RPL
Understanding Pregnancy Loss

Recurrent
Pregnancy Loss

Most losses have identifiable, treatable causes. This guide explains the four main mechanisms — and the investigations and interventions that can change outcomes.

50–60%
of losses are chromosomal aneuploidy
5–15%
of RPL cases have antiphospholipid syndrome
20%
of RPL women have thyroid antibodies
>25%
sperm DFI is clinically significant
The Biology

Four Mechanisms Behind Recurrent Loss

Most causes of RPL are identifiable with appropriate investigation and have targeted treatments. Understanding the mechanism is the first step.

  • →Chromosomal aneuploidy (abnormal chromosome number in the embryo) accounts for 50–60% of first-trimester losses. This is predominantly a random error in meiosis, not a heritable condition — the recurrence risk from a single aneuploid loss is not significantly elevated.
  • →Advanced maternal age is the primary risk factor for aneuploidy, as the frequency of meiotic errors increases with age due to declining oocyte mitochondrial function and spindle integrity. This is why egg quality optimisation (CoQ10, melatonin, inositol) is the most evidence-based intervention for reducing aneuploidy risk.
  • →Preimplantation genetic testing for aneuploidy (PGT-A) can identify euploid embryos before transfer in IVF, reducing miscarriage rates significantly in women with recurrent aneuploid losses.
  • →Sperm DNA fragmentation is an underappreciated contributor to early pregnancy loss — fragmented sperm DNA can fertilise an egg but leads to abnormal embryo development and early loss. Sperm DNA fragmentation index (DFI) >25% is clinically significant.
What to Request

Recommended Investigations

Bring this list to your GP or specialist. Not all tests are routinely ordered — you may need to request them specifically.

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Karyotype (both partners)
Identifies balanced translocations — present in 3–5% of RPL couples
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Antiphospholipid antibodies (×2, ≥12 weeks apart)
Diagnoses APS — most treatable cause of RPL
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Thrombophilia screen (Factor V Leiden, Prothrombin G20210A)
Identifies inherited clotting disorders
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MTHFR genotyping
Guides folate supplementation strategy
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TSH + anti-TPO + anti-Tg antibodies
Thyroid dysfunction and autoimmunity associated with RPL
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Progesterone (day 21 or 7 days post-ovulation)
Confirms adequate luteal phase progesterone
→
Sperm DNA fragmentation index (DFI)
Elevated DFI (>25%) contributes to early loss
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Pelvic ultrasound / hysteroscopy
Identifies uterine anomalies (septum, polyps, fibroids, adhesions)
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Vitamin D (25-OH)
Deficiency associated with immune dysregulation and RPL
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B12, folate, homocysteine
Nutritional contributors to RPL risk
Recurrent Pregnancy Loss — Quick Reference
One-page PDF cheat sheet · Supplement doses, food priorities & action steps
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Your Protocol

Action Plan

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Investigations — Request These

Nutritional Protocol

Lifestyle & Monitoring