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Recurrent Pregnancy Loss

Overview

Women are often reluctant to talk about miscarriages, or spontaneous pregnancy losses. While one pregnancy loss can merit a visit to the doctor, two or more pregnancy losses should prompt a thorough examination for reproductive issues.

Major advancements in reproductive medicine have helped identify the causes of recurrent pregnancy loss. In the past, a woman might never know why she lost two or more pregnancies in a row. But today, an accurate diagnosis is possible in about 60% of cases. The most commonly identified causes include uterine problems, hormonal disorders, and genetic abnormalities.

Yale Medicine’s Recurrent Pregnancy Loss Program is the only such dedicated program in the state. It brings together experts from an array of fields to evaluate and treat women in a comprehensive, compassionate manner.

What is recurrent pregnancy loss?

Recurrent pregnancy loss is two or more failed pregnancies. The definition of “loss” can include pregnancies that were confirmed via pregnancy test or confirmed in the clinic via ultrasound. 

How common is recurrent pregnancy loss?

About 15% to 20% of pregnancies end in miscarriage. Often, pregnancy loss is random, and does not mean there is any underlying genetic or reproductive issue.

Recurrent pregnancy loss occurs in approximately 1% of reproductive-aged women, according to the American College of Obstetricians and Gynecologists (ACOG). A full medical examination is recommended after two or more losses.

What are common causes for recurrent pregnancy loss?

Issues in a woman’s uterus can cause problems during pregnancy. Uterine abnormalities could include fibroids, polyps, or adhesions. The most common uterine abnormality leading to pregnancy loss can be attributed to a septate uterus, in which there is a wall of tissue dividing the uterine cavity.

Hormonal disorders, including uncontrolled diabetes and thyroid disease, could contribute to recurrent pregnancy loss. Because proper hormone levels are needed for successful pregnancy, elevated prolactin levels can also contribute.

bIn about 50 percent of cases, pregnancy loss can be attributed to an abnormal number of chromosomes in the embryo. These issues usually occur at the time of conception, but may occasionally be inherited from parents.

There are other potential causes of recurrent pregnancy loss, including infections and sperm problems, although these are less well defined. Lifestyle factors such as smoking, drug use, caffeine and alcohol intake, toxin exposure and obesity should be addressed, as these can be contributing factors.

How is recurrent pregnancy loss evaluated?

We offer couples who have experienced recurrent pregnancy loss a thorough and systematic analysis of each loss. We consider the timing of the loss and developmental milestones prior to the loss (for example, fetal heartbeat on ultrasound). If available, we perform a genetic analysis of the pregnancy loss tissue (products of conception).

Couples are evaluated initially with a thorough history and physical examination. This is followed by a series of diagnostic tests including blood work on both partners and evaluation of the uterus, usually with a specialized ultrasound study to look for fibroids, scar tissue or polyps, that may compromise implantation.

Additional evaluation may include tests to look for infection, biopsy, and analysis of the sperm.

We also offer couples genetic testing for diseases that may silently impair their reproductive success. If tissue from the pregnancy loss can be obtained, we will perform genetic analysis on this to look for a genetic cause.

How is recurrent pregnancy loss treated?

After two or more pregnancy losses, we start a full medical evaluation, including a series of diagnostic tests as mentioned above.

Because there are many potential underlying causes, we call on a team of experts across disciplines, including genetics (if a genetic cause is suspected), high-risk pregnancy specialists, and pathology.

If the cause of recurrent loss is identified—for example, a polyp—it can be removed surgically. Or if a genetic link is identified, a woman could do in vitro fertilization and screen embryos for the genetic problem.

If we can't find anything wrong, we offer what we call tender-love-and-care protocol, or TLC, which involves weekly monitoring of the pregnancy, initially with blood work and then with ultrasounds every week.

We also offer assistance on lifestyle factors that might impact pregnancy, such as smoking, alcohol consumption, caffeine use, toxic exposures, and obesity. Even with improved technology, sometimes recurrent pregnancy loss remains unexplained.

Even if a specific cause is never identified, the outlook is still very positive. In the majority of cases, a woman’s next pregnancy is normal and successful. Multiple studies show that the very practice of monitoring this condition and receiving emotional support can improve the odds of having a successful pregnancy.

What makes Yale Medicine's approach to recurrent pregnancy loss unique?

At Yale Medicine, we understand that recurrent pregnancy loss can put women and families under tremendous stress, both physical and emotional.

Our Recurrent Pregnancy Loss Program aims to ease these factors by combining compassionate, patient-focused care with the latest technology.

Working closely with patients to determine the root cause of specific difficulties is the first step towards achieving the dream of a healthy pregnancy. At Yale, we have the capabilities to offer a comprehensive evaluation of pregnancy losses including the latest in-depth genetic analysis for couples.