Hum. Reprod. Advance Access originally published online on May 17, 2006
Human Reproduction 2006 21(9):2216-2222; doi:10.1093/humrep/del150
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Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage
1 Academic Department of Obstetrics and Gynaecology, Royal Free and University College London Medical School, London 2 Department of Obstetrics and Gynaecology, Liverpool Women’s Hospital, Liverpool, UK 3 Fertility Clinic 4071, Rigshospitalet, Copenhagen, Denmark and 4 Department of Obstetrics and Gynaecology, Spaarne Ziekenhuis, Hoofddorp, The Netherlands
5 To whom correspondence should be addressed at: Academic Department of Obstetrics and Gynaecology, University College London Medical School, 86-96 Chenies Mews, London WC1E 6HX, UK. E-mail: e.jauniaux{at}ucl.ac.uk
Recurrent miscarriage (RM; 
3 consecutive early pregnancy losses) affects around 1% of fertile couples. Parental chromosomal anomalies, maternal thrombophilic disorders and structural uterine anomalies have been directly associated with recurrent miscarriage; however, in the vast majority of cases the pathophysiology remains unknown. We have updated the ESHRE Special Interest Group for Early Pregnancy (SIGEP) protocol for the investigation and medical management of RM. Based on the data of recently published large randomized controlled trials (RCTs) and meta-analyses, we recommend that basic investigations of a couple presenting with recurrent miscarriage should include obstetric and family history, age, BMI and exposure to toxins, full blood count, antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies), parental karyotype, pelvic ultrasound and/or hysterosalpingogram. Other investigations should be limited to particular cases and/or used within research programmes. Tender loving care and health advice are the only interventions that do not require more RCTs. All other proposed therapies, which require more investigations, are of no proven benefit or are associated with more harm than good.
Key words: early pregnancy/evidence-based/management/recurrent miscarriage/treatment
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