Fertility 101: Fertility Testing/Services
Recurrent Miscarriage
The evaluation of repetitive miscarriage usually begins after 2 or 3 first trimester miscarriages may include the following 
diagnostic steps:
Anatomical: a uterine abnormality such as a septum, scarring or fibroids may be detected by an HSG (X-ray of the uterus). Occasionally an MRI or ultrasound is needed to complement any abnormal findings noted. HSG exams can be performed at Carolina Conceptions or radiology office.
Hormonal: thyroid, glucose intolerance and prolactin abnormalities may contribute to ovulation dysfunction. Simple blood testing and asking the woman to keep tract of the length in days of her luteal phase (from a positive urinary LH surge to start of next period) may be helpful.
Genetic: only about 3 percent of recurrent miscarriages are due to a chromosomal abnormality. Blood testing for a karyotype may be suggested in the male and female. The yield, however, is low.
Antibody formation: It is rare that husband and wife are so similar that the woman fails to produce blocking antibodies to her fetus and cause miscarriage. The diagnosis and treatment of HLA similarities is highly controversial and not done at our center.
More common, yet still rare, is the formation of antibodies such as lupus anticoagulant and anticardiolipin that result in miscarriage. Blood testing can rule this out. If positive then a coordinated approach from your obstetrician and Drs. Couchman, Meyer and Park will ensue. The association between other thrombophilic antibodies or deficiencies such as Factor V, Prothrombin, Protein S and C are even more controversial when no history of blood clotting exists. Baby aspirin and low molecular weight heparin may be needed.
Infectious: A rare cause of miscarriage. The ability to establish the diagnosis is difficult and in most cases a two week course of antibiotics may be prescribed without any further testing to the couple
Ovarian dysfunction: Diminished ovarian functioning is difficult to diagnose but a baseline FSH and estradiol level may be helpful. We have found that an AMH level is most helpful and can be obtained at any part of the cycle. Couples may require the use of injectible FSH followed by progesterone suppositories to improve pregnancy rates.
See "Recent Miscarriage (RM)-Quick Thoughts" for additional information. (82.9k pdf)