RPL Meaning and How It Affects Pregnancy

Pregnancy loss is a devastating time in anyone’s life, with about 15% to 20% of pregnancies resulting in miscarriage. Now imagine experiencing multiple pregnancy losses, which is the case for approximately 1% of reproductive-aged women. This is known as recurrent pregnancy loss, or RPL.

“Recurrent pregnancy loss is having two or more consecutive first-trimester pregnancy losses,” explains Jessica Ryniec, M.D., a reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston.

For women diagnosed with RPL, the effects on their health can be traumatic. Lillian Ostrach, 39, of Flagstaff, AZ, received her RPL diagnosis in March 2020 following her third pregnancy loss, and after several subsequent miscarriages – and no living children – she and her husband are now pursuing gestational surrogacy. 

“Repeated and recurrent pregnancy loss has taken all the joy out of trying to have a live baby,” Ostrach tells Rescripted. “It's affected my physical health, my mental health, my job/career, and my relationships. I don't really trust anyone – medical providers, experts, etc. – and I don't trust my body, either. My body has failed us seven times despite doing everything right.”

Kayla is a 31-year-old mom of one from Michigan who desperately wants to give her daughter a sibling. She was diagnosed with RPL in October 2024 after her second missed miscarriage – and sustained her third miscarriage while being interviewed for this article: “I wanted very badly to give my living daughter a sibling,” she tells Rescripted, “but as these losses continue to happen, it feels like I lose a part of myself each time. I’ve been struggling a lot with a sense of depression, bitterness, and rage. I’m angry at others for getting pregnant, angry at my body for continuing to fail me over and over, resentful of people with two children or more.” 

What makes RPL that much more challenging it’s not always possible to determine a cause – or a treatment. Rescripted spoke with Dr. Ryniec to better understand the complexities of RPL, and how it can affect pregnancy in the long run.

Potential causes of RPL

“Unfortunately, when it comes to recurrent pregnancy loss, about 50% of the time we do not find a cause even after a thorough evaluation,” says Dr. Ryniec. This is the case for both Kayla and Ostrach. Despite undergoing genetic testing, Kayla still has no explanations for her losses: “Per the doctors, the losses I have experienced are ‘random chance’ and ‘bad luck.’”

Ostrach believes her RPL is due to a “uterine issue,” citing her care team’s theory of “incorrect placental development.” Still, she ultimately “doesn’t have specific or definitive diagnoses for why we continue to lose genetically normal pregnancies.”

But for the 50% who are able to receive an explanation for their RPL, Dr. Ryniec lists the following as potential causes that can be confirmed via testing:

• Uterine factors include congenital uterine variants like a uterine septum, unicornuate, and bicornuate uterus. Other uterine-related causes include fibroids, polyps, intrauterine scarring, and adenomyosis.

• Antiphospholipid syndrome, which is an autoimmune blood clotting disorder 

• Hormonal factors such as diabetes or insulin resistance, thyroid dysfunction, PCOS, or elevated prolactin

• Genetic factors including parental chromosomal rearrangements like a balanced translocation

Evaluation and treatment for recurrent pregnancy loss

Finding out the reasons behind your recurrent pregnancy loss can be an arduous process, but the more information you have about your body, the better-armed you and your care team will be should you wish to try to conceive again. 

Evaluating uterine factors 

“Evaluation for uterine factors could include a hysterosalpingogram, saline ultrasound, 3D ultrasound and/or hysteroscopy,” says Dr. Ryniec. “Some may recommend an endometrial biopsy as well.”

Treating uterine factors

“Treatment depends on what is found, but often includes surgery to resect a uterine septum, or to remove fibroids, polyps, or scar tissue,” says Dr. Ryniec. 

Evaluating Antiphospholipid syndrome 

“Evaluation includes bloodwork looking for antiphospholipid antibodies typically on two occasions 12 weeks apart.” 

Treating Antiphospholipid syndrome  

“Treatment is baby aspirin and heparin or Lovenox (a blood thinner) during pregnancy”

Evaluating and treating hormonal factors

“Evaluation for hormonal factors such as diabetes or insulin resistance, thyroid dysfunction, PCOS, and elevated prolactin includes bloodwork and treating the underlying issue.”

Evaluating and treating genetic factors

“Evaluation includes bloodwork called a karyotype for both partners," says Dr. Ryniec. "Treatment could include in vitro fertilization with preimplantation genetic testing for structural rearrangement (PGT-SR) to find an embryo that is not affected by the chromosomal rearrangement.”

Moving forward with RPL

Although grief and pregnancy loss do go hand in hand, an RPL diagnosis isn’t necessarily a sign to stop TTC. “Many people with recurrent pregnancy loss go on to have a healthy live birth with (or without!) treatment,” says Dr. Ryniec. “Studies have shown up to 65-75% of people go on to have a successful live birth after RPL.”

Since pursuing another pregnancy after RPL is a personal decision, Dr. Ryniec first recommends “a thorough evaluation, and then [you can] determine how much intervention you want to do.” She also reiterates that “there is no perfect, clear treatment for RPL since a cause is only found half the time.” 

While Kayla plans to keep working with her fertility specialist and voices a desire to attempt pregnancy one more time, she also admits she “[doesn’t] have it in me to continue losing pregnancies over and over.” 

Ostrach, meanwhile, decided to go the gestational surrogacy route and now uses her experiences to help others on their fertility journey. She regularly shares her story on her Instagram, @inconceivablyflagstaff, where she also provides support and resources for others in the infertility community. “RPL has wrecked me, completely devastated me from the inside out,” says Ostrach, “and yet it has also led me to become a better, softer, and more understanding person.” 

Whatever your post-RPL next steps are, keep Dr. Ryniec’s words of wisdom in mind:  “The most important thing to know is [RPL] is not your fault. Find a good support system and don't be afraid to lean on it.”

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Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.