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Recurrent Pregnancy Loss

Recurrent pregnancy loss, or RPL, is defined as three or more miscarriages before 20 weeks of pregnancy. The risk of a single miscarriage ranges from 15 percent to 50 percent or more per pregnancy, depending on the woman's age.

About 1 percent of couples suffer from RPL. RPL is an emotionally challenging experience.

UCSF's reproductive endocrinologists are trained specialists in RPL, and offer scientifically proven approaches to understanding miscarriage and preventing future pregnancy loss. We also offer ongoing close monitoring of all subsequent pregnancies, to provide support during what is generally an anxiety-provoking time. We recognize the emotional toll that miscarriage can take on a couple, and our team psychologist is available to provide additional emotional support to all couples with RPL.

With a thorough fertility evaluation, we are able to identify the cause of recurrent pregnancy loss (RPL) in 50 percent of couples. Potential causes are described below.

Chromosomal Cause

In approximately 4 percent of couples who experience RPL, one or both partners will have an abnormality of chromosome structure.

Anatomical Abnormalities

Abnormalities of the uterine cavity account for about 15 percent of RPL cases. Abnormalities may include a uterine septum (an abnormally-shaped cavity), scar tissue within the uterus, polyps or fibroids.

Immunological Causes

About 15 percent of couples with RPL have circulating antibodies that interfere with the proper function of the placenta, the tissue that supports the pregnancy. Blood tests can identify a set of these antibodies and, if found, the diagnosis of anti-phospholipid antibody syndrome (APS) can be made.

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The treatment for recurrent pregnancy loss (RPL) depends on what's causing the condition.

Chromosomal Cause

In cases where an abnormality of chromosome structure is causing RPL, one possible therapy is in vitro fertilization (IVF), with biopsy and chromosomal evaluation of each embryo, called pre-implantation genetic diagnosis.

Anatomical Abnormalities

Diagnostic tests such as hysterosalpingograms, saline sonohysterograms and hysteroscopy (an endoscopic inspection of the uterus) can be used to evaluate the uterine cavity. Many abnormalities within the uterine cavity can be corrected with minor surgery.

Immunological Causes

Anti-phospholipid antibody syndrome (APS) has been shown to respond to treatment with blood thinning medications.

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UCSF Clinics & Centers

Reproductive Health

Center for Reproductive Health
2356 Sutter St., Seventh Floor
San Francisco, CA 94115
Phone: (415) 353-7475
Fax: (415) 353-7744
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