Recurrent loss: when IVF alone isn't the answer

Recurrent pregnancy loss is one of the hardest conversations I have. And one of the most important things I tell patients on day one is: this is not your fault, and we can almost always learn something.

The first thing we look at is whether the losses were chromosomally normal. PGT-A on embryos before transfer dramatically lowers the chance of a chromosomal loss. But if a loss happens after a euploid transfer, that's our cue to look at uterine factors and immunology.

I want to be careful about reproductive immunology. There are real findings — antiphospholipid syndrome, certain thyroid antibodies — and there are findings that don't yet have rigorous data behind them. We treat what's evidence-based and we don't add cost or risk for the rest.