Immunologic and rheumatologic aspects of recurrent pregnancy loss: have the sirens enchanted us onto the rocks?
Volume 112, Issue 6, Pages 1000–1001
Zev Rosenwaks, M.D.
Of the many disorders presenting to the reproductive medicine specialist, recurrent pregnancy loss (RPL; also designated as recurrent miscarriage [RM]) represents a most challenging and frustrating entity. While it is generally acknowledged that chromosomal aneuploidy of gametes and embryos is the most common cause of RPL, other causes such as anatomic defects, infections, endocrine disorders, antiphospholipid antibodies, thrombophilias, and immunologic and rheumatologic disorders have been implicated. Indeed, some of the aforementioned causes are difficult to diagnose and treat. As many as 30–50% of RPL cases are unexplained. RPL remains highly enigmatic and often appears to be of a multifactorial and complex etiology. Of the many putative etiologies described herein, immunologic and rheumatologic causes have remained the most perplexing and have engendered great debate and controversy.