Title : Recurrent pregnancy loss (RPL): Recent evidence-based guidelines
Abstract:
Background:
Recurrent pregnancy loss (RPL) remains a challenging reproductive disorder affecting approximately 1–2% of couples of reproductive age. Recent advances in reproductive medicine and updated international guidelines have refined the diagnostic evaluation and management of RPL, emphasizing evidence-based approaches while discouraging ineffective interventions.
Objective:
To review and summarize the most recent evidence-based international guidelines regarding the definition, evaluation, and management of recurrent pregnancy loss.
Methods:
A narrative review of recently updated guidelines and consensus statements from major international societies, including the European Society of Human Reproduction and Embryology, American Society for Reproductive Medicine, and Royal College of Obstetricians and Gynaecologists, was conducted. Current evidence regarding genetic, anatomical, endocrine, immunological, thrombophilic, and male factors associated with RPL was analyzed.
Results:
Recent guidelines define RPL as two or more failed pregnancies and recommend individualized evaluation after two pregnancy losses, particularly in women of advanced maternal age or those with infertility. Recommended investigations include parental karyotyping in selected cases, assessment for antiphospholipid syndrome, uterine cavity evaluation, thyroid function testing, and selective genetic analysis of products of conception.
Current evidence does not support routine testing for inherited thrombophilia, immunological biomarkers, natural killer cell assays, or empirical immunotherapy in unexplained RPL. Similarly, therapies such as intravenous immunoglobulin, corticosteroids, and routine anticoagulation in women without antiphospholipid syndrome are not recommended because of insufficient evidence of benefit.
Progesterone supplementation may be considered in women with recurrent miscarriage associated with early pregnancy bleeding, while lifestyle optimization, psychological support, and multidisciplinary care remain essential components of management. Emerging evidence highlights the growing role of chromosomal microarray analysis and precision reproductive medicine in reducing the proportion of unexplained RPL.
Conclusion:
Modern evidence-based guidelines advocate a targeted, patient-centered approach for the management of RPL. Avoidance of unnecessary investigations and non-evidence-based therapies is essential to reduce patient burden and healthcare costs. Continued research in reproductive genetics, immunology, and personalized medicine is expected to improve future outcomes for couples experiencing recurrent pregnancy loss.
