Recurrent Pregnancy Loss: Advanced Testing and Treatment ...

Fertility & IVF · 5 · December 28, 2025

Recurrent pregnancy loss (RPL) — defined as two or more consecutive miscarriages — affects 1-2% of couples trying to conceive. Standard testing identifies a cause in only 50% of cases. The other 50% are labeled 'unexplained' — a diagnosis that leaves patients desperate for answers.

Standard Workup: What Should Already Be Done

The baseline RPL evaluation includes: karyotyping of both partners (chromosomal rearrangements found in 3-5%), uterine anatomy assessment (hysteroscopy or MRI to detect septum, fibroids, or polyps — found in 10-15%), antiphospholipid antibody testing (positive in 5-15%), thyroid function and prolactin (abnormal in 5-10%), and HbA1c for undiagnosed diabetes. If your doctor hasn't ordered all of these after two losses, ask why.

Advanced Testing: Beyond the Basics

Thrombophilia panel (Factor V Leiden, prothrombin mutation, protein C/S deficiency): found in 8-15% of RPL patients and treatable with low-dose aspirin and heparin. ERA (endometrial receptivity analysis): identifies implantation timing disorders. Uterine natural killer (NK) cell testing: elevated uNK cells are found in 30-40% of unexplained RPL patients — treatment with intralipid infusions or prednisolone is controversial but practiced at several international centers.

PGT-A of embryos: For couples with RPL and normal karyotypes, PGT-A reveals that 50-60% of their embryos are aneuploid — random chromosomal errors causing miscarriage rather than a maternal health problem. Selecting only euploid embryos for transfer reduces miscarriage risk to 5-10%.

Reproductive Immunology Clinics: Where to Go

Reproductive immunology is a subspecialty available at limited centers worldwide. In the UK, Professor Siobhan Quenby's Implantation Research Clinic at University Hospitals Coventry is the leading evidence-based center. In the US, the Yale Reproductive Immunology program and Dr. Alan Beer's legacy clinics offer comprehensive protocols. In India, Nova IVF's RPL program in Bangalore provides advanced immunological workup at $500-$1,500 versus $3,000-$8,000 in the US.

Key Takeaways

- Standard RPL testing identifies a cause in only 50% of cases — advanced testing closes the gap

- PGT-A reveals that 50-60% of embryos in RPL couples are aneuploid — explaining many 'unexplained' losses

- Thrombophilia is treatable with aspirin and heparin — found in 8-15% of RPL patients

- India offers comprehensive RPL immunological workup at $500-$1,500 vs $3,000-$8,000 in the US

Compare real-time pricing using our global cost calculator.