Fertility Testing

Recurrent Miscarriage

The evaluation of repetitive miscarriage usually begins after 2 or 3 first trimester miscarriages and includes the following diagnostic steps:

Anatomical: a uterine abnormality such as a septum, scarring or fibroids may be detected by an HSG X-ray of the uterus. Occasionally an MRI or ultrasound is needed to complement any abnormal findings noted.

Hormonal: thyroid, glucose intolerance and prolactin abnormalities may contribute to ovulation dysfunction. Simple blood testing and asking the woman to keep tract of the length in days of her luteal phase (from a positive urinary LH surge to start of next period) may be helpful.

Genetic: only about 3 percent of recurrent miscarriages are due to a chromosomal abnormality. Blood testing for a karyotype is suggested in the male and female.

Antibody formation: It is rare that husband and wife are so similar that the woman fails to produce blocking antibodies to her fetus and thus cause miscarriage. The diagnosis and treatment of HLA similarities is highly controversial and not done at our center.

More common, yet still rare, is the formation of antibodies such as lupus anticoagulant and anticardiolipin that result in miscarriage. Blood testing can rule this out. If positive then a coordinated approach from your obstetrician and Drs. Couchman and Meyer will ensue. The association between other thrombophilic antibodies or deficiencies such as Factor V, Prothrombin, Protein S and C are even more controversial when no history of blood clotting exists.

Infectious: Most likely a rare cause of miscarriage. The ability to establish the diagnosis is difficult and in most cases a two week course of antibiotics may be prescribed without any further testing to the couple

Ovarian dysfunction: Diminished ovarian functioning is difficult to diagnose but a baseline FSH and estradiol level may be helpful. Couples may require the use of injectible FSH followed by progesterone suppositories to improve pregnancy rates.

While recurrent pregnancy loss is a most difficult challenge personally, new tests and treatments now often lead to successful pregnancies. Specialists at Carolina Conceptions can help patients navigate these many choices with the main goal being the successful delivery of a healthy baby. It is indeed an exciting time in the field of reproductive medicine, as many causes of recurrent miscarriage can be diagnosed and often overcome.

See "Recent Miscarriage (RM)-Quick Thoughts" for additional information. (82.9k pdf)