Recurrent miscarriage (RM), the accepted definition of which is three or more consecutive miscarriages, is relatively uncommon - affecting about 1 to 2% of couples who conceive. Three strands of evidence support the contention that RM is a distinct clinical entity rather than one which occurs purely by chance alone. First, the observed incidence of RM is significantly higher than that expected by chance alone (0.4%); second, a woman's risk of miscarriage is directly related to the outcome of her previous pregnancies ; and third, in contrast to sporadic miscarriage, women with RM tend to lose pregnancies with a normal chromosome complement, suggesting the presence of a persistent underlying cause for pregnancy loss among these women [2,3].
Despite major advances in our understanding of the aetiology of RM over the last 20 years, even after comprehensive investigation, no cause for pregnancy failure is identified in approximately 50% of couples. This has led to the situation where women with RM have been, and continue to be, subjected to investigations and treatments based on anecdotal evidence, historical beliefs and the personal prejudices of their clinicians . This chapter aims to provide a comprehensive, evidence-based approach to the investigation and treatment of RM while at the same time highlighting new avenues of research.
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