Recurrent Pregnancy Loss

Recurrent pregnancy loss is not a single disease but a symptom that can arise from several different underlying issues. A pregnancy loss is the spontaneous end of a pregnancy before the baby can survive outside the womb (before 24 weeks). When this happens two or three times in a row, it is more likely — though not certain — that there is an underlying factor contributing, rather than simple bad luck occurring repeatedly. It is important to understand that each individual miscarriage is most often caused by a random chromosomal error in that particular pregnancy, and is very rarely something the mother did or could have prevented. The purpose of an RPL assessment is to look specifically for the smaller number of persistent, treatable factors that can recur from pregnancy to pregnancy.

Several recognised factors are linked to recurrent loss, though many couples have none of these:

• Antiphospholipid Syndrome (APS): An autoimmune clotting disorder and the most important *treatable* cause, found in roughly 15% of women with RPL.
• Uterine (Anatomical) Factors: A septate (divided) uterus or other structural differences can interfere with implantation and growth.
• Genetic / Parental Karyotype: In a small percentage of couples, one partner carries a balanced chromosomal rearrangement (such as a translocation) that is harmless to them but can cause repeated losses.
• Endocrine Disorders: Poorly controlled thyroid disease (both under- and over-active), poorly controlled diabetes, and possibly low progesterone.
• Thrombophilia: Certain inherited clotting tendencies.
• Age & Lifestyle: Advanced maternal age increases chromosomal errors; smoking, high alcohol intake, and obesity also raise the risk.
• Consanguinity: Where parents are related, shared recessive genetic factors may play a role, which is a particularly relevant consideration for many families in the UAE.

Even after a full workup, around half of couples will have no cause identified — this is called *unexplained* RPL, and importantly it still carries a good prognosis.

The RPL workup is a systematic set of investigations, ideally arranged when you are not pregnant so results are reliable:

1. Antiphospholipid Antibodies: Blood tests for lupus anticoagulant, anticardiolipin, and anti-beta-2-glycoprotein antibodies, repeated 12 weeks apart to confirm a diagnosis of APS.
2. Pelvic Ultrasound (± 3D or MRI): To assess the shape of the uterus and look for structural factors, fibroids, or adhesions.
3. Parental Karyotyping: Blood chromosome analysis of both partners, usually offered when a genetic cause is suspected, alongside testing of pregnancy tissue (products of conception) where available.
4. Thyroid & Metabolic Screen: Thyroid function (TSH and antibodies) and screening for diabetes.
5. Thrombophilia Screen: Considered in selected cases.

We review your full history together, including how far each pregnancy progressed, as this often guides which tests are most useful.

Treatment is directed at any cause we find, and is always combined with supportive care:

• Antiphospholipid Syndrome: The evidence-based treatment is low-dose aspirin plus low-molecular-weight heparin (a blood-thinning injection) started in early pregnancy. This significantly improves live birth rates in women with APS.
• Thyroid Disease: We optimise thyroid hormone levels *before* conception and monitor them closely throughout pregnancy; treating an underactive thyroid is straightforward and effective.
• Uterine Factors: A uterine septum can sometimes be corrected with a minor hysteroscopic procedure.
• Genetic Factors: Where a parental chromosomal rearrangement is found, we offer genetic counselling and discuss options including natural conception with prenatal testing, or IVF with preimplantation genetic testing.
• Progesterone: For women with early bleeding and a history of miscarriage, vaginal progesterone in early pregnancy is offered based on current evidence.
• Supportive Care: Early pregnancy reassurance scans, close monitoring, and emotional support are a cornerstone of care and are themselves associated with better outcomes.

The outlook after recurrent loss is far more hopeful than many couples fear. Even with unexplained RPL and no specific treatment, the chance of a successful next pregnancy remains around 60–75%, and higher still when a treatable cause is found and addressed. The single strongest factor is often maternal age. We understand that the anxiety of a subsequent pregnancy can be intense, so we provide a dedicated early pregnancy pathway with frequent scans and direct access to our team for reassurance. Each pregnancy is monitored on its own, and reaching each milestone — a heartbeat, the end of the first trimester, the anomaly scan — is a meaningful step forward.

You should seek specialist assessment if you have experienced two or more consecutive pregnancy losses. There is no need to wait for a third loss to be investigated. Referral is particularly important if:

• You have a known autoimmune condition, thyroid disorder, or clotting disorder.
• There is a family history of recurrent loss or a known chromosomal rearrangement.
• You and your partner are related (consanguineous), which may warrant genetic counselling.

At the MFM Unit, Dr. Leanne Bricker and our team provide a complete recurrent loss service — from investigation and genetics counselling to a supported, closely monitored next pregnancy. Reaching out for help is a positive and proactive step.