Two losses. Three losses. Normal chromosomal results. A doctor who calls it bad luck and recommends trying again. This experience is one of the most heartbreaking and isolating in the fertility journey. I want you to know: there are answers. They are just not being looked for in the standard workup.
The Immunological Causes That Are Routinely Missed
Elevated uterine natural killer cell activity is one of the most significant and underdiagnosed causes of recurrent pregnancy loss. In a normal pregnancy, natural killer cells are suppressed to allow the embryo to implant. In some women, this suppression does not occur adequately, and the immune system attacks the developing pregnancy.
Antiphospholipid syndrome creates blood clotting that disrupts the developing placenta and is present in 5 to 10 percent of women experiencing recurrent loss or repeat implantation failure. Many women are tested for one or two antiphospholipid antibodies but not the full panel. Thrombophilia disorders, including Factor V Leiden, affect blood flow to the implanting embryo and require their own targeted testing.
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Structural Factors That Standard Imaging Misses
A uterine septum, a band of tissue dividing the uterine cavity, is one of the most commonly missed structural causes of recurrent loss. It is often invisible on a standard 2D ultrasound and requires a 3D ultrasound or hysteroscopy to identify. Intrauterine adhesions from previous D&C procedures can reduce the surface area available for implantation.
Subclinical chronic endometritis (CE), inflammation of the uterine lining without obvious infection, impairs the receptivity of the lining and is diagnosed by endometrial biopsy. When women with recurrent loss are actually tested for it, up to 66 percent come back positive, and most were never tested at all.
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What to Ask For
Request a full reproductive immunology panel. Ask about NK cell testing, antiphospholipid antibodies including the extended panel, and thrombophilia screening. Request a 3D uterine ultrasound or diagnostic hysteroscopy if structural issues have not been fully ruled out. Ask about an endometrial biopsy for chronic endometritis. These are not fringe tests. They are appropriate and indicated after two or more losses, and it is worth insisting on them even if a previous doctor has attributed everything to egg quality alone.
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This post is for educational purposes only and is not a substitute for personalized medical advice. Please consult your own doctor before making changes to your care.