Recurrent Miscarriage

Q: What is the cause of recurrent miscarriage and what exams should be done?

A: When more than two miscarriages occur in a row, this is known as recurrent pregnancy loss (RPL), habitual or recurrent abortions or miscarriages. About 5% of couples have two miscarriages in a row, and up to 2% have three miscarriages in a row. "Primary recurrent pregnancy loss" refers to couples that have never had a live birth, while "secondary RPL" refers to those who have had repetitive losses following a successful pregnancy There are many known causes for RPL, however, there is a significant number of couples in whom even after a thorough workup, no specific cause is found. Many doctors usually perform most, if not all, the following procedures:

• Evaluation of ovarian reserve (LH, FSH, estradiol on CD 3)
• Evaluation for uterine anomalies (Sonogram, hysterosalpingogram)
• Genetic evaluation of both partners (Chromosome karyotyping)
• Hormone evaluation (Progesterone after ovulation, endometrial biopsy)
• Evaluation of autoimmune problems (Lupus screen, ANA, anticardiolipin antibody, factor V Leiden, APPT)

According to the American College of Obstetricians and Gynecologists, cultures for bacteria and viruses, glucose tolerance testing, thyroid tests, antibodies to infectious agents, antithyroid antibodies, paternal human leukocyte antigen status, or maternal antiparental antibodies are not beneficial and, therefore, are not recommended in the evaluation of otherwise normal women with recurrent pregnancy loss.