Recurrent Pregnancy Loss: The Overlooked Factors More Women Deserve to Know About
If you’ve experienced recurrent pregnancy loss, first of all, we need to acknowledge something important:
You are not crazy for wanting answers.
And you are not “doing too much” by asking questions, researching, getting second opinions, or trying to understand what’s happening in your body.
Let’s be honest: being told your losses are “just bad luck” after multiple pregnancies is not exactly comforting. Especially when your intuition is screaming that something deeper might be going on.
Now, to be very clear, recurrent pregnancy loss is complex. Sometimes there is a clear explanation. Sometimes there are multiple contributing factors. And sometimes, frustratingly, medicine still doesn’t have great answers.
There are areas of fertility medicine where the research is strong and well established. And there are other areas — like the uterine microbiome, chronic endometritis, reproductive immunology, and implantation dysfunction — where the science is still emerging, evolving, and honestly… often debated.
But “limited research” does not mean “not worth investigating.” And this distinction matters for women navigating recurrent pregnancy loss.
What Counts as Recurrent Pregnancy Loss?
Clinically, recurrent pregnancy loss (RPL) is often defined as two or more failed pregnancies confirmed by testing or ultrasound.
Depending on the provider, the evaluation process may begin after two losses or after three. Unfortunately, many women still report being told to “keep trying” long after they feel emotionally and physically exhausted.
And while chromosomal abnormalities are one of the most common causes of miscarriage, they are not the only possible explanation — especially in cases of repeated loss.
Other potential contributing factors can include:
Structural uterine abnormalities
Hormonal dysfunction
Autoimmune conditions
Blood clotting disorders
Thyroid dysfunction
Sperm DNA fragmentation
Chronic inflammation
Infection
Endometrial dysfunction
Vaginal or uterine dysbiosis
The challenge? Some of these areas are much better studied than others.
Chronic Endometritis: One of the Most Overlooked Conversations in Fertility
Let’s clear something up first because the names are confusing.
Endometriosis ≠ Endometritis
These are not the same thing.
Endometriosis involves tissue similar to the uterine lining growing outside the uterus.
Chronic endometritis is chronic inflammation inside the uterine lining itself.
And despite sounding similar, they are entirely different conditions with different mechanisms.
Chronic endometritis has increasingly been studied in relation to infertility, implantation failure, and recurrent pregnancy loss.
One review published in the American Journal of Reproductive Immunology reported that chronic endometritis may be present in approximately 30% of women with recurrent pregnancy loss.
That’s not a small number and yet many women have never even heard the term before entering fertility treatment.
The Difficult Part: Research Is Still Inconsistent
This is where things get complicated — and where nuance matters.
There is currently no universal diagnostic standard for chronic endometritis.
Some clinicians diagnose it based on the presence of plasma cells in an endometrial biopsy. Others disagree on what number of plasma cells is clinically significant.
One doctor may treat at a certain threshold. Another may not. This inconsistency can be incredibly frustrating for patients because it means two people with nearly identical results may receive completely different recommendations depending on the clinic.
This does not mean chronic endometritis is fake or irrelevant. It means medicine is still trying to determine:
how best to diagnose it,
when it truly impacts fertility,
and which treatments are most effective.
That matters because women are often dismissed simply because the research isn’t fully settled yet.
But emerging research still deserves attention — especially in cases of recurrent pregnancy loss where obvious explanations have already been ruled out.
Vaginal Dysbiosis and Fertility: Another Emerging Area of Research
Now let’s talk about the microbiome because this area is getting a lot more attention in fertility conversations.
Your vaginal microbiome is made up of bacteria that help maintain a healthy environment. Ideally, Lactobacillus species dominate because they help maintain a protective acidic environment.
When that balance shifts — called vaginal dysbiosis — certain bacteria may overgrow.
One of the most discussed bacteria in fertility research is Gardnerella vaginalis, commonly associated with bacterial vaginosis (BV).
Here’s where things get tricky:
Many women with dysbiosis have no symptoms.
No odor.
No discharge.
No obvious signs anything is wrong.
Which means some women experiencing recurrent pregnancy loss may never think to investigate the microbiome at all.
Research has suggested associations between vaginal dysbiosis, implantation failure, miscarriage risk, and altered reproductive outcomes.
But again, this is an evolving field.
The uterine microbiome itself is still controversial in some medical circles because researchers are actively debating:
what constitutes a “normal” uterine microbiome,
whether certain bacteria are causal or incidental,
and how reliable current testing methods are.
So while microbiome testing is becoming increasingly popular, we need honesty here:
the science is promising, but not definitive, and women deserve transparency about both the possibilities and the limitations.
Stress and Miscarriage: The Conversation We Need to Handle Better
We need to talk about the “just relax” comment.
Because if you’ve experienced infertility or recurrent pregnancy loss, there’s a good chance someone has said some version of:
“Maybe you’re too stressed.”
“It’ll happen when you stop trying.”
“Your body just needs to relax.”
And honestly? Even when people mean well, these comments can land like a punch to the throat.
Here’s the reality:
Stress is not healthy for the body long term. Chronic stress absolutely impacts hormones, inflammation, sleep, immune function, and overall health.
This is all true.
But saying stress causes recurrent pregnancy loss as a blanket explanation is not only scientifically oversimplified — it can also place enormous guilt on women who are already suffering.
Of course women experiencing loss are stressed. Loss is stressful! And telling someone who is desperately trying to grow their family that their emotions may be the reason it isn’t happening can quickly spiral into shame and self-blame.
Could stress influence overall health and pregnancy experience? Absolutely.
But reducing recurrent miscarriage to “you need to relax” ignores the complexity of reproductive health and often dismisses legitimate medical concerns that deserve investigation.
The Problem With “Unexplained”
Sometimes unexplained infertility or recurrent loss truly remains unexplained.
But sometimes “unexplained” simply means:
current testing is limited,
research hasn’t caught up yet,
or certain areas weren’t fully investigated.
That’s an uncomfortable reality in medicine. Especially in women’s health.
There are still enormous gaps in fertility research, particularly around:
implantation,
immune function,
microbiome health,
inflammation,
and early pregnancy signaling.
And patients often end up caught in the middle of those gray areas. This is why self-advocacy matters so much.
Not because every internet theory is correct.
Not because every emerging test is validated.
And not because every root-cause explanation is legitimate.
But because women deserve informed conversations, nuanced care, and providers willing to acknowledge uncertainty without dismissing symptoms entirely.
A Balanced Perspective on Root-Cause Fertility Care
At Clear Skin Lab, we believe it’s important to hold two truths at once:
Not every trendy fertility theory is backed by strong evidence.
Women still deserve thoughtful investigation beyond “everything looks normal.”
Both can be true. And in areas where research is still developing, honesty matters.
There is no guaranteed protocol. No magic supplement. No universal fertility root cause roadmap. But there are women who benefit from deeper investigation into:
inflammation,
microbiome health,
uterine abnormalities,
immune dysfunction,
sperm quality,
and overall metabolic health.
The key is approaching these conversations with critical thinking instead of fear-based marketing or blind dismissal.
If You’re Navigating Recurrent Pregnancy Loss
Here’s what we want you to know:
You are allowed to ask questions.
You are allowed to seek second opinions.
You are allowed to advocate for yourself.
And you are allowed to want more than “just keep trying.”
At the same time, it’s important to approach emerging fertility research with discernment, realistic expectations, and providers who are willing to explain both the potential benefits and the limitations of testing and treatment options.
Because fertility is rarely simple, and women deserve conversations that reflect that complexity.
Want Support Navigating Root-Cause Health?
At Clear Skin Lab, our team approaches chronic inflammatory conditions through a science-backed, root-cause lens. While we do not diagnose or treat infertility, we work with clients navigating complex health histories, inflammation, gut health concerns, microbiome imbalances, and chronic immune-related symptoms.
If you’re interested in functional testing or personalized support, reach out to our team to learn more about available services and educational resources.