Guideline No. 464: Recurrent Pregnancy Loss

Area of Science:

• Reproductive Medicine
• Genetics
• Endocrinology

Background:

• Recurrent pregnancy loss (RPL) affects numerous women, with causes often remaining unexplained.
• Causes can range from chromosomal and anatomical to endocrine, immune, infectious, and lifestyle factors.

Purpose of the Study:

• To provide clinicians with the most up-to-date evidence for evaluating and managing patients experiencing recurrent pregnancy loss.
• To outline evidence-based strategies for improving live birth rates in women with RPL.

Main Methods:

• A comprehensive literature search was conducted in major databases (PubMed, Cochrane Library, etc.) from 2008 to 2025.
• Search terms included various forms of recurrent pregnancy loss and abortion.
• Evidence quality and recommendation strength were assessed using the GRADE approach.

Main Results:

• Management strategies include lifestyle modifications, screening for conditions like thyroid dysfunction and antiphospholipid syndrome, and treating uterine anomalies.
• Genetic testing and parental karyotyping can identify chromosomal issues.
• Progesterone therapy and antibiotics for chronic endometritis may be beneficial, with cautious use of empirical treatments.

Conclusions:

• Personalized evaluation and care are essential for patients with recurrent pregnancy loss.
• Trauma-informed care, shared decision-making, and equitable access to investigations are critical components of management.
• While evidence for some treatments varies, a systematic approach can improve outcomes and provide etiological answers.