The treatment of RPL should be directed at the cause. Given the good outcome for most couples with unexplained recurrent miscarriage in the absence of treatment, it is difficult to recommend unproven therapies, especially if they are invasive and expensive. Explanation and appropriate emotional support are possibly the two most important aspects of therapy.
In approximately half of all cases of RPL, a complete evaluation will reveal a possible etiology. Abnormal findings during the evaluation should be corrected prior to attempting any subsequent pregnancy. If no cause can be found, the majority of couples will eventually have a successful pregnancy outcome with supportive therapy alone. Once a pregnancy occurs, the patient should be monitored closely with evaluation of quantitative hCG levels at least twice and documentation of adequate progesterone levels. Early sonography should be scheduled and any encouraging results should be communicated to the couple. In women with a history of RPL, the presence of a normal embryonic heart rate between 6 and 8 gestational weeks that is confirmed with repeat sonography in one week is associated with a live birth rate of 82%. Any subsequent failed pregnancies should have genetic testing on the products of conception. When aneuploidy is found this can be reassuring to both the physician and patient that this loss was not due to a treatment failure or any patient activity.
Thankfully, the prognosis for women with RPL to eventually deliver with medical therapy is quite good. A recent study evaluating 987 women with RPL found that the chances of achieving a live birth within five years of initial physician consultation was in excess of 80% for women under the age of 30 and approximately 60-70% for women ages 31 to 40.