You have been through a loss
most people don't understand.
This guide exists to give you an honest framework about what medicine actually knows, what it does not, and how to make sense of a space where hope and science do not always move at the same speed.
Hopefully it brings you both comfort and the content to help you keep moving forward.
This takes about 10 to 15 minutes. At the end you will have a printable, personalized question list to bring to your care team. Nothing is stored or transmitted.
Not a substitute for clinical care.
Tell me a little
about where you are.
These answers shape which questions get generated for you. Skip anything you are unsure about.
Are you currently pregnant, actively trying, or neither?
How many pregnancy losses have you had?
Have you seen a Reproductive Endocrinologist (REI) for your losses?
Standard RPL workup
Mark what you have already had done. Anything marked "Not yet" will generate specific questions for your provider.
How are you feeling emotionally right now as you work through this?
What medicine knows;
and what it doesn't yet.
Read through each section. Select any treatments you want to discuss with your provider by tapping the circle; they will feed into your personalized question list. Tap any highlighted term for a definition.
Before anything else
What you are carrying is real
It is important to name it. A pregnancy loss, no matter when, is a death. It is the death of a future you had already begun to build in your mind; a due date, a name you may have chosen, a version of your life that included this child. That loss is real whether it happened at five weeks or twenty. Whether anyone around you acknowledged it or even knew. Whether you have had one loss or five.
Recurrent pregnancy loss, typically defined as two or more pregnancy losses, affects approximately 1 to 2% of couples trying to conceive. It is not rare enough that you should have to explain it. It is not uncommon enough that the medical community has solved it. Those two things are both true, and they leave patients in a painful gap.
"You are not broken. You are not being punished and most importantly THIS IS NOT YOUR FAULT. And the fact that medicine cannot yet fully explain what is happening to you is not a reflection of how hard you have tried."
What we know
The legitimate workup and its limits
When RPL is evaluated by a qualified provider, there are specific, evidence-supported things to look for. These are the conditions where we have both a biological explanation and a treatment that makes a documented difference.
Treatable; guideline-supported
Antiphospholipid Syndrome (APS)
APS is an autoimmune condition increasing thrombotic risk and impairing placentation. Treatment with low-molecular-weight heparin (Lovenox) plus low-dose aspirin is well-established and genuinely improves live birth rates. Testing requires specific antibody panels confirmed on two occasions at least 12 weeks apart.
APS diagnosis requires confirmation. A single positive test is not sufficient. There are specific values that determine a true positive, so even an abnormal flag on a lab test may not represent a true abnormal result.
Most common; no proven cause found
Unexplained RPL
In the majority of RPL cases, even after a thorough workup, no definitive cause is found. Estimates suggest 50% or more of cases remain unexplained after standard evaluation. This is not a failure of your workup and it is not a failure of your body. It is the current boundary of what medicine understands.
The probability of a successful pregnancy after unexplained RPL, even without treatment, is meaningful; often 60 to 70% by the third subsequent pregnancy in women under 40. This matters because it is easy to be trapped by anecdotes; by the person who had three losses and then succeeded with a new treatment. But many times it is just biology and chance, which is why understanding the difference between positive and negative studies matters.
Chromosomal analysis of pregnancy tissue (POC) can sometimes identify aneuploidy as the cause of a specific loss. This information does not change future treatment but can provide meaningful understanding.
The hardest truth
Medicine does not yet have the answers
We do not know why most recurrent pregnancy losses happen. We have hypotheses, some of them compelling. We have biological frameworks that are scientifically plausible. We have treatments that seem like they should help, based on mechanisms that make sense on paper. But when those treatments are tested rigorously in controlled trials, many of them do not hold up. Not yet, anyway.
"Not yet" is doing important work in that sentence. We are at an early and genuinely uncertain moment in reproductive immunology. An honest practitioner can hold that uncertainty. The question to ask is not whether your provider is a good person; it is whether this treatment is supported by evidence rigorous enough to justify its cost and risks, given where the science currently stands.
A panel of immune tests with proprietary reference ranges, results that come back abnormal, a treatment protocol at significant out-of-pocket cost, and success attributed to the treatment without a comparison group. This can exist even when the provider running it is sincere. Right now there is a lot of money in these things but much of it remains unproven.
The treatments
What is being offered; and what the evidence shows
Select any treatment you want to discuss with your provider. Expand any card to read the full evidence summary and how guidelines in the UK, Canada, and Europe compare to US practice.
Clarifying what
feels most true.
These questions shape your personalized question list. There are no right answers. Skip anything that does not apply.
Questions to bring
to your care team.
Generated from your situation, workup, selected treatments, and values. Add your own below. Print or save as PDF to bring to your appointment.
A note on international guidelines
Your own questions
What else do you need to know? These will appear on your printed list.
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