RPL refers to two or more consecutive miscarriages (pregnancy losses), typically in the first trimester.
It affects a small but significant portion of couples (~1–2 %) trying to conceive.
Multiple pregnancy losses can be deeply distressing. Emotional support is a key part of care.
Genetic causes: Chromosomal abnormalities in either parent (balanced translocations, etc.)
Uterine structural issues: Such as a septate uterus, fibroids, polyps, or adhesions.
Hormonal imbalances: Thyroid disorders, luteal phase defects, PCOS, etc.
Blood clotting / Thrombophilia: Inherited clotting disorders can lead to placental problems.
Immune / Autoimmune factors: Like antiphospholipid syndrome (APS) → antibodies that affect pregnancy.
Sperm / Male factor: Poor sperm quality or DNA fragmentation can contribute.
Lifestyle & other factors: Obesity, stress, infections, environmental factors.
Unexplained RPL: In many couples, no definite cause is found even after detailed evaluation.
A thorough and structured evaluation is key. Typical work-up includes:
Detailed medical history, previous pregnancy losses, family history.
Genetic testing / karyotyping for both partners.
Imaging: Ultrasound, 3D ultrasound or hysteroscopy to assess uterine anatomy.
Hormonal testing: Thyroid, progesterone, other relevant reproductive hormones.
Blood-clotting / thrombophilia panel: To detect inherited clotting disorders.
Immune testing: Antiphospholipid antibodies (APL) or other immune markers.
(In assisted reproduction): Pre-implantation Genetic Testing (PGT) may be done in IVF to select embryos with normal chromosomes.
Depending on the identified cause(s), management is personalized. Some common interventions include:
Hormonal support: Progesterone supplementation, thyroid treatment.
Anticoagulation therapy: Low-dose aspirin, heparin if clotting disorder or APS is detected.
Surgical correction: For uterine abnormalities — resection of septum, fibroids, etc., using hysteroscopy.
Immunotherapy: In specific immune-mediated cases. (Some clinics may offer therapies like LIT — lymphocyte immunization therapy — though its use varies.)
Assisted Reproduction: IVF with PGT (to minimize genetic causes) in recurrent loss cases.
Lifestyle and supportive care: Weight management, stress reduction, nutrition, counseling.
