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Recurrent early pregnancy loss: Can cytogenic analysis help?

Evaluation of recurrent early pregnancy loss, based on this expert's algorithms, should include not only an array of tests but cytogenetic analysis of the products of conception.

Recurrent pregnancy loss has always been an emotionally wrenching experience for our patients. But now, due to technologic advances, miscarriage is becoming even more common among patients. Home pregnancy tests have become so sensitive that women are acutely aware of miscarriages that occur before they even miss a period. Also, with the expanding use of ultrasound monitoring for ovulation induction and in vitro fertilization, women are increasingly aware of pregnancy losses not long after embryo transfer. It's not surprising then that they are seeking evaluation and management of repeated preclinical miscarriages-and we must be ready to offer them appropriate guidance. With that in mind, my goal here is to help clinicians understand the impact of such early pregnancy testing, so we can offer patients that guidance.

Recurrent pregnancy loss is usually defined as two or more pregnancy losses at any gestational age. Recurrent miscarriage is more strictly defined as three or more consecutive miscarriages. The term early refers to pregnancies that end in demise before 10 weeks of gestation, while preclinical refers to those ending before 6 weeks of gestation. Incorporating such descriptive terminology permits us to easily summarize a patient's pattern of presentation.