The Recurrent Pregnancy Loss Program (RPL) at TRIO is a comprehensive program that focuses on all aspects  of recurrent pregnancy loss, sometimes called recurrent miscarriage. Dr. Sony Sierra, MD, FRCSC, REI and a specialist in treating recurrent pregnancy loss, answers your questions:  


1. What is recurrent pregnancy loss (RPL) and how do I know when I should seek medical treatment?

The medical definition of recurrent pregnancy loss, sometimes referred to as recurrent miscarriage, is the loss of three or more consecutive pregnancies before 20 weeks of pregnancy. At TRIO, we see patients who have a history of two or more consecutive pregnancy losses in the first trimester, or any pregnancy loss after 15 weeks gestation. Please ask your family physician or gynecologist for a referral to the program. 


2. What is the recurrent pregnancy loss program at TRIO and how is it unique?

It’s a comprehensive program that focuses on the evaluation and treatment of recurrent pregnancy loss. Unique features include early monitoring, serial ultrasounds, a specialized nursing team that provides ongoing support, highly trained physicians with many years of experience treating RPL, and the ability to facilitate early referrals to special programs and arrange for prompt testing. Essentially, we create a personalized management strategy for each patient or couple to increase the probability of a successful pregnancy. 


3. Are there risk factors for recurrent pregnancy loss and is there anything I can do on my own to help decrease the chance of a loss?

Most of the time losses are random genetic errors that cannot be controlled. However, if you have had two or more losses, we recommend you come in to be evaluated. Risk factors for RPL can include: genetic, structural (uterine), hormonal, autoimmune/blood clotting, male factor, infection, lifestyle, or maternal age.  


4. Are there tests or treatments that are helpful in reducing the risk of pregnancy loss or that I should have before getting pregnant again?

Fifty percent of the time we find a treatable reason that can increase your odds of a take-home baby. In those cases where we don’t find a specific cause, we will evaluate all of the tools and treatments available and create a treatment plan best suited to your needs.


5. I’ve heard PGS can help…how and is it really worth the extra expense?

This depends on the results of your evaluation. PGS, medications or specific procedures can be very helpful, but this depends on your specific situation and risk factors. For example, PGS is an invaluable tool if the issue is genetic or in certain cases of advancing age; medications can be the answer for hormonal or infection issues; and procedures can be used to solve uterine abnormalities. This is the reason that your personalized evaluation with a physician trained in treating RPL is so important.   


6. What do you look for in the monitoring phase and can monitoring prevent another loss?

There is good evidence that monitoring in an early pregnancy program can increase the odds of a take-home baby to 70 percent. Factors that influence this include regular monitoring of beta HCG levels, serial ultrasounds, and ongoing support and counselling by specialists with expertise in reproductive issues.


7. What kind of specialized experience do your doctors have in treating RPL?

Our program is the largest in Canada devoted to studying and treating recurrent pregnancy loss and is built on the original research, history, and success of its predecessor, The TERM Programme. TERM was known for its successful medical interventions, promoting live births and experience with more than 5,000 cases of recurrent pregnancy loss over the past 30 years. Dr. Sony Sierra and Dr. Carl A. Laskin and their team have unparalleled expertise in Recurrent Pregnancy Loss, including Dr. Sierra’s specialized training and dedication of half of her practise to the issue; and Dr. Laskin’s extensive clinical and research work in recurrent pregnancy loss and reproductive medicine.


“We look at elements that are standards of practise in other areas of medicine and apply them in new and
innovative ways to find answers for our patients who experience RPL,”

Dr. Carl Laskin


“The gynecologic, endocrinology and autoimmune perspectives that are brought to the treatment of recurrent pregnancy loss in this program make it the only one of its kind in Canada,”

Dr. Sony Sierra