Recurrent Pregnancy Loss

Experiencing pregnancy loss can be deeply distressing, particularly when it happens more than once. Understanding possible contributing factors is an important step toward finding answers and regaining a sense of control. Through careful assessment and personalised investigation, we can identify potential causes and create a plan tailored to your needs. I’m here to support you with compassionate, evidence-based care - helping you make sense of your experiences, explore your options, and move forward with clarity, reassurance, and hope for a healthy pregnancy.

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“Understanding recurrent pregnancy loss helps you make sense of your experiences, explore your options, and feel supported and empowered on your journey toward a healthy pregnancy.”

Recurrent Pregnancy Loss (RPL)

Expert assessment, clear answers, and supportive care

Recurrent pregnancy loss (RPL) affects 1-2% of women and can be emotionally devastating. It’s definition has been an area of debate. ESHRE guidelines define it as two or more consecutive pregnancy losses. Many causes are identifiable and treatable with the right evaluation.

Comprehensive Evaluation for RPL

  • Genetic: Parental karyotype, products-of-conception testing when appropriate

  • Endocrine: Thyroid disorders, hyperprolactinaemia, PCOS, luteal phase deficiency

  • Anatomical: Uterine septum, adhesions, fibroids, polyps (3D ultrasound ± hysteroscopy)

  • Immunological/Haematological: Antiphospholipid syndrome (APS) testing, inherited thrombophilias (selective testing)

  • Lifestyle & metabolic factors: Weight, nutrition, smoking, alcohol, environmental exposures

  • Male factor: Semen analysis, sperm DNA fragmentation (if indicated)

Treatment Options

  • Progesterone supplementation (per PRISM and PROMISE data – benefit in early pregnancy bleeding and selected women)

  • Surgical correction of uterine septum, polyps, adhesions

  • Endocrine optimisation - thyroid, prolactin treatment, metabolic support

  • APS-specific therapy (low-dose aspirin ± heparin as per guideline)

  • Lifestyle optimisation and preconception planning

  • Chromosomally tested embryos (PGT-A) in selected cases where recurrent aneuploidy is suspected

  • Emotional and psychological support

RPL demands clinical expertise and sensitive care. Dr Rebecca Mackenzie-Proctor works closely with patients to understand the cause, explain findings clearly, and develop a plan that improves the likelihood of a healthy pregnancy while addressing the emotional impact.

Recurrent Implantation Failure (RIF)

Investigation and tailored strategies for those struggling to achieve implantation

Recurrent implantation failure is typically defined as failure to achieve a clinical pregnancy after transfer of multiple high-quality embryos, usually ≥3 blastocysts or embryo transfers depending on patient age and circumstances.

Assessment Framework

A comprehensive evaluation includes:

  • Embryo-related factors

    • Embryo morphology, blastocyst development, aneuploidy rates

    • Consideration of PGT-A

    • Culture review with embryology team

  • Uterine & endometrial factors

    • 3D ultrasound, saline infusion sonogram or hysteroscopy

    • Endometrial thickness, pattern, polyps, adhesions

    • Chronic endometritis screening when appropriate

  • Hormonal & systemic factors

    • Thyroid function, prolactin, metabolic assessment

    • Luteal phase adequacy

    • Vitamin D and micronutrient profile

  • Transfer technique & laboratory factors

    • Review of transfer difficulty

    • Endometrial preparation protocol (natural, modified natural, HRT cycle)

    • Timing of progesterone exposure and receptivity window

  • Lifestyle & environmental factors

    • Weight, sleep, nutrition, exercise, endocrine disruptor exposure

    • Smoking, alcohol, stress management

Evidence-Based Treatment Options

  • Optimisation of transfer technique

  • Endometrial preparation individualised to natural cycles, modified natural, or HRT

  • Hysteroscopy to address adhesions or polyps

  • Treatment of chronic endometritis (if confirmed)

  • Progesterone protocol adjustment

  • Addressing metabolic, thyroid, and hormonal conditions

  • Considering PGT-A in selected cases

  • Lifestyle optimisation programs (nutrition, stress support, antioxidant strategies)

Note: Immune therapies such as intralipids or steroids are not recommended without an evidence-based indication.

RIF requires a precision-medicine approach. Dr Rebecca Mackenzie-Proctor collaborates with fertility scientists, embryologists, and multidisciplinary specialists to optimise every factor: embryo quality, endometrium, transfer technique, and systemic health. Care is transparent, data-driven, and aligned with international evidence.

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