Most recurrent pregnancy loss patients have live birth after multiple euploid transfers

A 2025 study suggests that most patients with recurrent pregnancy loss who transfer up to 3 euploid embryos go on to have a live birth, though data from later transfers are limited.

Recurrent pregnancy loss (RPL) refers to repeated miscarriages and is usually defined as two or more losses. In many cases, no clear cause is found, although uterine, endocrine, and immune factors can sometimes play a role.

Because chromosomal abnormalities are common in miscarriage, some RPL patients use PGT-A to select euploid embryos. However, most studies report success per transfer rather than the overall (cumulative) chance of having a baby after several transfers.

A study by Xu et al. (2025) examined cumulative live birth rates after up to three sequential transfers of euploid blastocysts in patients with RPL. Patients with untreated uterine abnormalities were excluded, and those with select endocrine or immune conditions (thyroid dysfunction, hyperprolactinemia, or antiphospholipid syndrome) were included after standard treatment.

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Study details

Study design: Retrospective cohort study from two academic fertility centers in China between 2018 and 2024.
Participants: 269 patients with RPL undergoing PGT-A with at least one euploid embryo available for transfer. The average age was 34.9 years, and patients had an average of 2.9 prior pregnancy losses.
RPL definition: Patients with RPL had ≥2 consecutive or non-consecutive pregnancy losses, including biochemical pregnancies.
Primary outcome: Cumulative live birth rate after up to three transfers

Most RPL patients had a live birth after continued euploid transfer

A total of 269 patients had a first frozen single euploid blastocyst transfer. Of these, 195 patients completed up to three sequential transfers, with 74 patients having a second transfer and 16 patients having a third transfer (overall dropout rate 27.5%).

Among patients who completed up to three transfers, the cumulative live birth rate was 96.9% (189 out of 195, meaning that only 6 didn’t have a live birth):

First transfer live birth rate: 53.2% (143/269)
Among those who returned for a second transfer: live birth rate was 48.6% (36/74)
Among those who returned for a third transfer: live birth rate was 62.5% (10/16)

Where’s the cumulative live birth rate after the second transfer? Unfortunately, the authors didn’t report this. While it seems possible to calculate this from the published numbers, the changing denominators across transfers and patient dropout make this unreliable. As a result, the live birth rate after the first transfer (53.2%) and the overall cumulative rate after three transfers (96.9%) can be reported clearly, but a cumulative rate after two transfers can’t be reported confidently.

Live birth rates looked similar across transfer attempts (53.2%, 48.6%, and 62.5%), but the study didn’t test to see if there were any statistical differences.

Conclusions

This study found that patients with RPL, without uterine abnormalities and with treated thyroid dysfunction, hyperprolactinemia, or antiphospholipid syndrome, had a cumulative live birth rate of 96.9% after up to three single euploid transfers.

These results are also similar to a recent study (covered in this post) for patients with recurrent implantation failure (RIF), which showed a 92.6% cumulative live birth rate after 3 euploids were transferred sequentially. Together, this suggests that in both RPL and RIF, repeated transfer of euploid embryos can lead to a live birth for many patients.

More data are still needed though, especially for later transfers. In this study, there were few patients who reached a third transfer, which limits how confident we can be about the result. In addition, these results apply only to patients without uterine abnormalities and with treated select endocrine or immune conditions, so they may not be generalizable to all RPL patients.

Want to read more about RPL?

Study finds immune signature in endometrium of recurrent pregnancy loss patients

Researchers in a 2025 study found that women with RPL show distinct immune-related gene activity in their endometrium, identifying a possible molecular signature that could help diagnose or personalize treatment for RPL in the future. Read more.

Study finds nearly 25% of recurrent pregnancy loss patients have adenomyosis

A 2024 study found that patients with recurrent pregnancy loss have congenital uterine anomalies at a rate of 8-19%, with 23% having adenomyosis. Read more.

Sperm aneuploidy in recurrent pregnancy loss

Researchers in a 2020 study found that sperm from males in couples with recurrent pregnancy loss were more likely to be aneuploid, potentially leading to the diagnosis. Read more.

Related studies

These additional studies were referenced by the authors of the paper and haven’t been covered on Remembryo. They may be helpful if you’re exploring this topic further. This section is available for paid subscribers.

Reference

Xu J, Cai Y, Li M, Cheng Z, Cai G, Sun L. Cumulative live birth rates after three sequential single euploid blastocyst transfers in patients with recurrent pregnancy loss. Fertil Steril. 2025. doi:10.1016/j.fertnstert.2025.11.021

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.