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Human Reproduction, Vol. 17, No. 8, 1959-1963, August 2002
© 2002 European Society of Human Reproduction and Embryology

OPINION

Recurrent miscarriage: a defect in nature’s quality control?

Siobhan Quenby1, Gill Vince2, Roy Farquharson3 and John Aplin4,5

1 Department of Obstetrics and Gynaecology, 2 Department of Immunology, University of Liverpool, L69 3BX, 3 Liverpool Women’s Hospital, Crown Street, Liverpool L8 7SS and 4 Medical School and School of Biological Sciences, University of Manchester, Research Floor, St Mary’s Hospital, Manchester M13 OJH, UK

Recent data on recurrent miscarriage (RM) is discussed in the framework of the selection failure hypothesis which states, ‘Recurrent miscarriage is the result of failure of the prevention of ‘poor quality’ embryos implanting, allowing embryos that are destined to fail to implant and present clinically as recurrent miscarriage. Thus, recurrent miscarriage is a failure of nature’s quality control.’ The assumption that RM results from the maternal rejection of normal fetuses is challenged and evidence reviewed regarding the contribution of abnormal embryos and endometrial receptivity. Further research is needed to understand the mechanisms of maternal tract–embryo interaction and move towards improved management of recurrent pregnancy loss.

Key words: abnormal pregnancies/embryonic period of gestation/endometrial receptivity/recurrent miscarriage/recurrent pregnancy loss

5 To whom correspondence should be addressed. E-mail: john.aplin{at}man.ac.uk


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