In this chapter, common psychological experiences or consequences of recurrent pregnancy loss are discussed for affected women and their partners, with a focus on the experience of pregnancy after or during the course of recurrent loss. In this chapter, recurrent pregnancy loss is understood as a series of ongoing traumatic events and losses. Common experiences during pregnancies after loss, such as emotional cushioning and pregnancy-related anxiety, are conceptualized as understandable reactions to trauma and loss. Consequently, guidelines for helping patients to process trauma and loss and to mitigate associated symptoms of emotional cushioning and pregnancy-related anxiety are discussed, with a focus on the therapeutic relationship as an agent of change in individual and couples counseling.

There are many commercial tests for blood immune cell tests looking at NK cell numbers, cell cytotoxicity or associated cytokine levels. Despite the lack of evidence, patients with recurrent pregnancy loss and implantation failure are often advised to have these tests and are subsequently offered immunotherapies, not backed by trial evidence to treat apparently abnormal results. Blood NK cells are innate immune cells and a first line of host defence against pathogens and tumour cells. Uterine NK cells are phenotypically different to blood NK cells and function when activated to promote normal placentation when pregnancy occurs. Despite a lack of biological plausibility, meta-analyses have been suggestive of altered blood NK cells in subfertility and recurrent pregnancy loss. However they have not shown that blood NK cells have an impact on pregnancy outcome. It is imperative that we offer patients tests and treatment based on robust evidence rather than poor science.

A 22-year-old female, gravida 3, para 0, presents to the office for evaluation of recurrent pregnancy loss. Her obstetric history is significant for three prior first-trimester losses, all managed expectantly. She has regular menstrual cycles and has not had difficulty with conceiving in the past. She has been in a relationship with her partner for four years and they desire to conceive at this time. She has no significant past medical or family history and has not had prior surgery. She takes no medications and has no allergies.