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Recurrent Pregnancy Loss (RPL)

Understanding why it keeps happening—and what to do next.

What is Recurrent Pregnancy Loss?

Recurrent Pregnancy Loss (RPL), also known as recurrent miscarriage, is defined as two or more consecutive pregnancy losses—usually in the first trimester, but sometimes later. These losses can occur before a heartbeat is detected (chemical pregnancy), after one has been seen (clinical miscarriage), or even further along in pregnancy.

While most people are told that “miscarriage is common” (and it is—up to 1 in 4 pregnancies ends in miscarriage), recurrent loss is different. It’s emotionally devastating, physically exhausting, and often leaves couples desperate for answers they aren’t getting.

RPL affects about 1–2% of couples trying to conceive. And the truth is—just because it’s common doesn’t mean it’s normal.

 

Symptoms of Recurrent Pregnancy Loss

RPL isn’t a “symptom” in itself—it’s a pattern. But it can come with signs that your body is struggling to maintain pregnancy.

🧬 Positive pregnancy tests followed by early losses (chemical pregnancies)
❤️ Losses after a heartbeat has been seen on ultrasound
📉 Falling HCG levels or lack of HCG progression early on
🌸 Losses at similar points in pregnancy (e.g., always at 6 or 8 weeks)
⚠️ Secondary symptoms like spotting, cramping, or changes in early pregnancy symptoms before the loss occurs

It’s important to know: Even two losses in a row are considered recurrent and deserve thorough investigation.

 

Who Does Recurrent Pregnancy Loss Affect?

RPL can affect anyone—whether it’s your first pregnancy or your fifth. You may be at higher risk if:

🧬 You have a family or personal history of miscarriage
🎂 You’re over age 35 (egg quality tends to decline with age)
đź’‰ You have a history of autoimmune conditions, thyroid issues, or clotting disorders
🧪 You’ve gone through IVF or fertility treatments
🥀 You’ve previously had a healthy pregnancy and are now experiencing losses

Many of our clients come to us having been told “it’s just bad luck.” But we don’t believe in luck when it comes to fertility—we believe in data.

 

What Causes Recurrent Pregnancy Loss?

There’s no one cause of RPL, and in up to 50% of cases, it’s labeled as “unexplained.” Which is beyond frustrating and unacceptable in our honest opinion. But in our functional practice, we often uncover root causes missed in conventional care:

🧠 Hormonal Imbalances: Low progesterone, thyroid dysfunction, or high prolactin can prevent proper implantation and pregnancy maintenance.
🧬 Chromosomal Abnormalities: Either from the embryo or a balanced translocation in one partner.
🩸 Blood Clotting Disorders (Thrombophilias): Such as Factor V Leiden, MTHFR mutations, or antiphospholipid syndrome.
⚖️ Immune Dysregulation: Autoimmune issues like Hashimoto’s, or elevated natural killer (NK) cells and cytokines, may lead to embryo rejection.
🧫 Infections: Chronic or low-grade infections (like ureaplasma, endometritis, or mold exposure) can interfere with implantation or fetal development.
đź’¤ Poor Egg Quality: Often due to age, oxidative stress, mitochondrial dysfunction, or nutrient depletion.
🌱 Thin or Unreceptive Uterine Lining: If your lining isn’t optimal, implantation may fail or not hold.
🥗 Nutrient Deficiencies: Low levels of folate, B12, magnesium, zinc, selenium, or choline are common in RPL cases.
🧍‍♂️ Male Factor: DNA fragmentation in sperm can significantly impact early embryo development.

RPL is almost always multi-factorial, which is why looking at the full picture—not just one lab—is so important.

 

How is Recurrent Pregnancy Loss Diagnosed?

The diagnosis is made when you’ve experienced two or more pregnancy losses, typically confirmed via bloodwork, ultrasound, or passing of tissue. Once RPL is suspected, testing may include:

🩸 Bloodwork: To assess thyroid, progesterone, insulin, clotting factors, autoimmunity, and nutrient levels
🧬 Karyotyping: Genetic testing of both partners
🧫 Endometrial biopsy or receptivity testing
đź“· Transvaginal ultrasound or hysteroscopy: To check for uterine abnormalities (fibroids, septum, polyps, adhesions)
🔬 Sperm DNA fragmentation testing for male partners
🧪 Functional testing like DUTCH, GI-MAP, HTMA, organic acids or others to identify deeper root causes

Unfortunately, many people are told to “just try again” after multiple losses without any of this testing being done. That’s why advocacy—and comprehensive support—matters so much.

 

How Does RPL Affect Your Fertility Journey?

Each loss compounds the emotional toll and uncertainty, often leading to fear of trying again. You may feel like:

💭 “My body can’t hold a pregnancy.”
💭 “I must be doing something wrong.”
💭 “I’m broken.”
💭 “It’s only a matter of time before I miscarry again.”

But here's what we want you to know: your body is not broken. And you deserve answers, not assumptions.

With the right information, many cases of RPL can be addressed—and future pregnancies can succeed.

 

We Can Help!

Supporting recurrent loss isn’t about chance or luck. It’s about strategy, investigation, and rebuilding your body’s capacity to hold and nourish new life.

✨ One client had 3 back-to-back miscarriages before she came to us. With support for thyroid health, progesterone, and mold detoxification, she conceived naturally and carried to term.
 ✨ Another couple had been told IVF was the only option after 4 unexplained losses. We discovered a B12 deficiency, autoimmune activity, and sperm DNA damage. Six months later: pregnant—and stayed that way.
 ✨ A third client, diagnosed with “unexplained RPL,” got pregnant after addressing copper toxicity and restoring her uterine lining.

At The Greenhouse, we combine functional medicine with fertility expertise to uncover the why behind your losses—and create a personalized plan to help you hold your next pregnancy.

👉 Apply for 1:1 fertility support.

 

Learn More

📰 Miscarriage is not your fault

đź“° TTC? Get your magnesium

📰 When your client increases her luteal phase, boosts her progesterone, gets pregnant and avoids miscarriage.

📰 If you’re struggling to make it past 12 weeks, this is for you

📰 If you’ve experienced a miscarriage…

đź“° Chemical Pregnancies? This one is for you

 

 

References

  1. Ford, H. B., & Schust, D. J. (2009). Recurrent pregnancy loss: Etiology, diagnosis, and therapy. Reviews in Obstetrics and Gynecology, 2(2), 76–83.
  2. American College of Obstetricians and Gynecologists. (2020). Early pregnancy loss. ACOG Practice Bulletin No. 200. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss
  3. Royal College of Obstetricians and Gynaecologists. (2011). The Investigation and Treatment of Couples with Recurrent First-trimester Miscarriage. Green-top Guideline No. 17. https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/investigation-and-treatment-of-couples-with-recurrent-first-trimester-miscarriage-green-top-guideline-no-17/ 

 

**Not medical advice. Always consult your doctor before making changes to your health or fertility plan.