How does RRM approach recurrent miscarriage (RPL)?

RRM approaches recurrent pregnancy loss (RPL) through comprehensive 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 is defined as three or more consecutive pregnancy losses before 20 weeks gestation. However, evaluation may begin after two losses, especially in women over 35 or with specific risk factors. In practice, we see couples who have experienced this devastating pattern often receive limited evaluation or are told "it's just bad luck."

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

Comprehensive RRM Evaluation

Our evaluation includes several key areas. Genetic factors are assessed through parental karyotyping and consideration of preimplantation genetic testing when appropriate. 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. We evaluate thyroid function comprehensively, assess for undiagnosed diabetes or insulin resistance, and examine progesterone production. Immune and infectious factors include 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 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
• Royal College guidelines: Recommend comprehensive evaluation after 3 consecutive losses or 2 losses in women over 35
• Thrombophilia screening studies: Limited evidence for routine testing, but indicated in specific clinical scenarios

RRM's Distinctive Approach

What distinguishes RRM is our commitment to thorough investigation rather than empirical treatment. We don't assume pregnancy loss is unexplained until we've completed comprehensive evaluation. When treatable conditions are identified. such as thyroid dysfunction, anatomic abnormalities, or chronic endometritis. we address these systematically.

Our couple-centered approach recognizes that both partners contribute to pregnancy success. We 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 comprehensive alternative to the "just keep trying" approach.

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