ASRM Releases First Recurrent Pregnancy Loss Update in Over a Decade
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ASRM Releases First Recurrent Pregnancy Loss Update in Over a Decade
The new committee opinion favors targeted, evidence-based evaluation over routine panels and broadens the definition of qualifying losses.
Source: American Society for Reproductive Medicine (ASRM). June 1, 2026
The American Society for Reproductive Medicine (ASRM) released an updated Practice Committee opinion on recurrent pregnancy loss (RPL) on June 1, 2026, the first update on the topic since 2012. The opinion sets a more targeted, evidence-based approach to evaluation and care and moves away from broad testing panels that lack strong supporting evidence.
What Changed in the Definition
ASRM defines RPL as the spontaneous loss of two or more pregnancies, excluding confirmed molar or ectopic pregnancies. The updated opinion recognizes very early losses confirmed by blood or urine testing and clarifies that the losses do not need to be consecutive to warrant evaluation. This broadens who qualifies for a workup compared with older frameworks that emphasized consecutive clinical losses.
Key Recommendations
The opinion recommends chromosome testing of miscarriage tissue, when possible, as a first step in evaluation. It calls for more targeted testing based on the patient's history and risk factors, and screening for conditions such as thyroid disease and diabetes when appropriate. It advises against routine use of tests and treatments that lack strong evidence of benefit, and places greater emphasis on emotional support and counseling for patients and couples. ASRM notes that 50 to 80 percent of patients with RPL will go on to have a successful pregnancy, even without medical intervention.
What This Changes for Your Practice
Review your RPL evaluation protocol against the updated opinion. Prioritize karyotype analysis of pregnancy tissue and history-driven testing, and reduce reliance on low-yield panels. For osteopathic OB/GYNs who counsel patients after loss, the 50 to 80 percent success figure gives an evidence-based anchor for conversations that balance realistic hope with appropriate evaluation.
Clinical Takeaways
- Evaluate RPL after two or more losses; losses need not be consecutive under the 2026 ASRM opinion.
- Order chromosome testing of miscarriage tissue as a first-step evaluation when possible.
- Screen for thyroid disease and diabetes when history warrants, and avoid low-evidence routine panels.
- Counsel patients that 50 to 80 percent achieve a successful pregnancy, even without intervention.
- Build emotional support and counseling into the RPL care pathway.
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