What Is Recurrent Pregnancy Loss?
Pregnancy loss refers to the termination of pregnancy before the 20th gestational week. Women who experience three or more consecutive miscarriages are clinically diagnosed with recurrent pregnancy loss (RPL). However, according to recent international guidelines—such as ESHRE 2023—two or more consecutive losses are now considered sufficient to initiate diagnostic evaluation and management.
Approximately 50–75% of miscarriages are caused by genetic abnormalities, most commonly chromosomal disorders in the embryo, which prevent normal pregnancy progression. Other significant factors include immunological diseases, uterine structural anomalies, thrombophilic disorders, and various environmental or metabolic influences.
When Should Patients Be Evaluated?
Comprehensive evaluation is warranted in the following situations:
- Two or more consecutive miscarriages
- Pregnancy loss after fetal cardiac activity has been detected
- Recurrence of pregnancy loss despite normal genetic results from previous testing
- Maternal age over 35 years
- Infertility lasting more than one year
- Detection of chromosomal abnormalities (karyotype anomalies) in either parent
Early diagnosis and individualized management are essential for improving the chances of a healthy subsequent pregnancy.
Major Causes of Recurrent Pregnancy Loss
1. Anatomical (Uterine) Factors
Structural anomalies of the uterus, whether congenital or acquired, can impair implantation and fetal development. Common examples include:
- Uterine septum (intrauterine septum)
- Unicornuate uterus (one-sided uterine development)
- Bicornuate uterus (heart-shaped uterus)
- Uterus didelphys (double uterus)
Additionally, fibroids, intrauterine adhesions, and chronic endometrial infections may also interfere with embryo implantation.
2. Immunological and Thrombophilic Disorders
Sometimes, the immune system—normally protective—may mistakenly identify the pregnancy as foreign. Disorders such as systemic lupus erythematosus, antiphospholipid syndrome, inherited thrombophilias, and placental functional abnormalities are leading immunologic causes of recurrent miscarriage.
3. Genetic Abnormalities
More than half of recurrent pregnancy losses are linked to embryonic chromosomal abnormalities. When viable fetal tissue cannot be retrieved for testing, advanced technologies such as Comparative Genomic Hybridization (CGH) microarray and Next Generation Sequencing (NGS) enable a more precise evaluation.
In assisted reproduction, Preimplantation Genetic Testing (PGT) helps select chromosomally normal embryos, significantly improving pregnancy success rates by up to 40–50%.
Diagnostic Evaluation
In our clinic, evaluation begins with a comprehensive medical history and physical examination, followed by a personalized diagnostic plan. Core components include:
- Karyotype analysis (for both partners)
- 4D ultrasonography
- Hysterosalpingography (HSG)
- Hysteroscopy and laparoscopy, if indicated
- Thrombophilia and autoimmune screening panels
- Infectious disease testing
- NGS-based genetic analysis
To assess fetal chromosomal abnormalities following miscarriage, amniocentesis, chorionic villus sampling (CVS), and cordocentesis (fetal blood sampling) may be performed. These evaluations collectively identify the underlying cause in up to 70–80% of cases.
The Role of Perinatal Pathology
Perinatal pathology focuses on the microscopic and molecular examination of placental and membrane tissues to determine the cause of pregnancy loss. Using advanced molecular pathology and immunohistochemistry techniques, diagnostic accuracy is significantly improved.
This process provides valuable insight into recurrent miscarriages, intrauterine fetal demises, umbilical cord abnormalities, preterm births, and growth restriction syndromes. Proper preservation of these tissues after delivery enables better planning for future pregnancies.
Our Multidisciplinary Approach
At our clinic, recurrent pregnancy loss, preterm birth, premature rupture of membranes, and intrauterine fetal demise are addressed through an integrated, multi-layered approach.
Our assessment goes beyond visible clinical findings to explore genetic, immunologic, vascular, and environmental factors that influence reproductive outcomes.
Through our international collaborations with leading U.S. perinatal centers, we integrate state-of-the-art diagnostic and therapeutic innovations into every patient’s care plan—ensuring that each case is managed according to global best practices while remaining fully individualized.
One of our clinic’s defining features is the integration of functional medicine principles into conventional perinatal evaluation. This allows for the early identification and proactive management of underlying conditions such as:
- Immune dysfunctions
- Thrombophilic tendencies
- Endometrial infections
- Microvascular placental pathology
Intervention begins before conception or in the earliest weeks of pregnancy, significantly improving maternal and fetal outcomes.
Comprehensive and Holistic Care
Our management protocols extend beyond medical interventions to include:
- Nutritional optimization
- Stress regulation and lifestyle modification
- Hormonal and micronutrient balancing
- Personalized wellness and longevity programs
This holistic framework not only enhances pregnancy continuity but also strengthens the mother’s overall health and resilience.
Postpartum, pathological evaluation of the placenta and membranes remains a critical step. Insights gained guide preventive strategies for future pregnancies—transforming past losses into informed, data-driven care plans for healthier outcomes.
Conclusion
Our clinic’s individualized, multidisciplinary, and predictive approach achieves up to 70–80% success rates in helping patients with recurrent pregnancy loss achieve healthy, full-term pregnancies.
By combining advanced diagnostics, functional medicine, and internationally aligned clinical protocols, we redefine reproductive care for women facing this deeply challenging condition.
