Reccurent Pregnancy Loss (RPL) 101

Recurrent pregnancy loss is a difficult subject for many in this community, and our hearts go out to you all.  Our wonderful team at Fertilitae is here to provide support and resources to those affected, and to increase awareness of RPL and the challenges it poses on women and families. 

While a pregnancy loss is devastating regardless of when it occurs, the American Society for Reproductive Medicine defines recurrent pregnancy loss as the loss of two or more clinical pregnancies before the 20th week. 

RPL currently affects 1-3% of couples worldwide.  Aggressive assessment and medical interventions are not considered in patients without previous miscarriage. However, the risk of pregnancy loss increases with each loss from approx. 11%, to 40% after three or more losses.  Even more devastating, a cause for RPL is identified in fewer than 50% of couples. 

Certain hormonal factors have been associated with recurrent pregnancy loss: 

• Thyroid Function
• Prolactin Levels
• Diabetes 
• Being severely underweight
• Obesity 
• Luteal phase defects 
• Smoking

Immune factors have also been associated with recurrent pregnancy loss.  Antiphospholipid syndrome (APS) is an autoimmune condition that causes blood clots, and has been shown to increase the risk of miscarriage.  

Anatomical issues may also be a factor in recurrent pregnancy loss by blocking openings,  and/ or  hindering implantation: 

• Congenital anomalies
• Fibroids
• Endometriosis 
• Adhesions

The majority of miscarriages are thought to be caused by chromosomal abnormalities of the embryo.  This occurs when there is poor egg or sperm quality, errors in cellular divisions, or translocation. 

Infectious causes such as endometritis - chronic inflammation of the uterine lining - is also thought to increase risk of RPL.  

Lastly, lifestyle factors such as night work, cigarette smoking, alcoholism and drug use have all been associated with an increased risk of risk of miscarriage.  

Factors that are not associated with miscarriage:

• Abortion 
• Sexual activity in early pregnancy
• Contraceptives (oral or IUD) 

Oftentimes, no answers are found on the cause of RPL. There is still a lot of research lacking on RPL and many of the guidelines and recommendations on treatment and investigation are balanced between benefit versus harm to patients. It is important to remember that most people will go on to have a successful pregnancy!.   

Written By: Dr Cassandra Paiano, ND, Bsc.  

References:

1. Shahine, Lora. Not broken: an approachable guide to miscarriage and recurrent pregnancy loss. Publisher Not Identified, 2017.

2. “Evaluation and Treatment of Recurrent Pregnancy Loss: a Committee Opinion.” Fertility and Sterility, vol. 98, no. 5, 2012, pp. 1103–1111., doi:10.1016/j.fertnstert.2012.06.048

3. Atik, R. B., Christiansen, O. B., Elson, J., Kolte, A. M., Lewis, S., Middeldorp, S., … Goddijn, M. (2018). ESHRE guideline: recurrent pregnancy loss. Human Reproduction Open, 2018(2). doi: 10.1093/hropen/hoy004 

4. Li, Y. H., & Marren, A. (2018). Recurrent pregnancy loss: A summary of international evidence-based guidelines and practice. Australian Journal of General Practice, 47(7), 432–436. doi: 10.31128/ajgp-01-18-4459