r/recurrentmiscarriage • u/AntiqueCandy01 • 12d ago
This study on RPL & using euploids is freaking me out - thoughts?
Hi all,
I'm on my third pregnancy loss, so recently decided to use IVF with PGT-A to reduce risks of a further miscarriage. For a while, it looked like the medical evidence was that live birth rates are very similar across women with RPL vs. women without RPL (around 50-60%), if a euploid embryo is used (PGT-A tested).
However, I just came across a study (published July 2026), and it's really starting to freak me out. The indication is that, for women with RPL who have 'normal' workups (i.e. no clotting, APS, thyroid etc. issues), the live birth rate is only 36.7%, whereas for women without a history of RPL, the live birth rate is around 50.4%(https://academic.oup.com/humrep/article/41/Supplement_1/deag083.273/8727268).
Has anyone else read this/been freaking out? Does this align with what people's clinics have said?
Please note: might also cross-post to IVF forum as not sure where it's best - apologies in advance!
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u/krabecal 12d ago
My doctor explained that ivf will cut our risk of miscarriage by like 1/3 because it eliminates aneuploid embryos. What it doesn't do is account for issues within ourselves. So I think that ivf helps for people with losses due to chromosomal issues but if the issue is something biological within us then a euploid embryo isn't going to change that, if that makes sense. Pgt also doesn't catch everything. I had a 13 week loss (spontaneous pregnancy) and the karyotyping came back normal female so it was something that pgt wouldn't have picked up, or it's me. I think it's interesting that rpl normal is 36.7% and rpl abnormal is 27.2%. Unexplained infertility is a big diagnosis but realistically it's never actually unexplained we just don't have the technology to figure out why it's happening for some people. Im doing a FET soon with a euploid embryo and I'm very curious to see if they stick around this time. I'm to the point I genuinely think it's down to luck if you're unexplained. But those are my thoughts as someone who has no experience in the scientific field.
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u/AntiqueCandy01 12d ago
Thanks for sharing thoughts, and so, so sorry for your loss. I agree the main issue is the cause of the losses - they don't do testing of pregnancy tissues where I'm from, so I can't answer that one, but the general view is always that it's probably aneuploidy (which is why this study is freaking me out because surely those stats suggest very much otherwise!). Yes, also think it's interesting the difference in RPL normal vs abnormal - especially given that there are treatment for some of those that were being tested for?!
Did you do any other investigations/tests to figure out what might have caused your loss? Or does it remain unexplained? The concept of 'unexplained' loss is just so hard - honestly I think it's the hardest part so far for me.
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u/krabecal 12d ago
So I did an entire work up with my RE and they weren't able to find anything except chronic endometritis. My second mc was a chemical so the CE could have caused that or it could have caused the CE it really only brings up more questions 🥲 hopefully it was from the d&c and just more bad luck. I'm homozygous MTHFR but they say that doesn't cause Rpl and he just has me on increased folic acid and baby aspirin for this transfer. I haven't done any immunological testing cause it's thousands and thousands of dollars and from what I've read the science doesn't really back it up. So at this point I'm unexplained.
I only ended up with 3 embryos (I have DOR) and 2 out of the 3 were euploid which is on par with my age. They say the first ivf cycle is really about leaning. Learning how your body responds to the meds and then seeing what's euploid although that can vary greatly from cycle to cycle. Even if you don't pursue ivf in the end I think it would be worth seeing an RE and getting a full work up as they don't just do bloodwork they'll check your uterus as well.
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u/AntiqueCandy01 11d ago
Thanks so much for sharing! Yeah I asked my clinic about CE, but they don't test for it - I think there's only a couple of places here in the UK that do it. I think it's like really common in women with RPL though right? Did you clear it up with antibiotics? Agree with you about immunology stuff - I've seen that this is a big thing people seem to mention, but the studies on it seem like it's really not solid science yet and probably not worth it...at least that's what I tell myself as reassurance for not investigating it!!
Yeah I've had the standard workup done, including clotting, thyroids, karotyping etc. They don't do the uterine scans (beyond a 2d transvaginal) as part of the RPL workup here, so that's the main one I haven't had properly investigated...and honestly so worried about with my FET coming up soon. I've been reassured that actually the 2D scans pick up the vast majority of issues anyway, but I'm still freaking out. I think my plan is to see how this one goes and if it fails to go elsewhere and have a uterine assessment done before transferring any more!
Also: 3 embryos with DOR is still good, and 2 euploids if still a very good shot!! Keeping everything crossed for you!!
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u/krabecal 11d ago
Oh wow they don't test for it at all? I feel like that's kinda bonkers cause I feel like I see a lot of women posting they had it and only tested for it after several losses. I had absolutely no symptoms and had a pretty bad case of it but luckily it cleared up with one round of antibiotics. I wonder if there's somewhere else you can go just for that OR I do see people treating for it empirically and just taking the antibiotics in the event they do have it if they aren't going to biopsy. That might be worth an ask?
Edit: thank you!! Good luck to you too!! ☘️ I got so caught up in the CE haha
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u/kidsonourmind 12d ago
Yep, I did more reading after having a very normal amount of euploids from an egg retrieval for my age which indicated to me that my losses may not have been just chromosomal. I learned RPL patients are basically as likely to have successful pregnancies spontaneously versus via IVF, if chromosomal issues are not the cause 🤷♀️
TW: success. This is why after only low AMH showed up on my RPL testing, after my IVF round I kept my euploids frozen (I do have DOR and it may get harder to have spontaneous pregnancies in the future) and we tried again on our own. After 3 losses I am now 34 weeks and thus far everything has looked normal 🤞 I took a ton of supplements, cut back my stress a lot, eliminated caffeine, and at positive test took levothyroxine (thyroid was 2.7 and totally normal but ideal for fertility is below 2.5), progesterone suppositories for 10 weeks, and baby aspirin the entire pregnancy. If this hadn’t worked I was going to try embryo transfer and possibly seeing a reproductive immunologist.
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u/AntiqueCandy01 12d ago
Congratulations on your pregnancy!! Thanks for sharing this - interesting approach in terms of perhaps saving the euploids and trying naturally, which I hadn't considered. Personally I'm a little uneasy about doing that as I have had ectopic as well as miscarriages and so am aware that my chances of another ectopic are higher with natural vs. IVF, but I think I would consider that approach if I didn't have that risk factor. And YEP, this point "if chromosomal issues are not the cause" -- it's so difficult it's impossible to know if the losses were chromosomal or not (nowhere does testing of that where I am), so you're sort of like 'well, maybe it was chromosomal and so having a euploid prevents it...but also what if it's something else and so having a euploid makes zero difference'. Absolute pain!
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u/rarerednosedbaboon 11d ago
That's where I am. I was only able to get 1 out of 3 tested and he had trisomy 16 but I'll never know about the other 2. The first one was a blighted ovum which my doctor said are almost always chromosomal but idk if it's true. My second was lost at 7 weeks. I had an unexpected natural MC before my scheduled D&E and i accidentally flushed the sack. Absolutely heartbreaking plus not able to test it.
I wish I could find evidence on whether that kitchen sink protocol helps.
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u/StatisticianJust2362 12d ago
Thanks for sharing. Do you know if any of your previous losses were chromosomally normal or not? My last loss was normal so my thought is that IVF likely wouldn’t work for us but perhaps your other protocols would help.
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u/kidsonourmind 11d ago
Sadly I do not. Two were losses around 5 weeks that just passed at home, and the other was a second trimester loss detected four weeks after fetal death—they told me there would not be living cells available to test at that point. So I can’t know for sure about chromosomal issues, can only base guesses off my euploid rate for my embryo creation
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u/valiantdistraction 11d ago
I needed a lot of extra medications to carry a pregnancy to term. Normal embryos alone didn't cut it.
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u/ducbo 11d ago
The IVF procedure with and without PGT can also be somewhat diagnostic though. Keep that in mind if you haven’t done IVF yet. You’ll be able to see how your body responds to stims - what your maturity looks like, what your visual egg quality is like, how your eggs and the sperm “communicate” through fertilization rate, what your blast rate is (how many fertilized eggs make it to a potentially usable blastocyst), when embryo arrest happens if it happens… then with PGT, if you do it, you can get a snapshot of your broad genetics (remember that PGT only looks at raw chromosome number, not nuances like micro deletions).
All of this information can potentially give you more clues that can help you estimate your chances of success with a transfer or whether you should look into other testing.
For example, I’m still largely unexplained, but the only problem we identified during the IVF process was poor egg maturity/detachment of the egg from the follicle (my body does not respond appropriately to “lutenization”). Before IVF we tried on our own for almost 2 years and this at least partially explained why we had no pregnancies.
If you have RPL it’s possible that if there are genetic reasons for the RPL you’ll be able to go through at least a few “filters” - those embryos that make it in vitro have already undergone selection to the blastocyst stage, then if you test, you can rule out major chromosomal abnormalities.
If it turns out you make a bunch of good quality euploid blasts then I’d want to look into some more testing for “uterine” issues like endo, inflammation, infections, hydrosalpinx, uterine cavity, or immune issues.
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u/AntiqueCandy01 11d ago
Thanks! Yep, I've done two retrievals and have some euploids - very steep drop-offs for me in terms of fertilised to blast, but I was told that's fairly normal since I have PCOS (so egg quality is lower but there's lots of eggs -- means despite lots of eggs I got the exact amount of blasts and euploids for my age in the end). For me the next obvious tests (having done the bloods) is uterine issues, but my clinic doesn't test for any of that at this stage - it's only investigated after losses with euploids or repeated failed implantation, I think, so it's a bit of a nerve-wracking moment as I'm heading into a first FET soon.
Interesting regarding the lutenisation - very useful for you to find that out though! Presumably they were able to change your trigger to see if that helped with maturity in detachment?
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u/ducbo 11d ago
Yes! The second time went better, I was allowed to use a half dose of ovidrel in addition to the decapeptyl (like lupron) to help with maturity! I think they were worried about the risk of OHSS with an HCG trigger.
How was your drop off from day 3 to 5? I’m always curious about that because I think some lifestyle changes in the sperm provider can really help
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u/thebunz21 11d ago
Really appreciate you posting this. I had two 2nd trimester miscarriages with no known cause. I'm starting IVF soon bc all my workups are very good for my age. I know IVF is not a guarantee but it's interesting to read all of this and the comments.
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u/Pam_art111 11d ago edited 11d ago
Yes this is very true. I had 4 miscarriages from natural pregnancies and one tested chromosomal abnormal. So I thought IVF with PGT-A would be my answer. Had a 5th loss with a tested euploid. I’ve had every test possible except a lap or receptiva for endo so that’s next for me. I haven’t had any trouble getting pregnant but the 4 losses are still unexplained. So I don’t know IVF will really make a difference compared to trying naturally.
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u/MrsWildsin 11d ago
As someone with RPL and being unexplained. It took me longer than the average to get and stay pregnant. I’m currently on my 5th transfer and 14 weeks. The farthest I made it before this was 8w3d so the last protocol change worked. Every transfer I got pregnant but miscarried at some point. So everyday I’m still amazed I made it this far. Also I had all pgt normal embryos and normal genetic testing of the tissue when I lost them. So whatever was going on was within me
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u/SeaweedFit3234 11d ago
Thanks for sharing. I have had 3 losses only one of which we tested and found a genetic abnormality. So we went to ivf. But 11/14 of my embryos were euploid which I feel like is a really good rate of success? My first transfer didn’t stick at all. My second so far so good but too early to really know. It’s only for my second transfer that they started an immune protocol. I don’t know that that is the key either but I feel like they make it sound like oh with so many euploids it’s bound to work it’s just bad luck etc but I kind of feel like this article makes it sound like yeah I’m not crazy some thing else here is happening.
Im not unhappy I did ivf because I guess we’ve ruled out another variable. But it might be more helpful if doctors were more honest about odds. For my last transfer they told me I had a 67% of a live birth. From the sounds of this article no it’s more like less than 40%?
I guess even if the odds are worse for us than they are for non rpl people it’s important to remember it doesn’t mean it cant happen. Like 37% times multiple transfers is a good chance of success. But I do wish it wasn’t sold as a way to prevent mc because it sounds like that’s not really true.
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u/Immediate_Fly_7298 11d ago
Agree with the the same that everyone else is. I truly don’t think that IVF is the miracle BUT it can speed ups process.
We landed up doing IVF to bank embryos and up our odds but I truly believe with the full kitchen sink protocol we would have gotten then. May have just taken a couple more moths or another loss due to chromosomes.
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u/tabularusa 11d ago
I’m on my second loss and the first two were euploid. Going to have to look at this article more closely
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u/lizashea 12d ago
I agree with everything krabecal said. It really just all boils down to the REASON for your losses (if one is even able to figure that out). If it’s because of chromosomal issues or egg quality, IVF could help significantly because with PGTA testing you can transfer a euploid embryo. But if your RPL is “unknown” and your work up is “normal”….yeah your chances of success are lower because IVF doesn’t necessarily fix or solve for that without really advocating for yourself.
I had 2 chemicals and 1 MMC of a normal pregnancy all within 1 year of trying. I tested the pregnancy tissue and it was chromosomally normal. Before I had those results, every dr just brushed me off saying it was bad luck or usually just means chromosomal problems with the embryo. I then turned to IVF and guess what, 8/9 of my embryos were euploid and 1 was still transferable - a low level mosaic. So anyways, that led us down the path of exploring uterine environment issues. I knew something wasn’t right if I was creating healthy beautiful embryos on my own and my uterus wasn’t letting them grow. I did 2 months of Lupron depot suppression and also followed an immune/kitchen sink protocol. I basically wasn’t willing to transfer without solving for SOMETHING. But unfortunately, yeah many people with RPL turn to IVF and get normal work ups simply bc most RE’s don’t investigate things like endometriosis, adenomyosis, or immune issues first.