How does RRM approach recurrent miscarriage (RPL)?

RRM approaches recurrent pregnancy loss (RPL) through systematic evaluation of genetic, anatomic, endocrine, immune, and male factors, followed by targeted treatment based on evidence-based protocols including progesterone support when indicated.

Understanding Recurrent Pregnancy Loss

Recurrent pregnancy loss affects 2-5% of couples trying to conceive. Current evidence supports evaluation after two losses, particularly in women over 35 or with specific risk factors. Couples who have experienced this devastating pattern are often told "it's just bad luck" and sent home without further investigation.

RRM takes a systematic approach because RPL often has identifiable, treatable causes. Rather than accepting pregnancy loss as inevitable, RRM clinicians investigate the underlying factors that may be preventing successful pregnancy maintenance.

Systematic RRM Evaluation

Evaluation covers several key areas. Genetic factors are assessed through parental karyotyping. Anatomic evaluation examines uterine structure through hysteroscopy or specialized imaging to identify septae, fibroids, or adhesions that may interfere with implantation or early pregnancy development.

Endocrine assessment goes beyond basic hormone panels to include thyroid function, screening for undiagnosed insulin resistance, and progesterone production quality. Immune and infectious evaluation includes screening for antiphospholipid syndrome, inherited thrombophilias when clinically indicated, and chronic endometritis. Male factor evaluation includes sperm DNA fragmentation testing, as evidence suggests damaged sperm DNA may contribute to early pregnancy loss.

Evidence-Based Treatment Approaches

Treatment is tailored to identified causes. The PRISM trial (Coomarasamy et al., 2019) provided important evidence for progesterone supplementation in women with unexplained recurrent miscarriage and early pregnancy bleeding. This large randomized controlled trial showed progesterone support increased live birth rates in this specific population.

• PRISM trial (Coomarasamy et al., 2019): Progesterone supplementation increased live births in women with unexplained RPL and early bleeding
• ESHRE guidelines: Support evaluation after two losses, particularly in women over 35
• Thrombophilia screening: Indicated in specific clinical scenarios, not routinely

RRM's Distinctive Approach

RRM's commitment is thorough investigation rather than empirical treatment. The label "unexplained" is not accepted until evaluation is complete. When treatable conditions are identified, such as thyroid dysfunction, anatomic abnormalities, or chronic endometritis, clinicians address these systematically.

The couple-centered approach recognizes that both partners contribute to pregnancy success. RRM clinicians provide transparent information about what the evidence supports and what remains uncertain, allowing couples to make informed decisions about their care based on their individual circumstances and values.

RRM's systematic evaluation of recurrent pregnancy loss identifies treatable causes and guides evidence-based interventions, offering couples a thorough alternative to the "just keep trying" approach.

This information is educational and not a substitute for individualized medical care. Consult an RRM clinician or healthcare provider for guidance specific to your situation.