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, …
Practice Committee of the American Society for Reproductive Medicine (2026). Recurrent pregnancy loss: a committee opinion. Fertility and Sterility. https://doi.org/10.1016/j.fertnstert.2026.03.001
Practice Committee of the American Society for Reproductive Medicine. Recurrent pregnancy loss: a committee opinion. Fertility and Sterility. 2026. doi:10.1016/j.fertnstert.2026.03.001
Practice Committee of the American Society for Reproductive Medicine. "Recurrent pregnancy loss: a committee opinion." Fertility and Sterility, 2026.
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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.
Miscarriage affects approximately 15% of clinically confirmed pregnancies. Recurrent pregnancy loss (RPL), defined as two or more clinical losses, affects 2 to 5% of couples. Most causes are diagnosable and treatable. This guide covers what the standard workup misses, what RRM-trained clinicians evaluate, and what outcomes look like after cause-based treatment.
Clinical Guidelines and Standards › Guidelines by Clinical Area › Fertility and Infertility Guidelines · Infertility › Recurrent Pregnancy Loss › Immune and Thrombophilia Factors · Pregnancy › Early Pregnancy › Miscarriage
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
C Gracia, P Amato, J Anderson, Becky Flyckt, R Flyckt, K Hansen, M Hill, T Jain, S Jindal, S Kalra, B Pier, D Sakkas, A Steiner, C Tanrikut, B Yauger, T Plowden, R Smith, M Trolice, S Senapati, Bob Brannigan, Rob Brannigan, Bobby Brannigan, R Brannigan, A Sparks, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, J Robins, C Shannon, M Brooks, R Lathi, E Masaba, M Sauerbrun-Cutler, I Souter, Q Katler, Mike Strug, M Strug, D McQueen, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar
PMID 42062119 42062119 DOI 10.1016/j.fertnstert.2026.03.001 10.1016/j.fertnstert.2026.03.001 Practice Committee of the American Society for Reproductive Medicine et al. 2026, Practice Committee of the American Society for Reproductive Medicine 2026
