Squaring the circle of recurrent pregnancy loss (RPL)

The recent publication of a study into the contribution of embryo chromosomal abnormalities in recurrent pregnancy loss (RPL) affords the opportunity to revisit the hypothesis that women with an aneuploid pregnancy loss have a better chance of a successful pregnancy next time than women with a chromosomally normal loss. A previous miscarriage with an abnormal karyotype (unrelated to a parental chromosome rearrangement) should not be viewed as a marker of an increased likelihood of aneuploidy in a subsequent pregnancy; it is (counterintuitively) likely to be indicative of a reduced risk of clinical miscarriage (with a higher proportion of aneuploid products) and an excellent chance for the live birth of the next pregnancy. Each couple should be treated on their own merits and with appropriate investigations performed where indicated; caution should be advised regarding offering preimplantation genetic testing for aneuploidy (PGT-A).