Clinical Updates in the Management of Recurrent Pregnancy Loss (RPL)

Purpose of Review To apprise readers on recent updates in the clinical management of recurrent pregnancy loss (RPL) and review the role of reproductive immunology in RPL. Recent Findings Topics discussed include the epidemiological and clinical definitions of RPL, a higher chromosomal abnormality rate in blastocysts from young patients with idiopathic RPL, and the role of uterine natural killer (uNK) cells in underlying reproductive immunopathology. Summary Although clinically recognized pregnancy loss occurs in 15–25% of pregnancies, only 1–5% of losses can be attributed to RPL, a unique disorder defined as two or more failed clinical pregnancies. Despite a comprehensive evaluation, however, the etiology of 50% of RPL losses will remain unknown. Treatment of RPL focuses on addressing the underlying etiology: preimplantation genetic testing for structural rearrangement (PGT-SR) is recommended for patients with a balanced translocation, and preimplantation genetic testing for aneuploidy (PGT-A) has been shown to improve clinical pregnancy and live birth in patients with RPL. Recent studies promote the use of preconception low-dose aspirin at least 4 days a week, initiation of luteal start vaginal micronized progesterone, and treatment of occult chronic endometritis.