Recurrent pregnancy loss (or RPL) is when you’ve had multiple miscarriages, usually three or more. Although it’s possible to have multiple miscarriages in which each loss is caused by something different, it’s usually more likely that there’s a common underlying cause. So treating RPL means getting to the bottom of the condition that’s preventing the pregnancies from continuing.
It takes multiple tests to establish the underlying cause of your RPL. Here are some of the common conditions:
Many pregnancies are lost because of microscopic chromosome problems. These are genetic glitches that can prevent an embryo from growing into a viable fetus. However, we can’t get close enough to your eggs to investigate until we do IVF. We typically combine IVF with Preimplantation Genetic Screening (PGS) to get a solid understanding of what’s going on. This also doubles as a treatment: by seeing your eggs up close, we can identify the most genetically strong ones and transfer them instead.
Potential RPL-causing issues in your uterus include polyps, fibroids, scar tissue or midline structures (“subseptum”) that could hinder implantation. These tests are best done through either a sonohystogram (using ultrasound imaging) or a hysteroscopy (a day procedure). It isn’t clear which of the two procedures is better, and different doctors will suggest different options.
We also like to investigate your fallopian tubes: they can be very dilated, causing a hydrosalpinx and leakage of fluid into the cavity. This is best diagnosed through either an HSG (x-ray test), or through laparoscopy. We also often see it during a transvaginal ultrasound.
We can also look at the lining of your uterus. The standard method is to inspect your endometrial thickness. We need at least 7 mm, many doctors like 8 mm, and some studies suggest that implantation is best between 9 mm and 10 mm.
Some doctors do an endometrial biopsy to analyze it further. This is controversial, as it doesn’t really work as well as we would like. That said, some tests include Harvey Kliman’s Endometrial Function Test, the “E-tegrity Assay” for beta-3 integrin, and sending a biopsy specimen off for analysis.
Other issues
RPL can also be caused by the following issues. Click their links to learn more: