To observe the clinical effect of vitamin D combined with active immunotherapy for patients with immune recurrent spontaneous abortion. Methods: The clinical data of 200 patients with immune recurrent spontaneous abortion from January 2020 to August 2022 were analyzed retrospectively. These patients were divided into observation group (100 cases) and control group (100 cases) according to the different treatment methods. The patients in the control group were treated with low molecular weight heparin calcium injection combined with progesterone injection, while the patients in the observation group were treated with vitamin D combined with active immunotherapy. The abortion rate, the values of the uterine artery blood flow indexes during 12 gestational weeks, the sex hormone levels during 4 and 12 gestational weeks changes in early pregnancy (about 1 month of gestation) and 12 gestational weeks, the values of the coagulation function indexes and the serum inflammatory factor indexes, the pregnancy outcomes of successful pregnancy and the adverse reactions of the patients after treatment were compared between the two groups. Results: The spontaneous abortion rate (4.1%) of the patients in the observation group was significantly lower than that (16.3%) of the patients in the control group. the values of uterine artery flow indexes, such as the pulse index (PI, 1.19±0.25), the resistance index (RI, 0.53±0.22) and the ratio of systolic blood pressure /diastolic blood pressure (S/D, 3.20±0.29) during the 12 gestational weeks of the patients in the observation group were significantly lower than those（1.39±0.36, 0.72±0.27 and 3.51±0.33) of the patients in the control group. The levels of progesterone (62.65±3.21 nmol/L) and the human chorionic gonadotropin (91117.36±33.26 IU/L) of the patients in the observation group were significantly higher than those (56.23±4.03 nmol/L and 79568.23±29.56 IU/L) of the patients in the control group. The levels of fibrinogen (2.33±0.23 g/L), D-dimer (151.65±9.62μg/L), C-reactive protein (16.26±2.99 mg/L) and interleukin-6 (48.26±2.85 ng/L) of the patients in the observation group were significantly lower than those (3.14±0.26 g/L, 221.52±10.65μg/L, 21.01±3.37 mg/L and 51.23±3.41 ng/L) of the patients in the control group. The successful pregnancy to full term rate (98.0%) of the patients in the observation group was significantly higher than that (91.2%) of the patients in the control group (P<0.05). There was no significant difference in the adverse reactions (0 vs. 2.0%) of the patients between the two groups (P>0.05). Conclusion: Vitamin D combined with active immunotherapy for treating the patients with immune recurrent spontaneous abortion has good clinical effect, which can reduce the abortion rate and the levels of inflammatory factors, improve the coagulation function, hormone levels and pregnancy outcomes of the patients, and with the high safety and reliability.