Recurrent pregnancy loss is a frustrating clinical dilemma for both pa
tients and physicians because, in most cases, causes are nebulous and
few treatments with proven benefit can be offered. Involved, expensive
tests have frequently been proposed and their use has often filtered
into clinical practice before their utility has been firmly demonstrat
ed. Proposed causes of recurrent pregnancy loss include genetic and en
vironmental etiologies, infectious agents, maternal congenital and acq
uired anatomic abnormalities, and immunologic and endocrinologic dysfu
nction. Appropriate management relies upon a realistic understanding o
f the often substantial limitations of currently available therapies.