSH, Free T4, anti-TPO antibodies)
Blood glucose and insulin resistance markers
Hysteroscopy to assess uterine cavity
Sperm DNA fragmentation (when embryo chromosomal abnormality is a concern)
For women with no identified cause of RPL, early progesterone support (vaginal or oral) from the confirmed positive pregnancy test through the first trimester has been shown to reduce miscarriage rates in some subgroups, particularly those with a history of early losses. Dr. Sayali discusses this option at the pre-conception consultation.
