Recurrent miscarriage

Recurrent miscarriage is defined as the occurrence of three consecutive pregnancy losses during the first trimester. Although it affects only 1% of all couples, it is a most frustrating experience for the patient as well as for the clinician. Frustrating for the couple because they rarely obtain clear-cut reasons for the repeated failure to sustain a pregnancy, nor the prospect of a fail-safe treatment; frustrating for the clinician, too, because it is extremely difficult to disentangle the causes of sporadic and unavoidable miscarriage--most of which have a genetic background--from those of recurrent miscarriage. In the latter case, an underlying defect can potentially be detected and, ideally, should be amenable to treatment. Unfortunately, however, this is rather exceptional. In this paper, literature on genetic, anatomic, endocrine, metabolic, and autoimmune aspects of recurrent miscarriage are reviewed, and a survey of meaningful investigations and treatment is provided.