Endocrine, Immunological, and Thrombotic Determinants of Recurrent Pregnancy Loss: Clinical Evidence, Causal Inference, and Precision Care

Recurrent  pregnancy  loss  (RPL)  is  a  heterogeneous  reproductive  outcome  in  which  endocrine  dysfunction,  antiphospholipid  antibodies,  genetic  abnormalities, uterine factors, and diverse maternal exposures may converge. The  identification of biologically plausible correlates does not automatically establish  causality or justify empirical treatment. Objective: To critically examine the clinical  relevance of endocrine, immunological, and thrombotic pathways and develop a rigorous  framework  for  integrating  randomized  trials  with  real -world  evidence.  Methods: A structured, non-systematic synthesis was undertaken using identifiable  clinical  practice  guidance,  randomized  trials,  and  regulatory  methodological  resources published through October 2026.