A Comprehensive Review of Paternal Causes of Recurrent Pregnancy Loss
Year 2025,
Volume: 15 Issue: 4, 197 - 202, 31.07.2025
Damica Clerveau
Sathees Chandra
Abstract
Abstract:
Approximately 5% of couples attempting to reproduce face the challenge of recurrent pregnancy loss. Sadly, more than 50% of those couples will have their case remain unexplained. This can be problematic when families are trying to conceive. Past research mainly focused on maternal causes of recurrent pregnancy loss. A shift in research towards investigating paternal etiologies has revealed more causes of recurrent pregnancy loss. New research has shown how paternal age, physical health, lifestyle habits, sperm characteristics, metabolic disorders, inflammatory disorders, and clotting disorders all influence pregnancy outcomes. The purpose of this paper is to provide a review of the past twenty years of literature investigating the underexplored paternal causes of recurrent pregnancy loss.
References
-
1. Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. The Lancet. 2021;397(10285):1658–67.
-
2. The ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB,et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018;2018(2):hoy004.
-
3. Turesheva A, Aimagambetova G, Ukybassova T, et al. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. J Clin Med.2023;12(12):4074.
-
4. Youssef A, Vermeulen N, Lashley EELO, Goddijn M, Hoorn MLP van der. Comparison and appraisal of (inter)national recurrent pregnancy loss guidelines. Reprod Biomed Online. 2019;39(3):497–503.
-
5. Yu N, Kwak-Kim J, Bao S. Unexplained recurrent pregnancy loss: Novel causes and advanced treatment. J Reprod Immunol. 2023;155:103785.
-
6. de Jesus GR, Agmon-Levin N, Andrade CA, et al. 14th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome. Autoimmunity Reviews. 2014;13(8):795–813.
-
7. Tomkiewicz J, Darmochwał-Kolarz D. The Diagnostics and Treatment of Recurrent Pregnancy Loss. J Clin Med. 2023;12(14):4768.
-
8. El Hachem H, Crepaux V, May-Panloup P, Descamps P, Legendre G, Bouet PE. Recurrent pregnancy loss: current perspectives. Int J Womens Health. 2017; 9: 331– 45.
-
9. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024;143(5):645.
-
10. Vomstein K, Krog MC, Wrønding T, Nielsen HS. The microbiome in recurrent pregnancy loss - A scoping review. J Reprod Immunol. 2024;163:104251.
-
11. Muncey W, Scott M, Lathi RB, Eisenberg ML. The paternal role in pregnancy loss. Andrology. 2025;13(1):146–50.
-
12. Owen A, Carlson K, Sparzak PB. Age-Related Fertility Decline. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
-
13. du Fossé NA, van der Hoorn MP, van Lith JMM, le Cessie S, Lashley EELO. Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Hum Reprod Update. 2020;26(5):650-669.
-
14. Lindman J, Vomstein K, Egerup P, Krog MC, Nielsen HS. Is lifestyle different in male partners experiencing recurrent pregnancy loss compared to men fathering a live birth? Andrology. 2025 Jan 13;13(1):151–8.
-
15. Crafa A, Leanza C, Condorelli RA, La Vignera S, Calogero AE, Cannarella R. Relationship between degree of methylation of sperm long interspersed nuclear element-1 (LINE-1) gene and alteration of sperm parameters and age: a meta-regression analysis. J Assist Reprod Genet. 2024 Jan;41(1):87–97.
-
16. Kaltsas A, Moustakli E, Zikopoulos A, Georgiou I, Dimitriadis F, Symeonidis EN, et al. Impact of Advanced Paternal Age on Fertility and Risks of Genetic Disorders in Offspring. Genes. 2023;14(2):486.
-
17. Inversetti A, Bossi A, Cristodoro M, Larcher A, Busnelli A, Grande G, et al. Recurrent pregnancy loss: a male crucial factor-A systematic review and meta-analysis. Andrology. 2023;13(1):130–45.
-
18. Peuranpää PL, Gissler M, Peltopuro P, Tiitinen A, Hautamäki H. The effect of paternal and maternal factors on the prognosis of live birth in couples with recurrent pregnancy loss. Acta Obstet Gynecol Scand. 2022;101(12):1374.
-
19. Brandt NB, Kristensen MLS, Catalini L, Fedder J. Effect of paternal health on pregnancy loss - A review of current evidence. Andrologia. 2022;54(1):e14259.
-
20. du Fossé NA, van der Hoorn MLP, de Koning R, Mulders AGMGJ, van Lith JMM, le Cessie S, et al. Toward more accurate prediction of future pregnancy outcome in couples with unexplained recurrent pregnancy loss: taking both partners into account. Fertil Steril. 2022;117(1):144–52.
-
21. Ibrahim Y, Johnstone E. The male contribution to recurrent pregnancy loss. Transl Androl Urol. 2018;7(Suppl 3):S317–27.
-
22. Kasman AM, Zhang CA, Li S, Lu Y, Lathi RB, Stevenson DK, et al. Association between preconception paternal health and pregnancy loss in the USA: an analysis of US claims data. Hum Reprod. 2021;36(3):785–93.
-
23. Campbell JM, Lane M, Owens JA, Bakos HW. Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis. Reprod BioMedicine Online. 2015;31(5):593–604.
-
24. Sønnichsen-Dreehsen A-S, Fedder J, Wod M, Thorarinsson CT, Nørgård BM. The association between paternal diabetes mellitus and successful pregnancy-Examined in a nationwide population undergoing reproductive treatment. Andrology. 2024;13(3):485–93.
-
25. Friedman S, Thorarinsson CT, Wod M, Fedder J, Nørgård BM. Paternal Inflammatory Bowel Disease and the Risk of Pregnancy Loss. Inflamm Bowel Dis. 2025;31(4):995-1002.
-
26. Gubatan J, Barber GE, Nielsen OH, Juhl CB, Maxwell C, Eisenberg ML, et al. Paternal Medications in Inflammatory Bowel Disease and Male Fertility and Reproductive Outcomes: A Systematic Review and Meta-analysis. Clin Gastroenterol and Hepatolo. 2023;21(9):2222–38.
-
27. Liu X, Chen Y, Ye C, Xing D, Wu R, Li F, et al. Hereditary thrombophilia and recurrent pregnancy loss: a systematic review and meta-analysis. Human Reprod. 2021;36(5):1213–29.
-
28. Udry S, Aranda FM, Latino JO, de Larrañaga GF. Paternal factor V Leiden and recurrent pregnancy loss: a new concept behind fetal genetics? J Thromb Haemost. 2014;12(5):666–9.
-
29. Ang KC, Bogdanova N, Markoff A, Ch’ng ES, Tang TH. Association between M2/ANXA5 haplotype and repeated pregnancy loss: a meta-analysis. Fertil and Steril. 2019;111(5):971-981.e2.
-
30. Rogenhofer N, Engels L, Bogdanova N, Tüttelmann F, Markoff A, Thaler C. Paternal and maternal carriage of the annexin A5 M2 haplotype are equal risk factors for recurrent pregnancy loss: a pilot study. Fertil Steril. 2012;98(2):383–8.
-
31. Giannubilo SR, Marzioni D, Tossetta G, Montironi R, Meccariello ML, Ciavattini A. The “Bad Father”: Paternal Role in Biology of Pregnancy and in Birth Outcome. Biology (Basel). 2024;13(3):165.
-
32. Sah AK, Shrestha N, Joshi P, Lakha R, Shrestha S, Sharma L, et al. Association of parental methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in couples with unexplained recurrent pregnancy loss. BMC Res Notes. 2018;11(1):233.
-
33. Eisenberg ML, Sapra KJ, Kim SD, Chen Z, Buck Louis GM. Semen quality and pregnancy loss in a contemporary cohort of couples recruited before conception: data from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. Fertil Steril. 2017;108(4):613–9.
-
34. Naglot S, Thapliyal A, Tomar AK, Yadav S. Male Contributory Factors in Recurrent Pregnancy Loss. Reprod Sci. 2023;30(7):2107–21.
-
35. Ruixue W, Hongli Z, Zhihong Z, Rulin D, Dongfeng G, Ruizhi L. The impact of semen quality, occupational exposure to environmental factors and lifestyle on recurrent pregnancy loss. J Assist Reprod Genet. 2013;30(11):1513.
-
36. Davies R, Minhas S, Jayasena CN. The role of seminal reactive oxygen species assessment in the setting of infertility and early pregnancy loss. World J Urol. 2023;41(11):3257.
-
37. Schmid TE, Grant PG, Marchetti F, Weldon RH, Eskenazi B, Wyrobek AJ. Elemental composition of human semen is associated with motility and genomic sperm defects among older men. Hum Reprod. 2013;28(1):274–82.
-
38. Zhu XB, Chen Q, Fan WM, Niu ZH, Xu BF, Zhang AJ. Sperm DNA fragmentation in Chinese couples with unexplained recurrent pregnancy loss. Asian J Androl. 2020;22(3):296.
-
39. Mohanty G, Jena SR, Kar S, Samanta L. Paternal factors in recurrent pregnancy loss: an insight through analysis of non-synonymous single-nucleotide polymorphism in human testis-specific chaperone HSPA2 gene. Environ Sci Pollut Res Int. 2022;29(41):62219–34.
-
40. Khambata K, Raut S, Deshpande S, Mohan S, Sonawane S, Gaonkar R, et al. DNA methylation defects in spermatozoa of male partners from couples experiencing recurrent pregnancy loss. Hum Reprod. 2020;36(1):48–60.
-
41. Golin AP, Yuen W, Flannigan R. The effects of Y chromosome microdeletions on in vitro fertilization outcomes, health abnormalities in offspring and recurrent pregnancy loss. Transl Androl Urol. 2021;10(3):1457.
-
42. Mohanty G, Jena SR, Nayak J, Kar S, Samanta L. Proteomic Signatures in Spermatozoa Reveal the Role of Paternal Factors in Recurrent Pregnancy Loss. World J Mens Health. 2020;38(1):103–14.
-
43. Hamidian S, Talebi AR, Fesahat F, Bayat M, Mirjalili AM, Ashrafzadeh HR, et al. The effect of vitamin C on the gene expression profile of sperm protamines in the male partners of couples with recurrent pregnancy loss: A randomized clinical trial. Clin Exp Reprod Med. 2020;47(1):68–76.
-
44. The ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open. 2023;2023(1):hoad002.
A Comprehensive Review of Paternal Causes of Recurrent Pregnancy Loss
Year 2025,
Volume: 15 Issue: 4, 197 - 202, 31.07.2025
Damica Clerveau
Sathees Chandra
Abstract
Abstract:
Approximately 5% of couples attempting to reproduce face the challenge of recurrent pregnancy loss. Sadly, more than 50% of those couples will have their case remain unexplained. This can be problematic when families are trying to conceive. Past research mainly focused on maternal causes of recurrent pregnancy loss. A shift in research towards investigating paternal etiologies has revealed more causes of recurrent pregnancy loss. New research has shown how paternal age, physical health, lifestyle habits, sperm characteristics, metabolic disorders, inflammatory disorders, and clotting disorders all influence pregnancy outcomes. The purpose of this paper is to provide a review of the past twenty years of literature investigating the underexplored paternal causes of recurrent pregnancy loss.
Ethical Statement
None-All the rules are followed
Supporting Institution
Samuel Merritt University
References
-
1. Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. The Lancet. 2021;397(10285):1658–67.
-
2. The ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB,et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018;2018(2):hoy004.
-
3. Turesheva A, Aimagambetova G, Ukybassova T, et al. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. J Clin Med.2023;12(12):4074.
-
4. Youssef A, Vermeulen N, Lashley EELO, Goddijn M, Hoorn MLP van der. Comparison and appraisal of (inter)national recurrent pregnancy loss guidelines. Reprod Biomed Online. 2019;39(3):497–503.
-
5. Yu N, Kwak-Kim J, Bao S. Unexplained recurrent pregnancy loss: Novel causes and advanced treatment. J Reprod Immunol. 2023;155:103785.
-
6. de Jesus GR, Agmon-Levin N, Andrade CA, et al. 14th International Congress on Antiphospholipid Antibodies Task Force Report on Obstetric Antiphospholipid Syndrome. Autoimmunity Reviews. 2014;13(8):795–813.
-
7. Tomkiewicz J, Darmochwał-Kolarz D. The Diagnostics and Treatment of Recurrent Pregnancy Loss. J Clin Med. 2023;12(14):4768.
-
8. El Hachem H, Crepaux V, May-Panloup P, Descamps P, Legendre G, Bouet PE. Recurrent pregnancy loss: current perspectives. Int J Womens Health. 2017; 9: 331– 45.
-
9. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024;143(5):645.
-
10. Vomstein K, Krog MC, Wrønding T, Nielsen HS. The microbiome in recurrent pregnancy loss - A scoping review. J Reprod Immunol. 2024;163:104251.
-
11. Muncey W, Scott M, Lathi RB, Eisenberg ML. The paternal role in pregnancy loss. Andrology. 2025;13(1):146–50.
-
12. Owen A, Carlson K, Sparzak PB. Age-Related Fertility Decline. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
-
13. du Fossé NA, van der Hoorn MP, van Lith JMM, le Cessie S, Lashley EELO. Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis. Hum Reprod Update. 2020;26(5):650-669.
-
14. Lindman J, Vomstein K, Egerup P, Krog MC, Nielsen HS. Is lifestyle different in male partners experiencing recurrent pregnancy loss compared to men fathering a live birth? Andrology. 2025 Jan 13;13(1):151–8.
-
15. Crafa A, Leanza C, Condorelli RA, La Vignera S, Calogero AE, Cannarella R. Relationship between degree of methylation of sperm long interspersed nuclear element-1 (LINE-1) gene and alteration of sperm parameters and age: a meta-regression analysis. J Assist Reprod Genet. 2024 Jan;41(1):87–97.
-
16. Kaltsas A, Moustakli E, Zikopoulos A, Georgiou I, Dimitriadis F, Symeonidis EN, et al. Impact of Advanced Paternal Age on Fertility and Risks of Genetic Disorders in Offspring. Genes. 2023;14(2):486.
-
17. Inversetti A, Bossi A, Cristodoro M, Larcher A, Busnelli A, Grande G, et al. Recurrent pregnancy loss: a male crucial factor-A systematic review and meta-analysis. Andrology. 2023;13(1):130–45.
-
18. Peuranpää PL, Gissler M, Peltopuro P, Tiitinen A, Hautamäki H. The effect of paternal and maternal factors on the prognosis of live birth in couples with recurrent pregnancy loss. Acta Obstet Gynecol Scand. 2022;101(12):1374.
-
19. Brandt NB, Kristensen MLS, Catalini L, Fedder J. Effect of paternal health on pregnancy loss - A review of current evidence. Andrologia. 2022;54(1):e14259.
-
20. du Fossé NA, van der Hoorn MLP, de Koning R, Mulders AGMGJ, van Lith JMM, le Cessie S, et al. Toward more accurate prediction of future pregnancy outcome in couples with unexplained recurrent pregnancy loss: taking both partners into account. Fertil Steril. 2022;117(1):144–52.
-
21. Ibrahim Y, Johnstone E. The male contribution to recurrent pregnancy loss. Transl Androl Urol. 2018;7(Suppl 3):S317–27.
-
22. Kasman AM, Zhang CA, Li S, Lu Y, Lathi RB, Stevenson DK, et al. Association between preconception paternal health and pregnancy loss in the USA: an analysis of US claims data. Hum Reprod. 2021;36(3):785–93.
-
23. Campbell JM, Lane M, Owens JA, Bakos HW. Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis. Reprod BioMedicine Online. 2015;31(5):593–604.
-
24. Sønnichsen-Dreehsen A-S, Fedder J, Wod M, Thorarinsson CT, Nørgård BM. The association between paternal diabetes mellitus and successful pregnancy-Examined in a nationwide population undergoing reproductive treatment. Andrology. 2024;13(3):485–93.
-
25. Friedman S, Thorarinsson CT, Wod M, Fedder J, Nørgård BM. Paternal Inflammatory Bowel Disease and the Risk of Pregnancy Loss. Inflamm Bowel Dis. 2025;31(4):995-1002.
-
26. Gubatan J, Barber GE, Nielsen OH, Juhl CB, Maxwell C, Eisenberg ML, et al. Paternal Medications in Inflammatory Bowel Disease and Male Fertility and Reproductive Outcomes: A Systematic Review and Meta-analysis. Clin Gastroenterol and Hepatolo. 2023;21(9):2222–38.
-
27. Liu X, Chen Y, Ye C, Xing D, Wu R, Li F, et al. Hereditary thrombophilia and recurrent pregnancy loss: a systematic review and meta-analysis. Human Reprod. 2021;36(5):1213–29.
-
28. Udry S, Aranda FM, Latino JO, de Larrañaga GF. Paternal factor V Leiden and recurrent pregnancy loss: a new concept behind fetal genetics? J Thromb Haemost. 2014;12(5):666–9.
-
29. Ang KC, Bogdanova N, Markoff A, Ch’ng ES, Tang TH. Association between M2/ANXA5 haplotype and repeated pregnancy loss: a meta-analysis. Fertil and Steril. 2019;111(5):971-981.e2.
-
30. Rogenhofer N, Engels L, Bogdanova N, Tüttelmann F, Markoff A, Thaler C. Paternal and maternal carriage of the annexin A5 M2 haplotype are equal risk factors for recurrent pregnancy loss: a pilot study. Fertil Steril. 2012;98(2):383–8.
-
31. Giannubilo SR, Marzioni D, Tossetta G, Montironi R, Meccariello ML, Ciavattini A. The “Bad Father”: Paternal Role in Biology of Pregnancy and in Birth Outcome. Biology (Basel). 2024;13(3):165.
-
32. Sah AK, Shrestha N, Joshi P, Lakha R, Shrestha S, Sharma L, et al. Association of parental methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in couples with unexplained recurrent pregnancy loss. BMC Res Notes. 2018;11(1):233.
-
33. Eisenberg ML, Sapra KJ, Kim SD, Chen Z, Buck Louis GM. Semen quality and pregnancy loss in a contemporary cohort of couples recruited before conception: data from the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. Fertil Steril. 2017;108(4):613–9.
-
34. Naglot S, Thapliyal A, Tomar AK, Yadav S. Male Contributory Factors in Recurrent Pregnancy Loss. Reprod Sci. 2023;30(7):2107–21.
-
35. Ruixue W, Hongli Z, Zhihong Z, Rulin D, Dongfeng G, Ruizhi L. The impact of semen quality, occupational exposure to environmental factors and lifestyle on recurrent pregnancy loss. J Assist Reprod Genet. 2013;30(11):1513.
-
36. Davies R, Minhas S, Jayasena CN. The role of seminal reactive oxygen species assessment in the setting of infertility and early pregnancy loss. World J Urol. 2023;41(11):3257.
-
37. Schmid TE, Grant PG, Marchetti F, Weldon RH, Eskenazi B, Wyrobek AJ. Elemental composition of human semen is associated with motility and genomic sperm defects among older men. Hum Reprod. 2013;28(1):274–82.
-
38. Zhu XB, Chen Q, Fan WM, Niu ZH, Xu BF, Zhang AJ. Sperm DNA fragmentation in Chinese couples with unexplained recurrent pregnancy loss. Asian J Androl. 2020;22(3):296.
-
39. Mohanty G, Jena SR, Kar S, Samanta L. Paternal factors in recurrent pregnancy loss: an insight through analysis of non-synonymous single-nucleotide polymorphism in human testis-specific chaperone HSPA2 gene. Environ Sci Pollut Res Int. 2022;29(41):62219–34.
-
40. Khambata K, Raut S, Deshpande S, Mohan S, Sonawane S, Gaonkar R, et al. DNA methylation defects in spermatozoa of male partners from couples experiencing recurrent pregnancy loss. Hum Reprod. 2020;36(1):48–60.
-
41. Golin AP, Yuen W, Flannigan R. The effects of Y chromosome microdeletions on in vitro fertilization outcomes, health abnormalities in offspring and recurrent pregnancy loss. Transl Androl Urol. 2021;10(3):1457.
-
42. Mohanty G, Jena SR, Nayak J, Kar S, Samanta L. Proteomic Signatures in Spermatozoa Reveal the Role of Paternal Factors in Recurrent Pregnancy Loss. World J Mens Health. 2020;38(1):103–14.
-
43. Hamidian S, Talebi AR, Fesahat F, Bayat M, Mirjalili AM, Ashrafzadeh HR, et al. The effect of vitamin C on the gene expression profile of sperm protamines in the male partners of couples with recurrent pregnancy loss: A randomized clinical trial. Clin Exp Reprod Med. 2020;47(1):68–76.
-
44. The ESHRE Guideline Group on RPL, Bender Atik R, Christiansen OB, Elson J, Kolte AM, Lewis S, et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open. 2023;2023(1):hoad002.