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Video: What Tests Can Be Done After a Miscarriage?
Joseph A. Hill, III, M.D., a Boston fertility doctor with Fertility Centers of New England in Reading, MA, talks about tests to determine the cause of miscarriage. The majority of miscarriages prior to 11 weeks pregnancy are considered chromosomally abnormal until proven otherwise. Tests may include blood tests, an endometrial biopsy, evaluating the tissue, as well as other profiles depending on when in the pregnancy the miscarriage occurred.
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(text on screen): Ask the Expert
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Fertility Authority. Your Most Trusted Source
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What tests can be done after a miscarriage?
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Joseph A. Hill, III, M.D., Fertility Centers of New England: The evaluation for recurrent pregnancy loss consists of a peripheral parental blood karyotypes;
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that is chromosomes in the couple; an anatomic assessment, and most commonly either a office hysteroscopy, a sono-HSG or hysterosalpingogram.
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That’s for anatomic factors. For endocrine factors, a hormone profile on cycle day three, cycle day 10, and perhaps on cycle day 22.
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These are blood tests that will be obtained.
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For inflammatory factors, an endometrial biopsy, looking for a rare entity called endometritis,
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which is an inflammatory condition of the lining of the uterus, might be worthwhile.
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For women that have had losses; second-trimester losses, then a antiphosolipid antibodies, leukocyte anticoagulant may be in order, as well as a thrombophelia profile.
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And these are genetic mutations that, thankfully, are relatively rare.
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The median age of loss for those people are basically 20 weeks of pregnancy; certainly after 11 weeks of pregnancy.
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For the majority of individuals with losses prior to 11 weeks, they’re chromosomally abnormal until proven otherwise,
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so a case could be made for any miscarriage to try to have that tissue karyotyped; that is, try to determine what the chromosomes are.
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Because if it’s an abnormality, which sixths of them are, then that’s the reason for the loss.
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A case may even be made to do a karyotype assessment on an individual; one loss; first loss.
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And if it’s abnormal, then perhaps just do a parental karyotype on the couple and no other evaluation.
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If it’s normal, then perhaps go ahead and proceed with an evaluation.
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It’s very important for couples, especially the woman suffering losses, to be involved in some sort of program
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whether it’s a mind and body program, yoga, counseling, exercise, acupuncture, it doesn’t matter.
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Just something they do trying to incorporate this experience of loss into their life, rather than their life into this experience of loss,
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which is an easy thing to do, but a very difficult thing to accomplish.
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Comments
Dr. Hill very briefly
Dr. Hill very briefly mentioned "hysteroscopy", but I want to emphasize, that if you've had more than one loss, and especially if your losses were in the 2nd trimester, then you must have a hysteroscopy to rule out uterine abnormalities such as a septum.
A saline sonogram or HSG are simply not good enough - I know of at least 4 women (myself included!) who had normal sonograms and x-rays, but were found after devastating losses (mine were at 14 and 16 weeks) to have uterine septums.
You have to be your own advocate, do the research on the different types of testing, and ask your doctor to do the tests.
Also, make sure the tests are coded as "recurrent pregnancy loss" and not "infertility diagnosis" because it can make a huge difference in how much your out of pocket expenses are. My insurance only covered 50% of infertility testing, but it covered 100% for recurrent pregnancy loss diagnosis.
Hello Doctor, i lost my
Hello Doctor,
i lost my first pragnancy on 1st march2010 and second misscarrage was happened on 23may 2011.
Please help me what test should be done and how much gap sould be there for next pragnancy.