Comprehensive Insights into the Aetiology, Diagnosis, and Emerging Approaches for Recurrent Pregnancy Loss: Narrative review

Recurrent Pregnancy Loss (RPL), characterized by two or more consecutive pregnancy failures, poses a major reproductive health challenge, impacting roughly 1-3% of couples of reproductive ages. Its causes are highly complex and multifaceted, encompassing genetic, anatomical, hormonal, immunological, infectious, environmental, and acquired thrombophilia factors. Despite significant progress in reproductive medicine and diagnostic methods, more than half of RPL cases remain unexplained, underscoring the intricate nature of its underlying mechanisms. This review consolidates current knowledge on the various factors contributing to RPL, including chromosomal abnormalities, uterine structural anomalies, endocrine disturbances, immune responses, infections, and both inherited and acquired blood clotting disorders. It examines the physiological processes essential for pregnancy maintenance and outlines how their disruption leads to pregnancy loss focusing on alterations in hemostasis, immune tolerance, and genetic susceptibility. The review also identifies existing gaps in research and clinical practice, emphasizing the need for comprehensive, personalized diagnostic and treatment strategies. Recognizing key risk factors such as thrombophilia and chromosomal irregularities is vital for developing targeted interventions. Future directions should prioritize understanding gene-environment interactions and innovating diagnostic tools and therapies aimed at improving pregnancy success rates and providing holistic support for women experiencing RPL.