What is recurrent miscarriage? Spontaneous miscarriage is defined as a miscarriage in which the embryo or fetus is spontaneously expelled from the mother for some reason before the 28th week of pregnancy, and its incidence is about 15% to 20%. If a spontaneous abortion occurs 3 or more times in a row and occurs within the third trimester, it is called recurrent early spontaneous abortion (ERSA), which used to be called habitual abortion, but in fact is inaccurate. ERSA is a common obstetrical and gynecological disorder with complex and diverse causes, related to the patient’s own genetic, anatomical, endocrine, immune, and infectious factors. Strictly speaking, no factor is an absolute factor in ERSA, only the size of the pathogenic potential. Statistics show that: (1) genetic causes about 3-8% of ERSA couples have chromosomal abnormalities, such as ROBERSON ectopic, inter-arm inversion, etc., while the incidence of chromosomal abnormalities in the general population is only 0.2%; on the other hand, it is possible that both couples do not have chromosomal abnormalities, but the embryo has a chromosomal combination error during development. Couples of advanced age are prone to chromosomal abnormalities in embryos. There is no effective treatment for patients with chromosomal abnormalities resulting in ERSA, and the incidence of chromosomally abnormal fetuses can only be estimated through genetic counseling. If the incidence is high, pre-implantation genetic diagnosis (PGD), donor sperm or donor egg IVF can be used to eliminate or avoid abnormal embryos; if the incidence is low, pregnancy can be initiated followed by chorionic villus biopsy or amniocentesis to examine fetal chromosomes and terminate the pregnancy if fatal or teratogenic abnormalities are detected. (2) Uterine causes such as patients with uterine fibroids, uterine malformations or uterine adhesions are also prone to ERSA. In the case of malformations such as hypoplastic unicornuate uterus, bicornuate uterus or double uterus, surgery is difficult to correct and may result in miscarriage in late pregnancy. A thin endometrium or poor blood supply is also an important factor in early miscarriage. Such patients can be clearly diagnosed by ultrasound, hysterosalpingogram, hysteroscopy, MRI, etc. and effectively treated by hysteroscopic surgical plastic surgery. If it is due to thin endometrium or poor blood supply, herbal treatment, is a better choice. (3) Endocrine causes of ERSA are more common in patients with poor ovulation, luteal insufficiency, hyperprolactinemia and other endocrine factors, as well as abnormal thyroid and adrenal gland function that can lead to the above ovulation problems. Endocrine treatment of ERSA due to such causes, such as ovulation promotion and luteal support, is the most effective, and the success rate of pregnancy again after treatment can be over 90%. (4) Recent studies have concluded that immune factors are also an important cause of ERSA. 50% to 60% of patients with ERSA are immune-related, and about 30% of them have autoantibody production, which may be an autoimmune disease called autoimmune recurrent spontaneous abortion, based mainly on the detection of autoantibodies in this group of patients, with antiphospholipid antibodies being the most common. The main basis is that autoantibodies can be detected in these patients, with antiphospholipid antibodies being the most common. (5) For a period of time, it was believed that about 70% of patients might be associated with low reactivity to fetal paternal antigens, which is called alloimmune recurrent spontaneous abortion, and these patients lack closed antibodies and need active immunotherapy. However, recent clinical studies have shown that closed antibodies have little relationship with ERSA and active immunotherapy is not required. Diagnostic procedures for recurrent miscarriage The etiology of recurrent early spontaneous miscarriage is complex and must be clinically diagnosed and treated symptomatically after clarifying the cause to achieve better results. Our general examination procedures are chromosomal examination of both spouses – examination of the uterus and reproductive tract – ovulation monitoring and luteal function examination – determination of autoimmune antibodies – examination of thyroid and pituitary lactogen – determination of autoimmune antibodies – examination of chromosomes of aborted chorionic villi. However, there are some patients for whom our current conventional diagnostic methods do not detect the cause of miscarriage, which may be related to microdeletions of chromosomes and abnormalities of individual genes. Treatment options for recurrent miscarriage (1) Treatment for the cause, including ovulation promotion and luteal support, hysteroscopic surgery, treatment and adjustment of various medications, IVF with pre-implantation genetic diagnosis, etc. (2) Complementary treatment with Chinese medicine is also of considerable value. We started Chinese medicine intervention treatment in 2005 and have accumulated very rich clinical experience in anti-cardiolipin antibody positivity, anti-nuclear antibody positivity, uterine dystrophy, and poor luteal function, etc. The combination of evidence and disease identification is effective. Especially, the unique advantage of TCM in systemic identification can take into account ovarian function, intrauterine environment and inflammation of reproductive tract at the same time while targeting treatment, which can not only solve the problem of early miscarriage but also improve pregnancy and fertility. Traditional Chinese medicine has been an insightful treatise on post-pregnancy fetal preservation and antifetus, with many medical cases and prescriptions; plus the fact that fetal preservation and antifetus medicine is not only harmless to the fetus, but also very beneficial to its innate endowment. Therefore, Chinese medicine is an excellent choice in the treatment of ERSA. (3) After etiological treatment or in patients with unknown etiology, we will develop a pregnancy and fetus preservation plan, usually 3 cycles as a course of treatment. In the practice of clinical treatment, this program has yielded good therapeutic results.