What counts as recurrent pregnancy loss? Most doctors define it as 2 or more consecutive miscarriages (some still use 3). Evaluation is usually recommended after the second loss. Common causes of recurrent pregnancy loss 1. Genetic (chromosomal) causes — most common One parent may carry a balanced chromosomal rearrangement The embryo may have random chromosomal abnormalities Evaluation Karyotyping of both parents Genetic testing of miscarriage tissue (if available) Treatment Genetic counseling IVF with preimplantation genetic testing (PGT) in selected cases Many couples still conceive naturally with good outcomes 2. Uterine (anatomical) problems Examples: Uterine septum Fibroids (especially submucosal) Adhesions (Asherman syndrome) Congenital uterine abnormalities Evaluation Ultrasound Hysteroscopy MRI (sometimes) Treatment Surgical correction (often hysteroscopic) Very good success rates after treatment 3. Hormonal & metabolic causes Thyroid disease (hypothyroidism or hyperthyroidism) Uncontrolled diabetes Luteal phase defect (low progesterone) Polycystic ovary syndrome (PCOS) Evaluation Thyroid function tests Blood sugar testing Progesterone levels (controversial but sometimes checked) Treatment Thyroid medication if abnormal Blood sugar control Progesterone support in early pregnancy (commonly used) 4. Immune & clotting disorders Antiphospholipid syndrome (APS) is the most proven immune cause Evaluation Anticardiolipin antibodies Lupus anticoagulant Anti–β2 glycoprotein I Treatment Low-dose aspirin Heparin during pregnancy (This dramatically improves outcomes in APS) ⚠️ Other “immune causes” are controversial; many treatments lack strong evidence. 5. Infections Chronic endometritis (sometimes) TORCH infections are rarely a cause of recurrent loss Treatment Targeted antibiotics if diagnosed 6. Lifestyle & environmental factors Smoking Alcohol Obesity or being underweight Excess caffeine High stress (indirectly) Treatment Lifestyle optimization Weight management Prenatal vitamins with folic acid 7. Unexplained RPL (30–50%) This is frustrating, but important to know: ➡️ Even without a clear cause, future live birth rates are still 60–80% Supportive care alone often makes a huge difference. General management approach Detailed history + investigations Treat identifiable causes Early pregnancy monitoring Emotional support and counseling (this really matters) When to see a specialist After 2 miscarriages If losses occur after seeing a heartbeat If there’s a history of clotting disorders or autoimmune disease A reproductive endocrinologist or maternal-fetal medicine specialist is ideal.