Recurrent pregnancy loss: a committee opinion

Practice Committee of the American Society for Reproductive Medicine

doi:10.1016/j.fertnstert.2026.03.001

Clinical Guidelines and Standards · Guidelines by Clinical Area

Recurrent pregnancy loss: a committee opinion

Practice Committee of the American Society for Reproductive Medicine

Committee members: Clarisa Gracia, Paula Amato, Jake Anderson, Rebecca Flyckt, Karl Hansen, Micah Hill, Tarun Jain, Sangita Jindal, Suleena Kalra, Bruce Pier, Denny Sakkas, Anne Steiner, Cigdem Tanrikut, Belinda Yauger, Torie C Plowden, Ryan Smith, Mark Trolice, Suneeta Senapati, Robert Brannigan, Amy Sparks, Elizabeth Ginsburg, Jared Robins, Chevis N Shannon, Madeline Brooks, Ruth B Lathi, Erin Masaba, May-Tal Sauerbrun-Cutler, Irene Souter, Quinton S Katler, Michael Strug, Dana McQueen, Richard Reindollar

Published April 29, 2026 Fertility and Sterility

DOI 10.1016/j.fertnstert.2026.03.001 PMID 42062119

Read our synopsis

RRM Academy Synopsis

ASRM advises chromosome testing of tissue after a second miscarriage

A 2026 committee opinion on losing two or more pregnancies advises chromosome testing of miscarriage tissue as the first step after a second loss. The committee finds no benefit from blood thinners in unexplained loss. 50%–80% of patients succeed in their next pregnancy attempt without specific interventions.

Key Findings

The committee defines recurrent pregnancy loss as two or more losses, consecutive or not, and recommends array-based chromosome testing of miscarriage tissue from a second loss onward.
Whole-chromosome errors (aneuploidy) appeared in approximately 50% of tested miscarriages in women younger than 35 and in 75% of those in women older than 40.
In a 2016 retrospective analysis, live birth per attempt was 32% with IVF plus preimplantation genetic testing for aneuploidy (PGT-A) and 34% with expectant management.
The committee does not recommend routine testing for inherited thrombophilia, thyroid antibodies, ovarian reserve or immune markers. It cites high-quality evidence of no benefit from anticoagulants in unexplained loss.
A meta-analysis found more later miscarriage in couples with high sperm DNA fragmentation than low (RR = 2.16, 1.54 to 3.03). No well-controlled study shows treating it lowers loss.

Interpretation

The document is a committee opinion that reviews published studies. It describes the strength of evidence treatment by treatment. High-quality trials found no benefit from blood thinners in unexplained loss. Surgery for uterine anomalies and empiric progesterone rest on limited or conflicting studies. In one high-quality randomized trial, reported so far only as an abstract, antibiotic treatment of chronic endometritis showed no benefit on miscarriage or live birth. The guidance covers losses before 22 weeks and is not intended as the only approved standard of practice.

RRM Context

Restorative reproductive medicine starts with evaluation before treatment. The committee's first step, testing the miscarriage itself for a cause, follows that order. The document also evaluates the male partner and reports depression and anxiety risk in both partners. Its ineffective tier lists empiric blood thinners and immune treatments. The opinion does not discuss cycle charting, a tool many restorative methods use.

Our editorial summary of this paper, not the article's abstract.

Abstract

Current strategies for the assessment and treatment of recurrent pregnancy loss are discussed. This replaces the previous document, titled, "Evaluation and treatment of recurrent pregnancy loss: a committee opinion," last published in 2012.