Recurrent Pregnancy Loss and IVF: When Fertility Treatment May Help

What Is Recurrent Pregnancy Loss?

The recurrence of pregnancy loss refers to the loss of two or more pregnancies before 20 weeks. Two losses are usually sufficient in order to define a recurrence irrespective of whether the losses happened one after another. Some organisations, such as the World Health Organization (WHO) and the Royal College of Obstetricians and Gynaecologists (RCOG), adopt a more stringent criterion of three consecutive pregnancy losses. According to a study published in the Journal of Clinical Medicine in 2023, the loss of two pregnancies occurs in 5% of women, and the loss of three or more pregnancies occurs in 1%.

One-time miscarriage is normally a sporadic occurrence, often caused by a chromosomal accident (genetic material problems) during that pregnancy and does not necessarily imply a problem. Recurrent pregnancy loss, however, is a different story. If pregnancy losses are repetitive, the probability of identifying a potential cause increases. It may be a genetic cause, a problem with the uterus, a hormone imbalance or an immune condition. Finding that cause helps decide the next step reliably.

Common Causes of Recurrent Pregnancy Loss

Several distinct conditions may cause a repeated pregnancy loss, and sometimes more than one contributing factor may be present in a couple:

Genetic and Chromosomal Abnormalities

Most early miscarriages happen due to the wrong number of chromosomes in the embryo. This condition is known as aneuploidy. A 2026 ASRM committee opinion notes that chromosomal abnormality in the embryo accounts for close to half of all miscarriages, and this rate grows with the mother's age. Sometimes, one parent's own chromosomes are just arranged differently. It does not mean anything is missing. This doesn't affect the parent's health, but it can stop the embryo from developing properly.

Uterine Abnormalities

The shape and lining of the uterus (the womb) affect whether an embryo can implant and grow. A uterine septum (a band of tissue dividing the uterine cavity), fibroids (non-cancerous growths in the uterine wall) or scar tissue from a previous surgery can interfere with implantation or with blood supply to a growing pregnancy.

Hormonal and Endocrine Disorders

Thyroid disorders, poorly controlled diabetes and polyendocrine metabolic ovarian syndrome (PMOS; earlier known as polycystic ovary syndrome or PCOS) can affect the hormonal environment needed for the pregnancy to continue. A meta-analysis cited in ASRM's guidance found subclinical hypothyroidism (mildly underactive thyroid function with no obvious symptoms) in about 12.9% of women with RPL, compared with 3.5% of pregnant women overall.

Autoimmune Conditions

In antiphospholipid syndrome (APS), the immune system produces antibodies that raise the risk of blood clots in the placenta, cutting off blood supply to the pregnancy. APS is one of the few autoimmune causes of repeat pregnancy loss that can be tested and treated.

Blood Clotting Disorders

Inherited clotting disorders, sometimes called thrombophilias, may also affect blood flow to the placenta. Their exact role in RPL is debated among researchers, so testing is usually reserved for specific situations rather than offered to everyone.

Male Factor Contributions

Sperm quality plays a role too. A 2025 study published in Translational Andrology and Urology linked higher levels of DNA fragmentation, meaning breaks in the genetic material carried by sperm, to a greater risk of miscarriage. This is a thorough RPL evaluation that includes a semen analysis.

Unexplained Recurrent Pregnancy Loss

In many couples, standard testing does not reveal a clear cause. This is called unexplained RPL. It does not mean nothing is wrong. It often means current tests cannot detect the cause, and a good outcome in a future pregnancy is possible.

When Should Couples Seek Fertility Treatment for Recurrent Pregnancy Loss?

Most guidelines recommend a fertility evaluation after two consecutive pregnancy losses, rather than waiting for a third, reflecting the two-loss threshold ASRM uses in its own criteria. Evaluation may also help even after a single loss:

• If you are over 35
• If that pregnancy showed a chromosomal abnormality
• If you already have a known condition such as PMOS, a thyroid disorder or a uterine abnormality.

Early assessment is important because maternal age affects both the chance of a future loss and the range of treatment options available. The right next step depends on factors including your age, how many losses you have had, whether any testing has already been done and whether you have a diagnosed medical condition. A fertility specialist can help you decide whether to test further, try again with closer monitoring or start a recurrent pregnancy loss treatment plan such as IVF.

Can IVF Help Couples with Recurrent Pregnancy Loss?

IVF for recurrent miscarriage can help some couples, though it is not the first or only option for everyone. In IVF, eggs are retrieved from the ovaries, fertilised with sperm in a laboratory, and the resulting embryo is transferred into the uterus after a few days of growth. For couples with RPL, this process allows embryos to be assessed before transfer using genetic testing and gives a fertility specialist more control over which embryo is placed and when.

IVF is more often recommended in the following cases:

• When a genetic cause is identified or suspected
• When a couple also has an unrelated fertility issue such as blocked fallopian tubes 
• When the likelihood of chromosomal errors in the embryo is higher due to maternal age

If the cause of RPL is a treatable hormone or immune issue, IVF may not be needed. The same is true for losses that are mostly linked to age-related chromosome errors, with no other fertility problem involved. Couples with RPL still have a meaningfully high chance of a healthy child through natural conception. This is why every case needs its own evaluation rather than a default move to IVF.

How IVF May Address Certain Causes of Recurrent Pregnancy Loss

IVF helps with recurrent pregnancy loss mainly through the additional control it gives over embryo selection and timing.

IVF with Preimplantation Genetic Testing (PGT)

PGT is a laboratory test that is done on embryos prior to transfer, looking for abnormalities like aneuploidy. If IVF is used in order to conceive an embryo, the test gives a specialist an opportunity to select the embryo with the proper chromosome number and therefore reduce the risk of a pregnancy loss due to this reason. The test is typically recommended to women over the age of 35, or couples who have experienced pregnancy loss due to chromosomal reasons in the past.

Managing Age-Related Chromosomal Risks

The incidence of chromosomal abnormalities in the egg increases with increasing age, especially after 35. The use of PGT during an IVF cycle allows testing for this particular risk before the embryo transfer, as opposed to learning about the risk once the pregnancy is miscarried. It will not improve the eggs' quality related to age, but it can decrease the chances of losing the pregnancy.

Addressing Male Factor Issues

When sperm DNA fragmentation or another male factor is contributing to pregnancy loss, IVF combined with intracytoplasmic sperm injection (ICSI), a single sperm injected directly into an egg, can improve fertilisation using the healthiest available sperm. Treating any underlying male-factor condition alongside IVF gives the best chance of a stable pregnancy.

Improving Embryo Selection

IVF laboratories also use tools such as time-lapse imaging, continuous monitoring of how an embryo develops, to track growth before deciding which embryo to transfer. This allows a specialist to choose the embryo most likely to implant, rather than relying only on the timing of a natural cycle.

Fertility Tests Recommended Before IVF for Recurrent Pregnancy Loss

Before recommending IVF, a fertility specialist usually orders a set of tests to confirm what is causing the losses.

Genetic Testing

This includes karyotyping, a test that maps the number and structure of each partner's chromosomes. Sometimes, it also includes genetic testing of tissue from a previous miscarriage, if it was preserved. A 2026 ASRM committee opinion recommends offering genetic testing of miscarriage tissue to all patients with RPL.

Uterine Evaluation

Imaging such as a hysteroscopy (a procedure where a thin camera is passed into the uterus) or a saline sonogram checks for structural issues like a septum, fibroids or scar tissue. ASRM recommends this evaluation for all women with RPL.

Hormonal Assessment

Blood tests check thyroid function, blood sugar control and other hormone levels affecting a pregnancy's ability to continue.

Autoimmune and Clotting Disorder Screening

Blood tests for antiphospholipid antibodies check for APS, and additional clotting tests may follow depending on personal or family history.

Semen Analysis

A semen analysis checks sperm count, movement, shape and sometimes DNA fragmentation, since male factors contribute to a portion of RPL cases.

IVF Treatment Process for Couples with Recurrent Pregnancy Loss

The IVF process for RPL follows the same core steps as standard IVF. Genetic testing is added where it is recommended.

• Ovarian stimulation. Daily hormone injections stimulate the ovaries to produce multiple mature eggs instead of the single egg released in a natural cycle, over roughly 10 to 12 days.
• Egg retrieval. Once the eggs reach the right size, they are retrieved through a minor procedure under sedation, taking about 20 minutes.
• Fertilisation and embryo development. The eggs are fertilised with sperm in the laboratory, either by mixing them together or through ICSI. The embryos are monitored for five to six days as they grow toward the blastocyst stage (an advanced stage of embryo development).
• Embryo testing, if recommended. If PGT has been advised, a few cells are removed from each blastocyst and sent for genetic analysis, taking one to two weeks.
• Embryo transfer. A single embryo, chosen based on quality and, if tested, genetic results, is placed into the uterus with a thin catheter, without sedation.
• Pregnancy monitoring. A blood test about two weeks after transfer confirms pregnancy, followed by closer monitoring through early ultrasounds, given your history.

Success Rates of IVF for Recurrent Pregnancy Loss

There are several factors that determine the success rate for the treatment through IVF following recurrent pregnancy loss, and these factors vary from one individual to another.

Age of the woman plays a crucial role in determining the success rate of the process, as both the quality of the eggs and the chances of chromosomal abnormalities increase with age. The quality of the embryo also determines the success rate. The cause of the RPL is also an important factor to consider. The success rate for those individuals who had their miscarriages because of chromosomal abnormality (which PGT screens for) is higher compared to other couples with other causes.

As so many factors are involved, a single success rate figure will not tell you much. It’s better to consult a specialist to get a clearer picture based on your age, test results and treatment history.

Pregnancy After IVF for Recurrent Pregnancy Loss

In the case of pregnancies following recurrent loss, there is often an increased need for monitoring compared to a normal pregnancy. Ultrasound scans done earlier than normal, even before week six, help keep an eye on how the pregnancy is progressing and locate it. Prenatal care and hormonal testing for conditions like luteal phase deficiency (a shortage of the hormone progesterone needed to support early pregnancy) continue throughout the first trimester and thereafter.

It is common to feel anxious during this stage, particularly around the point where a previous loss occurred. That anxiety is not a sign that something is wrong with this pregnancy. Many fertility clinics offer continued support through this period, including counselling and more frequent check-ins.

Questions to Ask Your Fertility Specialist

A first consultation can feel overwhelming. Seeing your fertility specialist with specific questions can help.

• Is IVF appropriate for my situation? Ask your specialist to explain why IVF is or is not being recommended, based on your test results.
• Do I need genetic testing? Find out whether PGT is suggested for your embryos, and why.
• What additional investigations are recommended? Ask which tests remain, if any, before a treatment plan is finalised.
• What are my chances of a successful pregnancy? Ask for the doctor’s opinion based on your age, cause, and test results, not a general statistic.
• How will my pregnancy be monitored? Ask what early monitoring will look like once you conceive.

Conclusion

Recurrent pregnancy loss has an identifiable cause in many couples. Each cause, whether genetic, uterine, hormonal, immune, or male-factor, leads to a different next step. For some, that step is IVF, often combined with preimplantation genetic testing, which lets a specialist select an embryo with a lower chance of a chromosomal error before transfer. For others, a treatable hormonal or immune condition means IVF is not the first line of treatment. In many cases, natural conception with closer monitoring remains a realistic path. What matters most is identifying, where possible, why the losses have happened. A thorough evaluation with a fertility specialist gives you a clearer picture of your options, whatever they turn out to be.