At Our Los Angeles Center Pregnancy Loss Testing is the First Step.
Spontaneous miscarriages are common, approximately 10-15% of pregnancies result in a miscarriage. However fewer than 5% of women will experience two consecutive miscarriages, and only 1% will experience 3 or more. Therefore RPL is distinct from sporadic miscarriages and warrant a thorough and systematic evaluation. We start with a comprehensive consultation with a reproductive endocrinologist to review your entire medical, surgical, and gynecologic/obstetric history. Included is also a review of the previously mentioned environmental exposures that may impact recurrent pregnancy loss.
The investigation is individualized but usually consists of: genetic, immunologic, anatomic, and endocrine screening.
Genetic: Parents should undergo karyotyping. This is a blood test. RPL may result from an abnormal number of chromosomes (aneuploidy) in the embryo or some type of structural abnormality like chromosomal translocation (rearrangement of a segment of genes from one chromosome to another), which can become unbalanced in the offspring.
Immunologic: Antiphospholipid syndrome (APLS) is an autoimmune disorder. Medical and obstetric complications of APLS positive women include thrombosis (clot formation), stroke, pregnancy loss, preeclampsia, and intrauterine growth restriction. The diagnosis is made by the presence of characteristic clinical features and specified blood levels of circulating antiphospholipid antibodies.
Anatomic: The uterus and the uterine cavity should also be evaluated with a combination of pelvic ultrasound, hysterosalpingogram, and saline infusion sonogram. We are looking for uterine abnormalities such as septate uterus, uterine fibroids that distort the uterine cavity, uterine polyps, and uterine scarring (Asherman’s syndrome) which may be surgically corrected.
Endocrine: Blood tests of hormone function may also be done. Thyroid function tests and thyroid antibodies may be checked, along with testing for diabetes if a woman is at risk for developing diabetes.