Given that pregnancy loss is a relatively common phenomenon, some patients might suffer several losses without any underlying predisposing factors. However, patients who suffer two or three consecutive spontaneous abortions may benefit from an evaluation to rule out any additional risk factors for poor pregnancy outcome and to determine whether any treatment might potentially reduce the risk of a recurrent loss.
In general, the causes of recurrent pregnancy loss can be divided into genetic, hormonal, anatomic, infectious, autoimmune, and thrombophilic categories. Approximately 40% to 50% of patients with two or three consecutive pregnancy losses will be determined to have an apparent etiology (source of the problem). In these cases, treatment would depend on the specific problem identified. In those patients without any obvious etiology of their recurrent pregnancy loss, treatment options include empiric progesterone, empiric baby aspirin, treatment with fertility medications and IUI, IVF, and IVF with preimplantation genetic diagnosis (PGD). Older patients with recurrent pregnancy loss or those with diminished ovarian reserve are probably best treated through the use of donor-egg IVF.