Evaluation and Management of Recurrent Early Pregnancy Loss MARY STEPHENSON, MD, MSc,* w and WILLIAM KUTTEH, MD, PhD, HCLDz *Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Illinois; w Recurrent Pregnancy Loss Program, University of Chicago Hospitals, Chicago, Illinois; and z University of Tennessee Health Sciences Center at Memphis, Memphis, Tennessee Abstract: Recurrent pregnancy loss affects up to 5% of couples trying to establish a family. Evaluation classically begins after 3 consecutive miscarriages of less than 10 weeks of gestation but may be warranted earlier if a prior miscarriage was found to be euploid, or if there is concomitant infertility and/or advancing maternal age. The evaluation begins with an extensive history and physical, followed by a diagnostic screening protocol. Management must be evidence-based; unproven treatments should be avoided. If no factor is identified, many couples will still eventually have a successful pregnancy outcome with supportive therapy alone. Key words: recurrent pregnancy loss, recurrent mis- carriage, cytogenetic analysis, translocations, anti- phospholipid syndrome, inherited thrombophilias Miscarriage in the general reproductive population is a very common occurrence. Approximately 30% to 50% of all conceptions and 15% of clinically recognized pregnancies (Z6 wk of gesta- tion) fail to result in a live birth. 1–3 Recurrent pregnancy loss affects up to 5% of couples who are trying to establish a family. 4 This reproduc- tive disorder is a challenge to the clinician because genetic, endocrino- logic, anatomic, immunologic, micro- biologic, thrombophilic, and iatrogenic factors may require evaluation. In approximately two-thirds of couples, one or more factors will be identified. 5 Psychologic support is often needed because recurrent pregnancy loss may lead to anger, guilt, and depression. Participation in support groups or grief counseling may be beneficial before attempting another pregnancy. Close monitoring of a subsequent pregnancy is associated with a higher likelihood of success. 6 132 Correspondence: Dr Mary Stephenson, MD, MSc, University of Chicago, 5841 South Maryland Avenue (MC 2050), Chicago, IL 60637. E-mail: mstephen@ babies.bsd.uchicago.edu CLINICAL OBSTETRICS AND GYNECOLOGY / VOLUME 50 / NUMBER 1 / MARCH 2007 CLINICAL OBSTETRICS AND GYNECOLOGY Volume 50, Number 1, 132–145 r 2007, Lippincott Williams & Wilkins