What is recurrent pregnancy loss?
Recurrent pregnancy loss (RPL) is most commonly defined as two or more clinical pregnancy losses, though some guidelines retain a threshold of three. ASRM's current definition is two or more failed pregnancies confirmed by ultrasound or histopathology. RPL is evaluated separately from primary infertility because the diagnostic workup and treatment considerations differ.
Causes of RPL fall into several categories: chromosomal abnormalities (in either parent or in the embryo), uterine anatomical factors (septum, fibroids, adhesions), endocrine disorders (uncontrolled diabetes, thyroid dysfunction), antiphospholipid syndrome, and a substantial "unexplained" group. Workup typically includes parental karyotyping, evaluation of the uterine cavity (sonohysterography or hysteroscopy), thyroid testing, antiphospholipid antibody panel, and review of medical and obstetric history.
Importantly, the underlying cause of most pregnancy losses (whether or not the patient meets RPL criteria) is chromosomal abnormality of the embryo. The probability that any given embryo carries a chromosomal abnormality rises sharply with maternal age.
How common is it among IVF patients?
Recurrent pregnancy loss is reported as a contributing diagnosis at 425 of 458 US clinics in the most recent CDC data, with an estimated 59,847 IVF cycles annually citing RPL as a diagnosis.
Patients with RPL who pursue IVF often do so with a goal of preimplantation genetic testing for aneuploidy (PGT-A), under the rationale that selecting chromosomally normal embryos for transfer may reduce miscarriage risk for couples whose losses are driven by aneuploidy. The evidence base for PGT-A in RPL is mixed and continues to evolve.
How RPL affects IVF outcomes
IVF success rates for RPL patients depend heavily on the underlying cause. When RPL is driven by aneuploidy in older patients, transfer of euploid (chromosomally normal) embryos identified by PGT-A is associated with lower miscarriage rates per transfer compared to untested embryos. However, the per-cycle live birth rate may not improve substantially because some cycles do not produce any euploid embryos for transfer.
For RPL with identified anatomical causes (uterine septum, submucosal fibroids), surgical correction before IVF or transfer is often recommended. For RPL with antiphospholipid syndrome, anticoagulation during pregnancy is the established intervention. For RPL where workup is negative ("unexplained RPL"), the next pregnancy is statistically more likely to succeed than to result in another loss, with or without IVF.
What approaches are commonly discussed
RPL management is highly individualized to the underlying cause:
- Workup-driven treatment. Correct identifiable causes: hysteroscopic septum resection, treatment of thyroid dysfunction, anticoagulation for antiphospholipid syndrome, etc.
- IVF with PGT-A. Considered when aneuploidy is the suspected mechanism, particularly in older patients.
- Donor gametes. Discussed in cases of severe parental chromosomal abnormalities or when multiple PGT cycles fail to produce euploid embryos.
- Expectant management with monitoring. For unexplained RPL in younger patients, supportive care during the next pregnancy with serial ultrasound and emotional support is often as effective as more interventional approaches, given that the next pregnancy is statistically more likely to succeed than fail.
ASRM has explicitly cautioned against unproven "reproductive immunology" treatments (intravenous immunoglobulin, immune therapies for non-antiphospholipid causes) outside of controlled research settings, citing absence of evidence and significant cost.
Questions to ask your fertility specialist
If RPL is part of your diagnosis, the following questions can help structure the conversation:
- What specific tests have we done, and what specific causes have we ruled in or out?
- Given my age and history, what is my expected live birth rate without IVF in our next attempt?
- If we're considering IVF with PGT-A, how does that change the math for us specifically?
- What is your clinic's policy on transferring untested versus tested embryos for RPL patients?
- If we don't get any euploid embryos, what's the next step?
- Are there any treatments you'd recommend that are not supported by current ASRM guidance, and why?
- What support resources do you offer for patients navigating recurrent loss?
US fertility clinics with the highest reported rpl cycle volume
The list below ranks US fertility clinics by estimated annual cycles citing rpl as a diagnosis, derived from each clinic's CDC-reported total cycle count multiplied by the percentage of cycles citing this diagnosis. Volume is a signal that a clinic regularly treats this diagnosis. It is not a measure of success rate or quality. CDC does not publish per-diagnosis success rates at the clinic level, so a "best clinic for rpl" cannot be derived from this dataset alone.
How we computed these numbers
The clinic-level numbers on this page come from the CDC's National ART Surveillance System (NASS), specifically the 2022 ART Surveillance Report, which is the most recent dataset available. CDC publishes these reports on a two-year lag.
Estimated annual cycles for this diagnosis are computed by multiplying each clinic's total reported cycles by the percentage of cycles in which rpl was cited as a diagnosis. The CDC reports these percentages but does not publish absolute cycle counts per diagnosis, so the figures here are estimates.
A single IVF cycle can have multiple diagnoses recorded. A patient with both male factor and diminished ovarian reserve would have both diagnoses counted, which is why the percentages reported by clinics often sum to more than 100%. The "share of all CDC IVF cycles" stat above is therefore an approximation of how often this diagnosis appears in any cycle's record, not a percentage of cycles where it is the sole cause.
Editorial content on this page was last reviewed on April 30, 2026. We aim to update each diagnosis page when major guidelines from ASRM, ACOG, AUA, the Endocrine Society, or related professional bodies are revised.