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Shanza Ghaffar: Recurrent Pregnancy Loss Beyond Diagnosis and Treatment
Shanza Ghaffar/Instagram
May 13, 2026, 16:24

Shanza Ghaffar: Recurrent Pregnancy Loss Beyond Diagnosis and Treatment

Shanza Ghaffar, Reproductive Medicine Specialist/Gynecologist at Omar Hospital and Cardiac Centre, shared a post on LinkedIn:

“Recurrent Pregnancy Loss –

What Every Clinician (and Patient) Needs to Know

One miscarriage is devastating. Two or more? It shakes a person to their core. Recurrent Pregnancy Loss (RPL) affects 1–5% of couples trying to conceive, yet it remains one of the most underdiagnosed and emotionally under-supported conditions in reproductive medicine.

Here’s what the ESHRE and ASRM guidelines tell us:

Definition

Both ESHRE and ASRM now define RPL as 2 or more pregnancy losses before viability – and recommend starting investigations after just 2 losses. We no longer ask patients to wait for three.

Causes — and the humbling truth

We can only identify a cause in less than 50% of cases. Known causes include:

  • Chromosomal / genetic factors (most common)
  • Uterine anomalies — especially septate uterus
  • Antiphospholipid Syndrome (APS)
  • Thyroid dysfunction, diabetes, hyperprolactinemia
  • Advanced maternal age

What we should do

  • Screen for antiphospholipid antibodies (LA, aCL IgG/IgM) after 2 losses
  • 3D ultrasound / hysteroscopy to rule out uterine anomalies
  • Check TSH — target < 2.5 mIU/L, treat if elevated with anti-TPO positivity
  • Parental karyotyping + POC chromosomal analysis
  • For confirmed APS: low-dose aspirin pre-conception + LMWH once pregnancy confirmed

What we should not do routinely

  • Routine inherited thrombophilia screening (Factor V Leiden etc.) — not recommended unless personal/family history of clots
  • IVIg — no proven benefit
  • Paternal leukocyte immunisation — trials show no improvement
  • Routine NK cell testing — evidence remains insufficient

The most underrated intervention?

Tender Loving Care.

Both ESHRE and ASRM acknowledge that dedicated early pregnancy surveillance and emotional support are associated with improved live birth rates – even without pharmacological intervention. Compassionate care is not soft medicine. It is evidence-based medicine.

Progesterone?

May be considered in unexplained RPL, especially with early pregnancy bleeding (PRISM trial data). ASRM is more cautious – insufficient evidence for routine use, but widely used empirically given its safety profile.

RPL is not just a clinical problem. It is a grief that most people carry silently. As clinicians, our job is not only to investigate – it is to witness, to validate, and to walk alongside our patients with both scientific rigour and human warmth.

References:

ESHRE Guideline Group on RPL, Hum Reprod Open 2023 ·

ASRM Practice Committee, Fertil Steril 2024″

Shanza Ghaffar

Stay updated on all scientific advances in the field of fertility with Fertility News.

3D Ultrasound Advanced Maternal Age Antiphospholipid Syndrome APS ASRM Chromosomal factor Diabetes ESHRE Fertility Fertility News Genetic Factors hyperprolactinemia hysteroscopy IVIG LMWH miscarriage NK cell Parental karyotyping Paternal leukocyte immunisation POC chromosomal analysis Recurrent Pregnancy Loss reproductive health Reproductive Medicine RPL Septate Uterus Shanza Ghaffar thyroid dysfunction TSH Uterine anomalies
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