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Recurrent pregnancy loss (RPL), also known as recurrent miscarriage, is typically defined as two or more consecutive pregnancy losses before 20 weeks of gestation. It's a deeply emotional and complex medical condition that can have various underlying causes.
Most common in early miscarriages.
Balanced translocations in one partner (chromosomal rearrangements without loss of genetic material).
Embryonic aneuploidy (abnormal number of chromosomes).
2. Anatomical Abnormalities
Uterine anomalies like septate uterus, fibroids, polyps, or adhesions.
Cervical insufficiency (especially for second-trimester losses).
3. Endocrine Disorders
Thyroid dysfunction (especially hypothyroidism or Hashimoto's)
Uncontrolled diabetes
Polycystic ovary syndrome (PCOS) with insulin resistance
Luteal phase defect (controversial but sometimes considered)
4. Immunologic Factors
Antiphospholipid syndrome (APS) – the most well-documented immune cause
Possible role of natural killer cells, HLA compatibility, etc., but evidence is still evolving
Thrombophilia
Inherited or acquired conditions causing blood clotting abnormalities can impair placental function
Work-up generally begins after two or more miscarriages:
Karyotyping of both partners
Ultrasound or hysteroscopy to assess uterine anatomy
Blood tests: thyroid function, antiphospholipid antibodies, thrombophilia panel
Endometrial biopsy (sometimes) to rule out chronic endometritis
Dr. Madhu Juneja is a highly skilled and compassionate gynecologist, obstetrician, and infertility specialist. With her extensive expertise and dedication, she has helped numerous patients navigate their reproductive health journey with confidence and care.
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