After my second miscarriage I started googling. And googling and googling. I searched through forums and blogs, obsessively taking in every story of miscarriage I could find, every bit of advice, anything that could make me feel less alone. I saw countless stories of women who had been told over and over to just try again, only to miscarry again and again. I started researching causes of recurrent pregnancy loss and what testing could be done, what issues could be fixed and how. I researched doctors and fertility centers. And then I started advocating for myself.
Some doctors are resistant to testing after pregnancy loss, unless you’ve had three consecutive losses (or are over the age of 35). Some doctors like to do some testing, and if you miscarry again do a little more testing, and so on. Because I had no obvious red flags to my health, I heard from four different doctors to just try again. But I could not get the courage to try again until I’d tested for everything that could possibly increase our odds for miscarriage. And it took ignoring the advice of those four doctors and insisting on getting certain tests despite being told the likelihood was “low” that anything would be wrong. It was only in doing this that we discovered issues that would have given me a 90% chance of miscarrying again.
Here is a list of tests for recurrent pregnancy loss (RPL). This is for use as a guide only. All decisions about RPL testing should be discussed with your doctor. Click here for further explanation of causes of RPL:
1. Genetic Problems
- TEST: Blood karyotype test for both the male and female partner
2. Uterine Defects
- TEST: HSG (Hysterosalphingogram) or SHG (Sonohystogram)
3. Thyroid function
- TESTS: TSH, T4 Free, Anti-thyroglobulin Antibody, Thyroid Peroxidase Antibody
4. Luteal phase defect
- TESTS: TSH, Prolactin, possible endometrial biopsy
5. Egg Quality
- TESTS: Day 3 FSH, LH, Estradiol, AMH
6. Polycystic Ovarian Syndrome (PCOS)
- TESTS: Testosterone, Fasting Insulin and ultrasound
7. Thrombophilic (blood clotting) disorders
- TESTS: Factor II, Factor V Leiden, Prothrombin gene, Protein C & S, Antithrombin III, Homocysteine, MTHFR, beta 2 glycoprotein 1 ab, g, a, m, Protime, Partial Thomboplastin Time
8. Male factor
- TESTS: Sperm DNA fragmentation test, Semen Analysis
9. Products of Conception Testing
- If you miscarry again, try to get the “products of conception” tested (the very cold, clinical term for the embryo/fetus that you will pass). If you miscarry at home, try to save it and keep it refrigerated (I’m sorry, I know that sounds awful). If you miscarry at the hospital or are having a D&C, ask them to do testing (even if it’s your first loss). This could give valuable insight into cause of loss.