Recurrent Pregnancy Loss After IVF

Most patients who lose a second pregnancy after IVF go straight into planning the next cycle. That’s understandable. But repeating the same protocol without investigating why the losses happened is what keeps the pattern going. Recurrent pregnancy loss after IVF — two or more losses after confirmed implantation — has an identifiable cause in more than half of cases, covering embryonic chromosomal errors, problems inside the uterine cavity, hormonal gaps, and immune or clotting disorders that weren’t part of the original fertility workup.

According to Dr. Pooja Papishetty, a fertility specialist at Best IVF Centre in Kondapur, “Recurrent loss after IVF is not a sign that pregnancy is impossible. It’s a signal that something specific needs to be identified and corrected before the next attempt.” 

Usually there’s a reason. It just hasn’t been found yet.

• Chromosomal errors in the embryo account for the largest share of early losses, both in IVF and natural conception, and the proportion of affected embryos rises steeply with maternal age — which is why patients over 35 can produce embryos that look perfect on Day 5 and still fail to sustain beyond 7 or 8 weeks consistently.
• Uterine structural issues. And this is where RPL cases most commonly go undiagnosed. A uterine septum present since birth, adhesions left from a past D&C or infection, or a submucosal fibroid sitting inside the cavity can all allow implantation to happen while still blocking the pregnancy from developing further. Standard ultrasound misses most of these.
• Antiphospholipid syndrome. Antibodies attack the early placental blood supply. Pregnancies start, then stop, at a consistent gestational age — and that timing pattern is actually a clue that points straight toward a clotting cause once someone tests for it.
• Thyroid and progesterone issues. So this one gets missed a lot because TSH within normal population range isn’t always adequate for early pregnancy. Subclinical hypothyroidism and luteal phase progesterone insufficiency are both correctable once confirmed, but neither gets identified unless the testing is done at the right point in the cycle.

Knowing which category a patient falls into is what allows IVF treatment to be adjusted in a way that actually addresses the problem.

Two losses warrant a full workup. Waiting for a third before investigating isn’t the right call.

• PGT-A embryo screening tests each embryo for chromosomal abnormalities before any transfer takes place, and for patients whose losses are driven by aneuploid embryos — which is genuinely the most common finding — this single protocol change has a measurable impact on what happens in the next cycle.
• Hysteroscopy. This one catches people off guard because they’ve had normal ultrasound reports. But a direct camera inside the uterine cavity finds things that scans can’t — adhesions, a septum, retained tissue from a prior loss — and whatever’s found gets corrected in the same sitting rather than in a separate procedure.
• Immune and clotting panel. Antiphospholipid antibody testing and thrombophilia screening are the core tests here. If antiphospholipid syndrome comes back positive, managing the next pregnancy with low-dose aspirin and heparin from the point of confirmed implantation changes outcomes in a way that no protocol tweak alone can match.
• Switching to a frozen transfer cycle. Many patients with RPL do better with a frozen embryo transfer using a carefully prepared endometrial lining rather than a fresh cycle, because stimulation hormones can affect uterine receptivity in ways that aren’t visible on the day of transfer but show up in the outcome weeks later.

Understanding why frozen embryo transfer gives better results in certain patient profiles is worth reading before planning the next cycle.

RPL patients who come to Matrika after two or three failed cycles elsewhere very often haven’t had a hysteroscopy. Or the thyroid test was done once, came back within range, and was never looked at again with pregnancy-specific cutoffs in mind. Dr. Pooja Papishetty, MBBS, MS Obstetrics and Gynaecology, Fellowship in Reproductive Medicine from Bedi Hospital Chandigarh, FOGSI and IMA member, builds a structured investigation into every RPL case before discussing another cycle. The protocol for the next attempt is decided by what the investigation found, not by what was used before.

That’s the part most patients haven’t experienced yet.

Call +91 7702934122 to book a consultation.

References

1. Immunological factors in recurrent pregnancy loss: mechanisms, controversies, and emerging therapies. PMC. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12292111/
2. Exploring immunological aspects and treatments of recurrent pregnancy loss and recurrent implantation failure. PMC. 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11818386/

Disclaimer: This blog is for educational purposes only and is not a substitute for professional medical advice.