Recurrent Pregnancy Loss

17 Jan
Recurrent Pregnancy Loss

Recurrent Pregnancy Loss (RPL) is defined as more than 3 consecutive first trimester losses or miscarriages. The incidence is approximately 2% of reproductive aged women. There are various causes of recurrent pregnancy loss including anatomic, endocrine, genetic, immunologic and infectious disorders. The causes can generally be categorized as a) problems with the embryos and b) problems with the environment that support the embryo.

Anatomic causes can include things such uterine polyps, fibroids or congenitally abnormal uteri. This can be diagnosed by several methods including hysterosalpingogram (HSG), sonohysterogram or fluid ultrasound (FUS), or hysteroscopy. Anatomic problems other than congenital disorders can typically be treated by minor surgery.

Endocrine disorders can involve problems such as an underactive or overactive thyroid gland, elevated prolactin levels, diabetes or insulin resistance. The disorders can be diagnosed with simple blood tests and can be treated rather easily through diet and medication.

Genetic problems can come from the parents or the fetus itself. Parental disorders can be diagnosed with a blood chromosome test called a karyotype. Fetal genetic problems can be diagnosed by biopsying an early stage embryo and testing a single cell with a test called comparative genomic hybridization (CGH). This is done during in vitro fertilization, and only genetically competent embryos are transferred to the uterus, thus reducing the risk of miscarriage greatly.

Immunologic causes result when the maternal immune system rejects the implantation process. There are several reasons for this, including rejection of the maternal aspect of the pregnancy, as well as rejection of the paternal aspect of the pregnancy. Good screening tests for immune disorders include natural killer cell (NK Cell) assay and antiphospholipid antibodies (APA).

In rare cases, certain bacteria have been implicated in recurrent pregnancy loss . These include bacteria such as mycoplasma and ureaplasma. These can easily be diagnosed with cervical cultures and treated with antibiotics.

Albert Peters is a physician with Sher Fertility New Jersey

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  • Ashli says:

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  • Andrea says:

    I wanted to ask does slightly elevated prolactin levels cause recurrent miscarriage? because my all blood tests was normal.

    • Geoffrey Sher says:

      Not in and of itself. However an elevated prolactin level can indirectly point to an autoimmune implantation dysfunction linked to antithyroid antibodies and uterine NK cell activation. Please go to the home page of this blog, . When you get there, find the search bar and type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1 ” Elevated blood prolactin….”

      2.. “Thyroid Autoimmune Disease and IVF”

      3.”Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

      Consider calling 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.