ABSTRACT
The European Society of Human Reproduction and Embryology distinguishes RPL from a similar entity, recurrent miscarriage, which is defined as a loss that has been confirmed as intrauterine. Etiology of RPL is not established in at least 50% of cases after workup. General categories include genetic, anatomic, endocrine, immunologic, thrombophilic, and environmental. RPL can be emotionally devastating to couples, and its impact on the mental health of both partners needs to be addressed. A meta-analysis of prospective studies showed an association between sperm DNA fragmentation and RPL. However, there is significant heterogeneity between the studies. Various forms of immunotherapy have been studied in the treatment of RPL. The theory is that the fetus is considered an allograft, and alteration of maternal immune response is needed for successful implantation. Effective treatment of an alleged alloimmune cause of recurrent miscarriage awaits more complete knowledge of the underlying pathophysiology.
