Abstract
The risk of pregnancy loss prior to 24 weeks gestation has been found to be 15.3% of all pregnancies, around 23 million losses each year. Recurrent pregnancy loss (RPL) - two or more pregnancy losses - are now presumed to affect 5% of couples. Clinical guidelines for health professionals for RPL are conflicting, lacking in good quality evidence and fail to involve those who experience RPL, especially the male partner. Despite folate being recommended for preconception support, no mention of folate exists in RPL guidelines. A national cross-sectional survey which assessed health professionals' recommendations, testing, prescribing and referral practices when providing care for couples in preconception and RPL was conducted. Clinical guidelines for RPL were found to be critically important for health professionals to provide care to couples experiencing RPL, however health professionals (n = 175) require stronger clinical guidance and more specialised training (47.3%), education (62.8%) and funding to better assist couples with RPL. Only 34% of health professionals reported having the necessary resources to support couples with RPL. Health professionals are aware of how important folate is to support preconception in females but are unaware of the critical role it plays in male fertility and as a result males are largely ignored in preconception care. Given the importance of folate supplementation in preconception and pregnancy, the guidelines for RPL fail to include dosing recommendations or variations in the type of folate that should be prescribed. Improved clinical guidelines, better resourcing and funding are required for health professionals to better support couples with RPL. Male partners need to be included in the preconception care and folate form and dosing must be considered.