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What tests will my doctor arrange to find out why I might have miscarried?

3 fertility expert(s) answered this question

Answer from: Luciano Nardo, MD, MRCOG

Gynaecologist, Subspecialist in Reproductive Medicine, CEO & Founder, NOW-fertility
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I think the first thing is to have a consultation to understand a little bit of the full history and then investigations can be recommended. The investigations for miscarriage will cover the various causes of miscarriage. So the investigations for infections inside the uterus and investigations for inflammation inside the uterus, investigation into the genetic causes of miscarriage – that will be a blood test for chromosomal abnormalities in both partners, investigation into the immune system and it could be a blood test to check the auto antibody profile as well as the NK cells and the presence of an abnormal cytokines ration and that is a known as a TH1, TH2 cytokine ratio, investigations into abnormalities within the uterus and that could be either a 3D ultrasound scan or a diagnostic hysteroscopy, investigations into the causes of blood clotting and that is to exclude the presence of either genetic or acquired thrombophilia and finally investigation into the sperm quality.

Answer from: Anu Chawla, MRCOG, MBBS, M.S., DNB

Gynaecologist, Specialist in Reproductive Medicine
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When we have that history of repeated miscarriages and nothing is explaining it and then we do a few tests and then I believe in not going vertically into one thing that you just keep checking one side of immunology but I go horizontally and I check antibodies, th1, th2 ratio and NK cells, DQ alpha. It makes more sense to go horizontally and do one basic test like endometrial immune profile. There’s a new test called KIRS in which the sample goes to Chicago and we wait for a couple of weeks and all this. So, we check a bit on every side that there is anything wrong and obviously it is guided by the history of the patient, for example, someone has thyroid issues or someone has massive diabetes history in the family or herself. I would think of making sure that there are no antibodies of other nature in her body. Similarly my other decisions are guided by that. That makes us very unique by the way that as a team, we try to not go too deep into one thing but we try to check everything horizontally and find out if some area is the problem area and then we go deep into that depending on how patient has to accept that whole thing actually is not based still on massive evidence but it is still experimental in nature and that is the information the patient needs to know and then she can go ahead and test more and treat more. There are various modalities. Some of them can have side effects like allergies so, it has to be very carefully selected. There are various modalities like use of intralipids or lid therapy – all those things have to be very carefully selected, in a very small set subset of patients only they should be very carefully given, not to everybody who has miscarriages for example. There are other tests like LED in which we check the the partner’s bloods also and see whether there is a problem in the HLA and the other areas why is the women’s body not accepting the baby, especially when it’s an early miscarriage and repeat it and there is no other problem. All these patients, if not tested, will be labeled as unexplained in otherwise a standard fertility practice which is not doing a very advanced practice that includes reproductive immunology but I have to emphasize this that this is only beneficial to a small subset of rightly selected patients and not everyone should be spending thousands and grams of pounds just without any genuine rationale behind that.

Answer from: Ingrid Granne, DPhil MA MBBS MRCOG

Gynaecologist, Consultant Gynaecologist and Sub-Specialist in Reproductive Medicine
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Usually if this is your first miscarriage, your doctor is likely to say to you that this is not something that’s particularly likely to happen to you again. Very much more than the next woman and it’s unlikely that they’ll offer you specific tests. If you’re in a situation where you’ve had repeated pregnancy losses and in some places that is pre-pregnancy losses, we look at women after two pregnancy losses. We do do some baseline investigations and some of that is dependent on the individual and some of it is looking at things, for example, thyroid dysfunction and that can be associated with miscarriage, autoimmune conditions such as the Antiphospholipid syndrome but there isn’t a great, big battery of tests and for the most part actually, it’s the support of care in the next pregnancy that can be really important. Sometimes, we also look at the chromosomes of the embryo were we to be able to test the tissue from a miscarriage and that can give us helpful information as to why that pregnancy loss has happened or whether there’s potentially any inheritable component from the parents that’s therefore worth looking at.

About this question:

What test should be done after miscarriage?

Can doctors tell what causes a miscarriage? How can I find out what caused my miscarriage? Will I have tests to find out why I miscarried?

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