Recurrent Pregnancy Loss: Novel Insights and Future Directions.

Recurrent pregnancy loss (RPL), defined as the spontaneous loss of two or more pregnancies before 20 weeks of gestation, remains a complex clinical challenge with multifactorial etiology. Genetic abnormalities, uterine anomalies, endocrine disorders, antiphospholipid antibody syndrome, infections, environmental influences, and male factors contribute to its occurrence. Evaluation involves comprehensive history, endocrine and genetic testing, uterine imaging, and screening for thrombophilia and infections. Management strategies include surgical correction of uterine anomalies, pharmacological interventions (levothyroxine, metformin, cabergoline, progesterone, low-dose aspirin, LMWH), and supportive care. Emerging therapies such as preimplantation genetic testing, stem cell-derived exosome therapy, lymphocyte immunotherapy, and pharmacogenomics offer promising avenues but require further validation. Psychological support and multidisciplinary care are essential to improve outcomes. Despite advances, unexplained RPL remains prevalent, underscoring the need for precision medicine and integrative approaches to optimize reproductive success.