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Testing and treatment of recurrent pregnancy loss / multiple miscarriages

multiple miscarriagesCouples who experience recurrent pregnancy loss (RPL) characterized by multiple miscarriages may benefit from a medical evaluation and psychological support. A detailed history and physical examination is the initial step in the evaluation. Important points in the history include:

  • The patient's age
  • Number of miscarriages
  • Gestational age of the fetus or embryo at time of miscarriages
  • Whether or not the miscarriages required surgery (dilatation and curettage)
  • Chromosomal test results of the products of conception
  • Family history of blood clotting disorders

A vaginal ultrasound is a useful tool for evaluating pelvic structures. This will help diagnose uterine anomalies, fibroids, polyps and ovarian volume and antral follicle count. Other tests done to evaluate the pelvic anatomy include a hysterosalpingogram (HSG, x-ray of the uterus and tubes with a radio-opaque dye injected in the uterine cavity using a catheter), sonohysterogram (vaginal ultrasound with saline injected in the uterine cavity using a catheter) or hysteroscopy (direct visualization of the uterine cavity with a fiber-optic telescope). Other blood tests (chromosome testing, thyroid, prolactin, blood sugar, immune tests, thrombophilia panel) may be called for.

Some patients will have RPL because of poor quality eggs. These are patients with severely diminished ovarian reserve (elevated FSH level, low anti-mullerian hormone or AMH level, reduced ovarian volume and astral follicle count).

Tests with no proven benefit for multiple miscarriages include: cultures for bacteria or viruses, tests for insulin resistance, antinuclear antibodies, antithyroid antibodies, maternal antipaternal antibodies, antibodies to infectious agents, and embryotoxic factors.

To see a fertility specialist with many decades of experience treating patients who have had multiple miscarriages and / or repeated pregnancy loss, make an appointment at one of InVia’s four Chicago area fertility clinics.

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Recurrent pregnancy loss InVia Fertility Specialists

Dr. Vishvanath Karande

Dr. Vishvanath Karande

Dr. Karande is Board Certified in the specialty of Obstetrics and Gynecology as well as the subspecialty of Reproductive Endocrinology and Infertility. He is a Fellow of the American College of Obstetricians and Gynecologists and Member of the American Society for Reproductive Medicine.

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