Recurrent Pregnancy Loss (RPL): Frequently Asked Questions
Written by: Dr. Susan Fox, DACM, L.Ac., FABORM
Credentials: Fertility Coach/Expert, Founder of Health Youniversity
Reviewed/Updated: Sept 2026
Reading Time: 8–10 min read
Medical disclaimer: This FAQ page is general educational and does not replace medical advice from your physician, OB-GYN, reproductive endocrinologist, urologist, midwife, oncologist, or licensed healthcare provider.
What is recurrent pregnancy loss (RPL)?
Recurrent pregnancy loss (also called recurrent miscarriage) is the loss of two or more pregnancies before the fetus can survive on its own. Most professional groups — including the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) — now define it as two or more pregnancy losses, which may be consecutive or non-consecutive, and can include losses confirmed only by a blood or urine pregnancy test (biochemical losses). Some older definitions, such as the Royal College of Obstetricians and Gynaecologists (RCOG), used "three or more consecutive first-trimester miscarriages."
RPL is not the same as infertility. Many people with RPL conceive easily but have difficulty carrying a pregnancy to term.
How common is RPL?
Recurrent pregnancy loss affects roughly 1–5% of couples trying to conceive, depending on the definition used. The figure is closer to 1% when three losses are required and rises to about 5% when the two-loss definition is applied (Coomarasamy et al., Lancet, 2021). Individual miscarriage is far more common, affecting an estimated 10–20% of recognized pregnancies.
Does having had recurrent losses mean I can't have a healthy baby?
No. Even after several losses, most people go on to have a successful pregnancy. A key message from the medical literature is that many couples achieve a live birth in a future pregnancy, even when no cause is found and even without specific treatment. This is important to keep in mind, because the emotional toll of RPL is significant and reassurance is an important part of care.
What causes recurrent pregnancy loss?
RPL usually has more than one contributing factor, and in about half of all cases no cause is ever identified ("unexplained" RPL). Recognized causes and risk factors include:
Chromosomal and genetic factors — Random chromosomal abnormalities in the embryo (aneuploidy) are the single most common cause of individual losses and become more frequent with age. In a small percentage of couples, one partner carries a balanced chromosomal rearrangement (such as a translocation).
Advancing age — Both maternal and, to a lesser degree, paternal age increase risk, largely because of age-related chromosomal errors.
Uterine (anatomical) abnormalities — A uterine septum is the anomaly most commonly linked to RPL; fibroids, polyps, and scar tissue (adhesions) may also contribute.
Antiphospholipid syndrome (APS) — An autoimmune clotting disorder that is one of the few clearly treatable causes of RPL.
Endocrine (hormonal) disorders — Thyroid disease, poorly controlled diabetes, polycystic ovary syndrome, high prolactin, and progesterone deficiency.
Lifestyle and environmental factors — Smoking, alcohol, excess caffeine, obesity, and certain environmental exposures.
Chronic endometritis — Ongoing low-grade inflammation/infection of the uterine lining.
What tests are done to look for a cause?
After two or more losses, guidelines recommend a focused set of investigations aimed at finding treatable causes. A widely agreed-upon core workup includes:
Antiphospholipid antibody testing — Lupus anticoagulant, anticardiolipin antibodies, and anti-β2-glycoprotein I antibodies. This is one of the most important tests because a positive result points to a treatable condition. Testing should ideally be done between pregnancies and confirmed on repeat.
Thyroid function tests (and often thyroid antibodies).
Pelvic ultrasound, preferably three-dimensional transvaginal ultrasound, to evaluate the shape and lining of the uterus.
Genetic testing of pregnancy tissue (chromosomal microarray) after a loss, which can explain whether a chromosomal abnormality was the cause.
Parental karyotyping (blood chromosome testing of both partners) in selected couples.
What treatments are available?
Treatment depends entirely on what, if anything, is found during the workup. Evidence-based options include:
Antiphospholipid syndrome — The combination of low-dose aspirin plus heparin (started when pregnancy is confirmed) increases live birth rates and is the standard treatment.
Thyroid disease — Levothyroxine for overt hypothyroidism; it may also be considered for subclinical hypothyroidism, especially with elevated thyroid antibodies. Certain dietary restrictions are recommended when antibodies are present.
Progesterone — Vaginal micronized progesterone in early pregnancy can increase the chance of a live birth in women who have a history of miscarriage and present with early-pregnancy bleeding, and in those with three or more prior losses.
Uterine abnormalities — Surgical correction of a uterine septum or removal of significant polyps, fibroids, or adhesions in appropriate cases.
Chronic endometritis — A course of antibiotics when this condition is diagnosed.
Supportive care — Early pregnancy assessment, close monitoring, emotional support, and trauma-informed care are essential parts of management.
How does Chinese Medicine understand and treat recurrent pregnancy loss?
Traditional Chinese Medicine (TCM) has been used for pregnancy-related conditions for thousands of years and approaches RPL through a framework distinct from Western medicine. It is often used alongside conventional care rather than as a replacement for it.
How TCM understands RPL. In TCM theory, "Qi" (life force) and "Blood" are the two basic elements involved in sustaining a pregnancy. Recurrent miscarriage is most often attributed to Kidney deficiency, or to a combined Qi and Blood deficiency. In the TCM system, the "Kidney" is regarded as responsible for growth, development, and reproduction, storing the essential Qi that "warms and activates" the body. The concept is that when Qi and Blood are sufficient, the womb provides a warm, stable environment in which a pregnancy can be sustained; when they are deficient, the pregnancy cannot be maintained. Treatment is therefore aimed at "correcting the deficiency," and treatments are individualized to the specific pattern diagnosed in each person.
How TCM treats RPL. The main modality is Chinese herbal medicine, given as multi-herb formulas rather than single herbs. Practitioners typically modify these classical prescriptions based on each person's presentation.
What the evidence shows. A Cochrane systematic review of Chinese herbal medicines for unexplained recurrent miscarriage found that when Chinese herbal medicines were combined with conventional pharmaceutical treatment, they were associated with higher rates of continuing pregnancy beyond 20 weeks (about 92% vs. 72%) and higher live birth rates (about 80% vs. 44%) compared with conventional pharmaceuticals alone.
Safety note. Herbal products are not standardized or regulated the same way as prescription medications, and some herbs can be harmful in pregnancy. Anyone considering Chinese herbal medicine should do so only under a qualified practitioner and should tell their obstetric provider about any herbs or supplements they are taking.
When should I see a specialist?
It is reasonable to seek evaluation after two pregnancy losses, especially at age 35 or older or when other risk factors are present. A reproductive medicine or maternal-fetal medicine specialist can coordinate the workup, interpret results, and tailor treatment. Emotional support and counseling should be offered at every stage.
This FAQ is for general education and does not replace individualized medical advice. Please discuss your specific situation with your healthcare provider.
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About The Author
Dr. Susan Fox
DACM, L.Ac., FABORM
Fertility Coach/Expert, Founder of Health Youniversity
Dr. Susan Fox, DACM, L.Ac., FABORM, is a fertility coach, Doctor of Acupuncture and Chinese Medicine, and Founder of Health Youniversity. She has 24 years of experience supporting women ages 30–45 navigating natural conception, IVF, IUI, PCOS, endometriosis, diminished ovarian reserve, and unexplained infertility. Her work blends Traditional Chinese Medicine, Functional Medicine, fertility education, nutrition, circulation support, lifestyle medicine, and emotional well-being to help women prepare their bodies for conception and pregnancy.
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