November 25, 2010

Recurrent Pregnancy Loss: Testing

Testing for recurrent pregnancy loss includes assessment of possible genetic, anatomic, hormonal, inflammatory, and immunologic causes. All testing can be accomplished within one menstrual cycle with tests timed during the cycle.
At the Fertility Centers of New England, we begin testing on Cycle Day #3 by obtaining blood for Follicle Stimulating Hormone (FSH), Estradiol, Thyroid Stimulating Hormone (TSH), Prolactin, a Cell Blood Count (CBC) with platelet count. Blood type and Rh factor should be assessed if not already known as should testing for Cystic Fibrosis (CF) mutation and immunity to Rubella. On Cycle Day #10, we obtain blood again for FSH and do a pelvic ultrasound. On Cycle Day #22 a blood test for Progesterone is obtained. We also obtain blood from the couple for chromosomes. In women with known ovulation dysfunction, we obtain a Fasting blood test on Cycle Day #3 test for glucose and insulin.

In cases where pregnancy losses have occurred after 12 weeks of gestation, we obtain blood tests for anticardiolipin antibody and a Lupus Anticoagulant (Russell Viper Venom Time) and a Thrombophilia profile consisting of Factor V Leiden, protein S, protein C, prothrombin (Factor II), anti-thrombin III, Beta-2 Glycoprotein I antibody IgG and a homocysteine level. There is no need to order these expensive tests in cases of first trimester pregnancy loss.

An intrauterine structural study to determine the internal uterine contour is performed following menses but before an anticipated ovulation. This tests may be either a Hysterosalpingogram (HSG), SonoHSG, or a hysteroscopy. We often couple this test with an endometrial biopsy to rule out the presence of endometritis.

A semen analysis is of less benefit unless the couple has also had difficulty conceiving, although, poor morphology has been associated with not only difficulty conceiving , but also with very early pregnancy loss (biochemical/aembryonic losses).

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Joseph A. Hill, III, M.D.

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility