Recurrent Miscarriages and Unsuccessful Embryo Transfers

When a pregnancy ends in early miscarriage multiple times or well-developed embryos fail to implant, it’s a heavy burden—both physically and, above all, emotionally. There are two things we’d like to share with you right from the start. First: The vast majority of couples eventually have a child, even after several setbacks. And second: In cases of repeated setbacks, we systematically search for the causes—honestly, calmly, and without false promises. In doing so, we clearly distinguish between what is truly proven and what is still experimental.

What This Is About

Recurrent pregnancy loss (RPL) is defined—depending on the criteria—as two or three early pregnancy losses. Recurrent implantation failure (RIF) is diagnosed when pregnancy does not occur even after multiple transfers of well-developed embryos. Both conditions are more common than people realize—and often, no single clear cause can be identified. This is frustrating, but it doesn’t mean there’s no solution.

The most common cause: the embryo’s genetic makeup

By far the most important factor is the embryo’s genetic material. The older the egg, the more likely an embryo is to have an abnormal number of chromosomes and be unable to develop further—it either fails to implant or is lost early on. This is not a case of the mother’s body “rejecting” the embryo, but rather a natural selection process. Preimplantation genetic testing (PGT-A) can examine the embryos’ chromosomes before transfer and thus help select the most promising one (more on this → “Preimplantation Genetic Testing”). It’s important to us to be open about this: Especially as women age, the cause is far more often related to the embryo than to the uterus “rejecting” it.

What We Investigate

In cases of repeated setbacks, we investigate the most important treatable causes—many of which we can assess directly here in our practice:

• Coagulation and antiphospholipid syndrome. Using a blood test, we specifically screen for antiphospholipid syndrome (APS)—an autoimmune disorder of blood clotting that can cause recurrent miscarriages and is easily treatable (with aspirin and blood-thinning injections). However, we no longer routinely perform a broad screening for hereditary coagulation disorders (such as Factor V Leiden or MTHFR): There is no clear link between these conditions and miscarriages, and an abnormal result would usually not require treatment (ESHRE).
• 3D ultrasound of the uterus. We use a three-dimensional ultrasound examination to assess the shape of the uterine cavity. This allows us to reliably detect a congenital malformation, such as a septum, and correct it surgically if necessary.
• Endometrial biopsy (Pipelle). During your appointment, we use a thin tube to take a small sample of the endometrium—this is quick and does not require anesthesia. We use this to check for silent inflammation of the endometrium (chronic endometritis), which can be identified by the presence of certain immune cells (plasma cells). If this is found, it can be easily treated with antibiotics (ESHRE).
• Thyroid and hormones. A thyroid disorder or certain thyroid antibodies can increase the risk of miscarriage; we test for both in a blood sample and, if necessary, treat them simply with medication.
• Parental Genetic Material. In selected cases, we also examine the chromosomes of both partners, as abnormalities are sometimes passed down through generations.

What We Can Treat

We treat whatever we find in a targeted manner: antiphospholipid syndrome with aspirin and blood-thinning injections, chronic endometritis with antibiotics, a thyroid disorder with hormones, and a septum in the uterus with a minor surgical procedure (for which we’ll refer you to a specialized center). In certain cases, we also support early pregnancy with progesterone.

And if no identifiable cause is found? As difficult as that is to accept—it’s often actually good news. It means there’s no permanent obstacle, and the chances of success on the next attempt remain high.

The Emotional Side

Repeated losses or unsuccessful attempts take a toll on your strength, your confidence, and sometimes even your relationship. You don’t have to go through this alone. We support you not only medically but also emotionally, and can connect you with additional support if needed (more on this → “The Emotional Side of Family Planning”).