Recurrent pregnancy loss can be due to multiple factors. Since a thrombophilia has been diagnosed, she should get Low molecular wt heparin after detecting cardiac activity. This is continued till 34 weeks. Prophylactic MacDonald's stitch doesn't have any benefit but also no harm if done properly. Progesterone supplements are recommended (both vaginal or intramuscular injections). Apart from these, immune issues need to be investigated and treated. A blood test for NK cell activity or Th1: Th2 cytokines, etc can diagnose these problems. Treatment includes immunotherapy in the form of endothelial cell vaccines, etc. Most cases (90%) are benefited by these modalities. However, if nothing works, then we resort to surrogacy.