Recurrent pregnancy loss (RPL) is multiple pregnancy losses. Inherited thrombophilia, which increases blood clot risk, contributes to RPL. Pre-gestational therapy with Low-Molecular-Weight Heparin (LMH) and Aspirin may improve pregnancy outcomes in these patients. This study aims to evaluate the effectiveness of pre-gestational management and the combination of LMH and Aspirin in patients with RPL and inherited thrombophilia. A hereditary thrombophilia test was performed on each of the 459 pregnant research participants, whose gestational ages ranged from 6 to 38 gestational week Medical center - Prime Clinic and KIRM- Pleven in Bulgaria period from January 2021- May 2023 were collected. Based on the treatment method, patients in a dataset with RPL and hereditary thrombophilia were split into three groups. Group I (Control) patients did not get any pre-gestational care or anticoagulant treatment. Group II: Patients who only received aspirin treatment with 100 mg. Group III: Patients receiving LMH and aspirin therapy. Compared to the treated groups (Group II and Group III), the pregnancy success rate was noticeably lower among the patients in Group I (Control). In addition, Group I experienced more thrombotic events than the groups that received treatment. Pre-gestational therapy with aspirin alone or in combination improves pregnancy outcomes and reduces thrombotic events in RPL and hereditary thrombophilia patients. LMH combined with aspirin may increase pregnancy success more than aspirin alone. These findings need further investigation and larger trials to maximize treatment for this patient population.