Recurrent Implantation Failure & Recurrent Miscarriage: Naturopathic Fertility Support

What is recurrent implantation failure?

Recurrent implantation failure, or RIF, is generally discussed in the context of IVF, when embryo transfers repeatedly don’t result in an established pregnancy.

But there isn’t one universally agreed number of unsuccessful transfers that suddenly means you have recurrent implantation failure.

Your age, embryo characteristics, the number of embryos transferred and their expected chance of implantation all influence how significant repeated unsuccessful transfers may be. This is why current thinking has moved away from treating an arbitrary number of failed transfers as proof that something must be wrong.

If you’ve had repeated unsuccessful transfers, the more useful question is whether implantation has failed more often than would reasonably be expected in your circumstances.

Because if it has, repeating the same transfer approach without considering whether anything else deserves attention may not be the only option.

What is a chemical pregnancy?

A chemical, or biochemical, pregnancy means something different has happened: implantation did begin.

There was enough implantation for hCG to become detectable in your urine or blood, giving you a positive pregnancy test, but the pregnancy stopped developing before it could be confirmed on ultrasound.

If you’ve experienced this, being told it was “only chemical” can feel incredibly dismissive.

You saw the positive test. You may have watched the line get darker, waited anxiously for your blood results and started imagining that perhaps this was finally it. Then, sometimes within days, you were dealing with another loss.

Clinically, that positive hCG gives us information too.

A biochemical pregnancy is different from a cycle or embryo transfer where pregnancy is never established at all. An embryo began the implantation process, but the pregnancy wasn’t able to continue developing.

Chromosomal abnormalities within the embryo are an important possible cause of very early pregnancy loss. But when chemical pregnancies happen repeatedly, it can be appropriate to consider the wider fertility picture rather than automatically assuming every loss was simply another “bad embryo”.

What is recurrent miscarriage?

Recurrent miscarriage, also called recurrent pregnancy loss, refers to repeated pregnancies that begin but don’t continue.

Depending on your individual history, investigation may include genetic factors, the structure of your uterus, antiphospholipid syndrome, thyroid function and metabolic health, alongside other recognised contributors to pregnancy loss.

But the timing and pattern of your losses matter too.

Were they all very early? Did you repeatedly reach a similar week of pregnancy? Were there pregnancies where a heartbeat had been seen? Have you had both chemical pregnancies and later miscarriages? Did the pattern change after a previous successful pregnancy?

These details can get lost when every pregnancy is considered as a separate event. Looking at them together can sometimes tell us much more.

And then there is the rest of your history.

Very painful or heavy periods may make endometriosis or adenomyosis relevant. Those conditions can also exist with surprisingly few symptoms. Recurrent vaginal or urinary symptoms, unusual discharge or other aspects of your history may give us a reason to think about infection or chronic endometrial inflammation. And your partner’s health and reproductive history deserve consideration alongside yours.

Not every possible cause needs to be investigated in every woman.

The goal is to use your history to decide which questions are actually worth asking, rather than putting you through every fertility test available because nobody knows what else to do.

When the Embryo Isn’t the Whole Story

If you’ve been trying to conceive for a while, you may feel as though almost every explanation eventually comes back to egg or embryo quality.

And embryo quality matters. Chromosomal abnormalities are a major cause of miscarriage, and their likelihood increases with maternal age. If pregnancy tissue has been genetically tested after a miscarriage, that result can also give us an important piece of the story. Knowing a pregnancy was chromosomally abnormal tells us something very different from repeatedly losing pregnancies where testing hasn’t found a chromosomal explanation.

But creating a developmentally competent embryo is only one part of establishing and maintaining a pregnancy.

That embryo also needs to interact with the endometrium, implant within a uterus capable of supporting the pregnancy and establish the hormonal, vascular and immune processes required for early development.

So when pregnancy repeatedly isn’t progressing, the question sometimes needs to become wider than “Was it a good embryo?”

Is the uterine environment supportive of implantation? Could endometriosis or adenomyosis be getting in the way? Is progesterone support appropriate? Are your thyroid function, insulin and metabolic health markers relevant? Is there a reason to investigate chronic endometritis or genital tract infection? Has the male contribution been looked at beyond a standard semen analysis?

Some of these factors have much stronger evidence than others. Some are routinely investigated after recurrent pregnancy loss, while others may only make sense when your symptoms, history or previous results give us a reason to look.

And sometimes, even after appropriate investigation, there still isn’t one satisfying explanation for why your pregnancies have been lost.

The answer isn’t to manufacture a hidden problem because you desperately want an answer. But it also isn’t to keep looking at the same part of the fertility picture when your history gives us a reason to look more widely.

The Uterine Environment and Implantation

You can have a good-quality embryo and still need the environment it is entering to be considered.

The endometrium isn’t simply a lining that needs to reach a particular measurement on an ultrasound. It is biologically active tissue that changes throughout your cycle and needs to become receptive at the right time for an embryo to attach, communicate with maternal tissue and begin establishing a pregnancy.

That doesn’t mean every unsuccessful transfer is an “implantation problem”, or that you need an expensive panel of endometrial tests after one failed cycle.

But when implantation repeatedly doesn’t occur, you experience recurrent chemical pregnancies or pregnancies repeatedly stop developing, the uterus and endometrium deserve to be part of the conversation rather than focusing exclusively on the embryo.

Progesterone, implantation and progesterone resistance

If you’ve had repeated chemical pregnancies, miscarriages or unsuccessful embryo transfers, progesterone may already have been checked. Perhaps you’ve been told yours is “normal”. If you’re going through IVF, you may already be taking progesterone and assume that means this part of the picture has been covered.

But progesterone matters for more than producing a normal result on a test. It is one of the key hormones that helps transform the endometrium into an environment capable of receiving an embryo and then supporting that pregnancy once implantation has occurred.

So when implantation repeatedly doesn’t happen, or begins but the pregnancy doesn’t continue, the more useful question isn’t simply whether your progesterone fell inside a laboratory reference range. It’s whether you are producing the progesterone you need, at the time you need it, and whether your tissues are responding to it as they should.

And if you’re trying to conceive naturally, that story actually begins before progesterone – with ovulation.

Your body produces progesterone after you ovulate. So if ovulation is happening late, irregularly or not consistently at all, the progesterone available afterwards can be affected too.

This is especially relevant if you have PMOS (formerly PCOS) or hypothalamic amenorrhoea (HA), where ovulation may already be disrupted. Significant stress, under-eating, over-exercising and other factors that interfere with the signals between your brain and ovaries can affect ovulation too.

Which means that if you’re repeatedly seeing a positive pregnancy test only to lose it days or weeks later, or implantation doesn’t seem to happen at all, it may be worth looking at what happened earlier in the cycle. The progesterone your body produces to prepare the endometrium for implantation and support early pregnancy depends on ovulation having occurred first.

This is why looking at one progesterone result in isolation can sometimes miss the bigger picture. The timing of the test, when you actually ovulated and what was happening across the rest of your cycle all matter when interpreting that result.

But producing enough progesterone is only one part of the picture. Your endometrium also needs to be able to respond to it – and this is where endometriosis can become particularly relevant.

Endometriosis is associated with progesterone resistance, which means the tissues that should respond to progesterone may not respond to its signals in the usual way. And that matters here because progesterone signalling within the endometrium is part of what helps create the conditions an embryo needs to implant and an early pregnancy needs to continue developing.

So having enough progesterone and responding appropriately to progesterone aren’t necessarily the same thing.

If you’re going through IVF or a frozen embryo transfer, the questions change again. You may be receiving progesterone as part of your treatment protocol rather than relying entirely on your own production. In that situation, the dose, timing and route of progesterone can all become relevant around implantation and early pregnancy.

None of this means issues with your progesterone are behind every unsuccessful transfer, chemical pregnancy or miscarriage.

But if pregnancy repeatedly isn’t progressing, “your progesterone is normal” shouldn’t necessarily be where the conversation ends. The more useful question is whether progesterone is genuinely doing what it needs to do at the stage your pregnancy depends on it.

Endometriosis, adenomyosis and the uterine environment

“But I can get pregnant, so surely my endometriosis or adenomyosis isn’t the problem?”

You may have had your endometriosis treated. Your scans may look reassuring. You may even conceive relatively easily. Yet embryos repeatedly don’t implant, you see a positive test only to watch your hCG fall, or you make it further into pregnancy and miscarry.

This is where I think we need to stop treating the condition and the pregnancy loss as two completely separate conversations.

Because some of the hormonal, inflammatory and immune changes associated with endometriosis or adenomyosis may also influence the environment an embryo needs in order to implant and continue developing.

Both conditions involve altered inflammatory, hormonal and immune signalling. And your immune system has a particularly delicate job around implantation. It needs to continue protecting you from infection while also developing the appropriate immune tolerance and controlled inflammatory response that allows an embryo to implant.

Now think about what happens if something else is continually asking that immune system to stay on alert.

A persistent vaginal infection is one example. That doesn’t mean an infection will cause miscarriage. But rather than automatically treating vaginal health, endometriosis and pregnancy loss as completely unrelated issues, sometimes considering how those pieces interact can add useful information to the wider fertility picture.

We’ve already seen another example with progesterone resistance. Endometriosis can alter the way the endometrium responds to progesterone – the same hormone signalling needed to prepare that endometrium for implantation and support early pregnancy.

Adenomyosis adds another layer. Because it affects the muscular wall of the uterus, it can be associated with changes in the junctional zone and uterine contractions, as well as the inflammatory and hormonal environment surrounding implantation. So even if you’re becoming pregnant, adenomyosis may still be relevant to understanding why implantation or early pregnancy repeatedly isn’t progressing as expected.

And you don’t necessarily need severe symptoms for either condition to matter. Endometriosis can be surprisingly silent, while adenomyosis doesn’t always produce the textbook heavy, excruciating periods you might expect.

So if pregnancy repeatedly isn’t progressing, I don’t just want to know whether endometriosis or adenomyosis is there. I want to understand how the hormonal, inflammatory and uterine changes associated with those conditions may fit into the wider fertility picture – and whether any of them are relevant to what keeps happening in your pregnancies.

When the structure of the uterus matters

Two women can both be told they have a fibroid. For one, it may have very little relevance to her fertility. For the other, it may be sitting exactly where an embryo needs to implant.

The diagnosis is the same. What it means for the pregnancy can be completely different.

This is why simply knowing that you have a fibroid isn’t enough. Its size matters, but so does its location and, importantly, whether it changes the shape of the uterine cavity.

An embryo needs somewhere it can successfully implant and continue developing. A fibroid that distorts that space may therefore deserve very different attention from one sitting elsewhere in the uterus.

And fibroids aren’t the only structural consideration. Polyps, scar tissue or adhesions within the uterus and differences in uterine anatomy can sometimes affect the space in which implantation and early pregnancy need to take place.

This is also why “my ultrasound was normal” and “the uterine cavity has been adequately assessed” aren’t always exactly the same thing. Different investigations can answer different questions, so what matters is what was actually looked at and whether it was the right investigation for your history.

If the appropriate investigations have already shown that the structure of your uterus is unlikely to explain what keeps happening, that’s useful information too. It means this may be one part of the fertility picture you don’t need to keep questioning.

Could a silent infection contribute to recurrent miscarriage or implantation failure?

When you’ve had more than one miscarriage, you start looking for the thing that everyone has missed.

You’ve had blood tests. You’ve had scans. Perhaps you’ve been told the embryo was probably chromosomally abnormal, or that sometimes there simply isn’t an explanation. If you’re going through IVF, you may have changed protocols, transferred another embryo and spent thousands of dollars trying again.

But has anyone actually looked at your vaginal microbiome?

There’s an important distinction here: some organisms being investigated for their potential relationship with implantation and pregnancy loss can be completely silent, yet they aren’t routinely included in standard fertility investigations.

Ureaplasma and Mycoplasma are good examples. You can carry these organisms without unusual discharge, irritation, pain or anything else that would make you think you have an infection. And because they aren’t routinely included in standard fertility investigations, it’s possible to go through repeated miscarriages or unsuccessful IVF cycles without anyone ever looking for them.

Which means “I don’t have an infection” can sometimes really mean “I’ve never been tested for the infections that don’t necessarily cause symptoms.”

Chronic endometritis is another piece of this picture. This is persistent inflammation within the endometrium itself, often associated with infection, and it too can exist with few obvious symptoms.

And its location matters. The endometrium is the tissue an embryo is actually trying to implant into. If infection or persistent inflammation is altering that environment, you want to know about it before asking another embryo to try.

Then there is the wider vaginal microbiome. A healthy vaginal environment is typically dominated by protective Lactobacillus species. When that ecosystem changes, potentially problematic organisms can become more established and the local inflammatory and immune environment can change too.

Research into exactly how reproductive microbiome patterns affect IVF, implantation and miscarriage is still evolving. But when you’ve already experienced recurrent miscarriage or implantation failure, I don’t think that means this part of the picture should simply be ignored.

This is why I screen the vaginal microbiome upfront in the women I work with in this situation – even when they have absolutely no vaginal symptoms.

Not because finding an organism proves it caused your miscarriages or failed transfers, or because every finding automatically needs treatment.

But because another attempt may mean another embryo, another IVF cycle, another early pregnancy and another enormous emotional investment.

For me, it’s information I’d rather have available before another attempt – so we can decide whether it is genuinely relevant to your wider fertility picture, rather than assuming it is simply because a test found it.

Recurrent Miscarriage Isn’t Only About the Woman

Trying to get pregnant can slowly turn into a full-time job of trying to optimise you.

What should you eat? Which supplements should you take? Should you stop drinking coffee? Exercise more? Exercise less? Lose weight? Gain weight? Get more sleep? And somehow, amongst the anxiety of trying to conceive after miscarriage, you’re also supposed to make sure you’re not getting too stressed about any of it.

It can start to feel as though the success of the next pregnancy rests entirely on how well you manage your body.

And sometimes that imbalance isn’t only happening in the fertility clinic. It’s happening at home too.

Perhaps you’re the one researching, making the appointments, changing what you eat and remembering the supplements, while getting your partner to make changes for his fertility feels like one more thing you have to manage.

Or perhaps he genuinely thinks his side has been taken care of. He had a semen analysis, the doctor said everything looked fine, and neither of you was given a reason to think about his fertility again.

Either way, you can end up carrying most of the responsibility for a pregnancy that, biologically, you didn’t create alone.

Half of the embryo’s nuclear DNA comes from the sperm. So when you keep getting pregnant but keep miscarrying, it doesn’t make sense for all the questions to keep coming back to your body.

This is where sperm DNA fragmentation becomes particularly relevant.

A standard semen analysis looks at things such as how many sperm there are, how well they move and their shape. But sperm can look relatively normal under those measures while still carrying damaged or fragmented DNA.

And here’s the part that’s particularly important if you’re experiencing recurrent miscarriage: a sperm with damaged DNA can still fertilise your egg.

You can still get the positive pregnancy test you’ve been desperately waiting for. You may even assume that because you became pregnant, his sperm must have been fine.

But fertilising an egg is only the beginning of what that sperm needs to contribute.

The DNA it carries becomes part of the embryo. If that DNA is significantly fragmented, it may affect how well the embryo continues to develop, and higher sperm DNA fragmentation has been associated with an increased risk of miscarriage.

So if you keep getting pregnant only to lose those pregnancies, the fact that conception happened doesn’t automatically rule out a male contribution.

And if sperm DNA fragmentation is elevated, the next question is what may be contributing to it.

Smoking, oxidative stress, certain environmental and chemical exposures, recent febrile illness, varicocele and increasing paternal age have all been associated with sperm DNA damage or increased fragmentation. These are reasons his health in the months leading up to conception matters too, rather than all of the preconception work automatically falling to you.

There is also emerging research into sperm epigenetics and DNA methylation, including how paternal health and environmental exposures may influence the biological information carried by sperm. It’s an interesting and developing area, but it isn’t yet an established clinical explanation for recurrent miscarriage.

This isn’t about transferring the responsibility from you to him. It’s about recognising that it was never yours to carry alone.

If you’ve spent months wondering what else you need to eat, stop eating, take, track or change before trying again, perhaps it’s time for a different question:

Has his contribution to the embryo been given the same attention as yours?

Immune Factors, Blood Clotting and Recurrent Miscarriage

If you’ve experienced recurrent miscarriage, at some point you may have come across the idea that your immune system is “rejecting” your pregnancies.

Perhaps you’ve read about natural killer cells, immune incompatibility, intralipids or other immune treatments. And when nobody can explain why you keep losing pregnancies, it’s easy to start wondering whether your own body is somehow working against the pregnancy you’re desperately trying to keep.

But the immune system’s role in pregnancy is much more nuanced than your body simply accepting or rejecting an embryo.

Successful implantation requires carefully regulated immune adaptation. Your immune system still needs to protect you, while creating the particular inflammatory and immune environment that allows an embryo to implant, establish a blood supply and continue developing.

There is, however, one immune-related condition that is particularly important to distinguish from the much broader world of reproductive immunology: antiphospholipid syndrome (APS).

APS is an autoimmune condition associated with abnormal blood clotting and pregnancy complications, including recurrent miscarriage. It is a recognised cause of recurrent pregnancy loss and, when appropriate for your history, there are established blood tests used to investigate it.

That is very different from assuming recurrent miscarriage means your immune system is simply “too active”.

You may also come across testing for natural killer cells, cytokines, HLA compatibility and other immune markers, particularly after repeated IVF failure or unexplained miscarriage. Immune signalling absolutely matters to implantation and pregnancy, but that doesn’t mean every difference we can measure is causing your miscarriages – or that treating it will increase your chance of having a baby.

And this is where it can become particularly difficult when you’re desperate for an explanation.

After being told again and again that your results are “normal”, imagine finally being handed a test showing something isn’t.

“Is this it? Is this why I keep miscarrying?”

Of course you want to do something about it before you try again.

But finding an abnormal result and knowing that result is actually contributing to your miscarriages aren’t necessarily the same thing. And if we don’t yet know whether treating that finding changes pregnancy outcomes, another test can sometimes give you another thing to worry about rather than the answer you’ve been searching for.

You don’t need every immune test available simply because nobody has been able to explain your miscarriages.

You need to know that recognised causes such as APS haven’t been overlooked, while being much more careful about tests and treatments where the science still can’t confidently tell you whether they will change what happens in your next pregnancy.

Thyroid, Insulin and the Metabolic Side of Pregnancy

Some of the factors relevant to recurrent miscarriage don’t begin with the pregnancy itself.

They may have been showing up much earlier in your cycles, your hormones or results that never seemed particularly connected to fertility.

Take insulin resistance.

If you have PMOS (formerly PCOS), you may already associate insulin with irregular cycles or difficulty ovulating. But its relevance doesn’t necessarily end once you’ve managed to get pregnant.

Your glucose and HbA1c can still look reassuring while insulin resistance is developing, because your body may initially compensate by producing more insulin. So normal glucose results don’t necessarily tell you everything about the metabolic picture, particularly if you have PMOS.

This can be particularly relevant with PMOS, where insulin resistance and hyperinsulinaemia are common and can influence ovarian hormone production, ovulation and the metabolic environment surrounding conception and early pregnancy. PMOS is also associated with an increased risk of miscarriage, although insulin is only one part of that relationship.

Thyroid function also belongs in this conversation for a different reason.

Thyroid hormones are important for reproductive function and early pregnancy, and recognised thyroid dysfunction is part of the medical assessment around recurrent miscarriage.

Depending on your history, there may also be a reason to understand a TSH result within the context of known thyroid disease, thyroid medication, symptoms and previous results rather than viewing one number in isolation.

The useful question isn’t whether every metabolic or thyroid marker can be made “optimal”. It’s whether your results tell us something relevant about the pregnancies you are trying to sustain.

When You Don’t Know What to Do Differently Next Time

After recurrent miscarriage or repeated implantation failure, you can end up knowing an enormous amount about your fertility – but still have no idea what you should actually do differently next time.

Your fertility specialist may be focused on your embryos and treatment protocol. Your GP has your blood results. Another specialist may be managing your endometriosis, adenomyosis, thyroid or PMOS. Your partner may have had his own testing.

You have all these separate pieces of information, but nobody has necessarily shown you how they fit together.

This is where looking at your fertility history as one story becomes important.

How easily do you become pregnant? Where do pregnancies tend to stop progressing? Is there a pattern across your losses or unsuccessful transfers? What was happening in your cycles beforehand? What has already been properly investigated – and what genuinely hasn’t?

From there, we can work out what deserves attention before you try again and, just as importantly, what doesn’t.

Sometimes that means identifying something worth investigating further with your doctor or fertility specialist. Sometimes it means looking differently at results you already have. And sometimes it means being able to stop worrying about something because it has already been adequately ruled out.

I work collaboratively with your fertility specialist, GP and other practitioners where needed, so this isn’t about replacing the medical care you already have.

It’s about helping you understand your particular fertility story and make your next decisions with a clearer sense of why you’re making them – rather than going into another pregnancy or embryo transfer wondering whether you’re simply repeating the same thing and hoping for a different outcome.