Abstract

The appropriate clinical care of women/couples with infertility experiencing recurrent miscarriage (RM) is overlooked in international guidelines. We sought to evaluate care provision for women/couples with RM and infertility across public and private sectors using adapted guideline-based key performance indicators (KPIs) for RM. We administered an online survey comprised of multiple-choice/open questions from November 2021 to February 2022, encompassing: (i) structure of care, (ii) investigations, (iii) treatments, (iv) counselling/supportive care and (v) outcomes. Clinical leads for pregnancy loss and fertility and clinical nurse/midwife specialists within each unit/clinic were invited to participate. The response rate 73% (24/33), varied by provider: Public RM care (18/19; 95%), 2/5 public fertility (40%); private fertility (3/9; 33%). Access to fertility expertise was limited in public RM clinics (39%). While investigations and treatments provided were mostly in line with guidelines, there was uncertainty regarding immunotherapies. Educational needs identified included fertility counselling, information and supportive care resources. Clinical outcomes were seldom audited (2/22; 9%). Greater engagement with the private sector is required to unify care across sectors and to ensure standardised evidence-based care. Audit and outcomes reporting should be a requirement. Lived experience of current care structures should inform service improvements.