Autoimmune sources of recurrent pregnancy loss should be evaluated, especially in women with a history of rheumatologic or autoimmune disease. Women with a preexisting autoimmune disease such as systemic lupus erythematosus (lupus) are clearly at risk for pregnancy loss and poor reproductive outcomes. In particular, lupus patients who have antiphospholipid antibodies (especially anticardiolipin antibodies) are at the highest risk for pregnancy loss. The presence of these antibodies in the absence of lupus also leads to an increased risk of miscarriage and poor pregnancy outcome. Treatment recommendations in such cases include daily pediatric doses of aspirin (81 mg/day), low-dose injectable blood thinners (such as heparin or Lovenox), or both.

Testing for antiphospholipid antibodies in all women who have infertility problems, even if they do not have a history of pregnancy loss, is unwarranted. In our practice, we usually restrict such testing to those patients with a history of pregnancy loss. Women who have a history of pregnancy loss should undergo both antiphospholipid antibodies and lupus anticoagulant testing.