Recurrent pregnancy loss

Recurrent miscarriage treatment in Dublin, Ireland

Medically reviewed by Dr. Phil Boyle, MICGP, MRCGP · Last reviewed June 2026

Recurrent miscarriage is the loss of two or more pregnancies before 24 weeks. At NeoFertility, we assess hormonal, immunological, infectious, thrombophilic, and structural factors before the next pregnancy. In the great majority of couples we see, there is an underlying cause that can be found and corrected.

NeoFertility takes a different approach from the first consultation. Whether you are between pregnancies and want deeper investigations before trying again, or you are pregnant right now and frightened, we can see you.

NeoFertility has supported many couples with repeated miscarriages who have gone on to have healthy babies. The question we ask: "Is it inevitable loss, or is it treatable?" In many cases, it is treatable.

Read how Michelle and Andy, Lynsey and Mick, and Declan and Lorraine found their way through recurrent loss to a healthy pregnancy. We also have a YouTube presentation which explains our RRM approach compared to standard treatment.

What actually causes recurrent miscarriage

The background risk of a single miscarriage for a woman with no prior losses is approximately 11%. After three losses, the risk of another rises to approximately 30%. After four losses: 40%. After five losses: 50%.

These are RCOG figures, and they are a sober reminder that waiting and watching is not a strategy when a pattern has already formed.

Recurrent miscarriage is often more than just bad luck. Clinical principle

In most couples we see, there is an underlying condition, and often more than one. Restorative reproductive medicine identifies and corrects the underlying causes of pregnancy loss, rather than bypassing them.

In the 2019 published infertility cohort of 187 couples (Boyle et al., JRRM 2025), 30% had a prior miscarriage. What had been labelled unexplained infertility dropped from 24% at presentation to just 1% after the full diagnostic workup. The cause was there.

It simply had not been found.

The conditions we investigate and correct include several families of factors:

• Hormonal: progesterone and oestradiol measured at 7 DPO (when the body is preparing to hold a pregnancy), thyroid function, DHEA and adrenal androgens. Low oestradiol and low DHEA are factors Dr. Boyle has published on directly, and are among the most correctable causes of repeated loss.
• Immunological: natural killer cell activity where indicated, and clinical endorphin deficiency (a pattern of persistent PMS, painful periods, disturbed sleep and low energy that, once you hear it described, you will probably recognise). This pattern responds to Low Dose Naltrexone.
• Thrombophilia screen: clotting disorders including antiphospholipid antibodies, lupus anticoagulant and anti cardiolipin antibodies.
• Structural: endometriosis is a significant and often silent contributor to recurrent loss; uterine abnormalities; and chronic endometritis, which is low-grade inflammation of the uterine lining, where clinically indicated.
• Male factor: DNA fragmentation and hormonal imbalances in the male partner can contribute directly to miscarriage risk and are assessed from the first consultation. You are not carrying this investigation alone.
• Chronic infection: sub-clinical infection of the male or female reproductive system can be detected with specialised testing of the microbiome, and appropriate treatment can optimise conditions for a successful pregnancy.

In many couples, more than one factor is present. If you have been told your case is too complex, or that you have "too many things going on" to be treated, please know that is entirely typical of the couples we see.

Finding multiple factors is common. A multi-factorial approach is exactly how we respond.

What the pre-conception workup investigates

So we always start before the next pregnancy, not after a positive test.

The NeoFertility approach is a pre-conception workup. We look at hormonal, infectious, immunological, thrombophilic, and structural factors before the next attempt. Then we provide close hormonal support from the moment of conception.

Giving progesterone only after a positive test is too little, too late in most cases. Before you build a house, you lay a solid foundation. The same principle applies here.

The central diagnostic tool is the timed 7 DPO blood test: a blood draw at 7 days post ovulation to measure progesterone and oestradiol. We target progesterone above 60 nmol/L and oestradiol above 400 pmol/L. The standard day-21 test only tells you whether you ovulated.

What we assess is the quality of ovulation.

In Dr. Boyle's clinical experience, approximately 8 out of 10 women with repeated loss or difficulty conceiving show suboptimal ovulations when properly assessed at 7 DPO. Correcting that hormonal picture is central to reducing miscarriage risk.

ChartNeo is the fertility charting app we use to identify pre-conception biomarkers that signal an at-risk cycle. Abnormal bleeding patterns, a short luteal phase, and limited mucus are visible in the chart before a couple tries to conceive.

So often we can see the problem jumping off the page before a second loss occurs. You do not need to have two miscarriages to say there is an issue. We can see it coming before it happens.

Alongside the hormonal assessment, we run a thrombophilia screen (as is standard practice for miscarriage clinics), a thyroid panel, DHEA and adrenal testing, and a natural killer cell test where indicated. Both partners are assessed from day one.

A semen analysis and, where indicated, DNA fragmentation testing gives us the male picture right away. We also look at endometriosis based on clinical indicators, and at hormonal reserve where the picture suggests it.

Both Dr. Boyle and Dr. Agnes Toth see patients at the clinic. They review cases together, so the plan you receive reflects the whole team's thinking.

What does the data say? In a 2010 NeoFertility clinic audit, 50 couples with three or more recurrent miscarriages were treated. Fourteen (28%) did not conceive during the treatment period. Of the 36 who went on to conceive, 29 delivered a live baby: approximately 80%.

Bear in mind that denominator: it is 80% of the 36 who conceived, not 80% of all 50 who came to us. This is a small clinic audit, not a peer-reviewed cohort study, but these are real numbers from real patients.

Treatment is multi-factorial and tailored

What we find in the investigation determines what we treat.

No two couples receive the same combination, and that is the point: you will not be put on a generic protocol. The treatment layers may include any of the following, applied according to what the data in your own results shows:

• Hormonal support: progesterone and oestradiol supplementation to reach 7 DPO targets above 60 nmol/L and 400 pmol/L respectively. Boosting and balancing the cycle before the next attempt, not simply after a positive test.
• DHEA for hypoandrogenemia: hypoandrogenemia: that is a mouthful, but it just means low androgen levels in the female partner. In a study published in Frontiers in Reproductive Health (Boyle P et al., 2024), DHEA supplementation was associated with a miscarriage rate of 17.5% compared with 45.5% in an untreated group with low oestradiol (p=0.038). DHEA is also relevant for couples with low AMH, where androgen deficiency and ovarian reserve overlap.
• Low Dose Naltrexone (LDN): prescribed to 71% of all couples in the 2019 published cohort pre-conception, and to 58% during pregnancy (Boyle et al., JRRM 2025, Tables 5 and 6). LDN addresses clinical endorphin deficiency and supports immune regulation in early pregnancy.
• Clexane for confirmed clotting disorders, where the thrombophilia screen identifies a specific risk.
• Dietary and food antibody assessment: where clinically indicated.
• Laparoscopic excision for endometriosis where clinical indicators are present. We refer to skilled gynaecologists who specialise in excision, not ablation. Timing depends on what we find: some couples are referred early, others after four balanced cycles without conception.
• Male partner treatment in parallel, for any sperm DNA fragmentation, hormonal imbalances, or other male factor conditions identified in Phase 1.

Treatment is a process over time. The work starts from the first consultation, not months later. Each cycle produces diagnostic information we did not have before.

If a miscarriage occurs during treatment, we review the data with you carefully. A second attempt with a modified protocol is always worthwhile. Both Dr. Boyle and Dr. Agnes Toth see patients at the clinic, and they review cases together.

For the full structure of how the three phases work, see the full treatment plan.

Pregnancy support from the moment of conception

For couples with a history of loss, early pregnancy is the highest-risk window.

The moment you see a positive test, the fear of another loss can be overwhelming. We know that. Support at NeoFertility does not ease off when a pregnancy begins: it intensifies.

Progesterone and oestradiol support starts right after a positive test, not at a 6-week booking appointment. We run weekly blood tests for the first three weeks, then every two weeks until 12 weeks, and monthly after that.

The first pregnancy scan is at around 7.5 weeks. A scan at 6 weeks can be falsely reassuring, so we wait for a clearer picture. A follow-up scan at 10 weeks confirms ongoing viability.

Where clinically indicated, LDN, DHEA, and other pregnancy-safe medications continue through the first trimester. Progesterone support continues until the blood work confirms hormonal self-sufficiency. The RCOG confirms that progesterone support in early pregnancy, where bleeding occurs before 16 weeks, has strong evidence behind it.

We use that evidence and extend it with closer monitoring and a broader hormonal protocol. You will not be handed off at the 12-week scan.

The safety data from that published cohort supports this. In the 2019 JRRM cohort (Boyle et al., JRRM 2025), the NeoFertility singleton prematurity rate was 4.0%, compared with 11.8% in CDC IVF data. The twin rate was 2.5%.

Read how Maria and Eamonn had two healthy NeoFertility babies after recurrent miscarriage, and how Caroline and David found their way to a healthy pregnancy after ectopic pregnancies, miscarriage, and treatment with one fallopian tube.

The care does not stop at the 12-week scan.

Published research on recurrent miscarriage

Dr. Phil Boyle has published directly on DHEA, progesterone, and oestradiol protocols for recurrent miscarriage.

Dr. Boyle is president of the International Institute for Restorative Reproductive Medicine (IIRRM), the secular international body of clinicians practising restorative reproductive medicine.

In Frontiers in Reproductive Health (Boyle P et al., 2024), a retrospective cohort study showed that DHEA supplementation in women with low oestradiol was associated with a miscarriage rate of 17.5%, compared with 45.5% in the untreated group (p=0.038).

A companion case report in Frontiers in Medicine (Boyle PC, Pandalache C, Turczynski C, 2024) documents a 30-year-old woman, gravida 6 para 1 (one prior live birth and five miscarriages, including a fetal demise at 24 weeks), who achieved a successful live birth following DHEA supplementation as part of a multi-drug protocol.

Both papers focus on the same mechanism: restoring androgen and oestradiol levels before the next pregnancy, rather than intervening only after conception.

Boyle, Stanford, and Zecevic (Journal of Medical Case Reports, 2022) documented a successful pregnancy after 16 years of infertility, three recurrent miscarriages, and eight failed IVF embryo transfers, using restorative reproductive medicine.

That case shows what we see at this clinic. These couples had not exhausted their options. They simply had not yet been properly diagnosed.

The 2019 JRRM cohort (Boyle PC, Toth A, Minjeur M, Turczynski C, JRRM 2025) included 187 couples on the full restorative protocol; 30% had a prior miscarriage. The singleton prematurity rate was 4.0% and the twin rate was 2.5%.

Tham, Schliep, and Stanford published outcomes for recurrent miscarriage using a restorative approach in Canadian Family Physician (2012), providing supporting evidence from an independent centre. For our published results across the full infertility cohort, see the results page.

Why IVF does not treat recurrent miscarriage

IVF does not treat the causes of recurrent miscarriage.

If you have been through one or more IVF cycles and still miscarried, we understand why you may feel you have run out of options. The RCOG states this clearly in its Green-Top Guideline No. 17: IVF does not help with recurrent miscarriage.

The hormonal, immunological, and thrombophilic factors that caused the previous losses are still present after embryo transfer.

A successful embryo transfer does not solve a progesterone deficiency, a clotting disorder, or an endorphin dysregulation. That is why so many couples who have miscarried during or after IVF cycles come to us with a fundamentally unresolved picture.

A single round of IVF in Ireland typically costs EUR 5,000 to EUR 8,000. Most couples with recurrent miscarriage need more than one round, and the underlying causes are not addressed by the process.

In a cohort of 403 couples who had previously failed IVF (Boyle et al., Frontiers in Medicine, 2018), the average couple had tried 2.1 IVF cycles before coming to us. The adjusted live birth rate after restorative treatment in that cohort was 32.1%.

These couples had not run out of options. They simply had not yet been properly assessed.

The NeoFertility treatment plan is a fraction of that cost. The right comparison depends on your personal history, so we do not list a single figure here. For details, see the treatment plan cost page.

What we can say is this: the investigation is thorough, the treatment is tailored, and the care does not stop at conception. If you are ready to take the first step, book a consultation.

See also the conditions hub for other reproductive health conditions NeoFertility treats alongside recurrent miscarriage, including PCOS/PMOS and hormonal dysfunction. Background reading on the wider evidence base for restorative reproductive medicine is available at rrmacademy.org.