Friday, January 23, 2009

Miscarriage Tests

For all who are dealing with miscarriage issues, I am posting a list of all of the tests I've gone through. This may provide a starting point for your own checklist if you have to go through this unfortunate testing. (Please note that the descriptions were cut and pasted from pregnancy websites, mainly I can't vouch for the accuracy of the information and I have no medical expertise. Please confer with your doctor about the specifics.)

If anyone out there has been through any miscarriage tests that are not listed here, I would love to hear from you.

1. Chromosomal Defect with Fetus: Fetal Karyotype

To determine if the miscarriage was due to a chromosomal abnormality, the doctor sends the fetal tissue to a lab after D&C.

2. Chromosomal Problem with Parents

Blood test of parents to determine if either parent has genetic problems that can lead to miscarriages.

3. Structural Problem with Uterus

Scarring or fibroids growing within the uterus can sometimes interfere with implantation and the embryo’s blood supply. For the hysteroscopy, the doctor fills the uterus with saline and inserts a thin telescope into the uterus to examine it.

4. Blood Clotting Related Tests (all tested with a simple blood test)

a. Anti-Cardiolipin Antibodies

Cardiolipin antibodies are proteins found in your body that work against cardiolipin. Cardiolipin is a molecule found in your blood platelets and various cell membranes. It is one of a group of molecules called phospholipids. You need cardiolipin in order to help regulate blood clotting throughout your body. Sometimes though, your body can mistake cardiolipin for an attacking substance. As a result, your body creates soldier-like molecules to fight against the cardiolipin.

b. Anti-Phospholipid Antibodies

Antibodies are special cells that are supposed to help our bodies attack foreign invaders, like bacteria from colds and infections. Sometimes though, the body mistakes its own cells for invaders and attacks them, causing a host of problems. This is the case with antiphospholipid antibodies - they attack our own cells.

Antiphospholipid antibodies are proteins that circulate around in the bloodstream. These proteins bind to cell membranes, making them sticky. This prevents our blood from flowing properly, resulting in blood clots. These antibodies can endanger the health of both you or your baby.

c. Lupus Anticoagulant

This is a protein in your blood that causes it to clot in your bloodstream and veins differently than it normally would. Women with large amounts of lupus anticoagulant in their blood often suffer from blood clots in their placentas.

d. Anti-Thrombin III Deficiency

Antithrombin III (AT-III) is a protein made in the liver. It inhibits coagulation and limits the forming of blood clots.

A shortage of AT-III affects the normal process of coagulation and can lead to excessive blood clotting. There are two categories of AT-III deficiency. Patients with Type I deficiency have reduced amounts of AT-III protein and functional activity, while patients with Types II and III deficiency have normal protein levels, but some of it does not function properly.

Antithrombin-III deficiency can cause or lead to thrombosis, a clot forming in a blood vessel. If a clot attached to a blood vessel wall breaks loose and travels in the bloodstream, it is called an embolus. An embolus that reaches a blood vessel in the lungs is called a pulmonary embolism. This type of clot can block the blood vessel, cut off the oxygen supply to the lung tissue, and, in some cases, cause death.

e. Protein C Deficiency

Protein C deficiency is one of a number of inherited coagulation disorders resulting in a hypercoagulable state known as thrombophilia. Recent advances in genetics and biochemistry have allowed us to identify numerous coagulation defects, each having the common result of thrombosis. Examples of such deficiency disorders include abnormalities of factor V Leiden, factor XII, three chains of fibrinogen, heparin cofactor II, plasminogen, protein C, protein S, and thrombomodulin.

f. Protein S Deficiency

Protein S deficiency is a genetic trait that predisposes one to the formation of venous clots.

g. Factor V Leiden Mutation

Factor V Leiden thrombophilia is an inherited disorder of blood clotting. Factor V Leiden is the name of a specific mutation that results in thrombophilia, or an increased tendency to form abnormal blood clots in blood vessels.

h. Factor II (Prothrombin) Mutation

A specific change in the genetic code causes the body to produce too much of the prothrombin protein. Having too much prothrombin makes the blood more likely to clot.

i. MTHFR Mutation/Hyper-Homocysteinemia

MTHFR stands for Methylenetetrahydrofolate Reductase. It is a type of gene mutation that impairs the body's ability to absorb folic acid, and some studies have associated MTHFR gene mutations with increased risk of miscarriages (but other studies have found no link).

5. Tests for Potential Hormonal Problems (all tested by simple blood test)

a. Progesterone Level

Progesterone is a female hormone produced by the ovaries. It plays a vital role in both ovulation and pregnancy. After an egg is released from your ovaries, the remaining follicle becomes the corpus luteum. The corpus luteum secretes estrogen which, in turn, produces progesterone. This progesterone softens your uterine lining, helping with implantation.

b. Follicle Stimulating Hormone (FSH)

FSH is one of a number of hormones that is secreted by your brain. Inside your brain, located just at the base of your neck, there is a tiny region called the pituitary gland. This gland is responsible for releasing a variety of different hormones, including FSH. FSH hormone is used to help encourage the growth of eggs in women and sperm in men.

If you are having troubles conceiving, your health care provider will try to analyze your ovarian reserve. Your ovarian reserve refers to the number of eggs that you have available for fertilization. A high ovarian reserve usually indicates a good number of viable eggs present in your ovaries. A low ovarian reserve may indicate that you have fewer available eggs. In order to test ovarian reserve, many health care professionals rely on measurements of your FSH. Levels of this hormone directly correlate to the number of eggs that you have "on reserve" in your ovaries.

c. Estradiol

Estradiol is a type of estrogen, which is the major female reproductive hormone. Estradiol is the primary type of estrogen, and it is produced in your ovaries. As they grow and develop, your egg follicles secrete estradiol, helping to trigger the rest of the reproductive cycle.

The estradiol test is a diagnostic procedure used to measure the levels of estradiol in your blood stream. It is performed in conjuction with the Day 3 FSH test. A simple blood test, the estradiol test is performed in order to determine a woman's ovarian reserve. It is also performed in order to confirm a woman's FSH test

d. Prolactin

Prolactin is a chemical that is secreted by your pituitary gland. This is the pea-sized gland found in the middle of your brain, which is responsible for triggering many of your body's processes. Prolactin is found in both men and women and is released at various times throughout the day and night. Prolactin is generally released in order to stimulate milk production in pregnant women. It also enlarges a woman's mammary glands in order to allow her to prepare for breastfeeding.

Prolactin inhibits two hormones necessary to your ovulation: follicle stimulating hormone (FSH) and gonadotropin releasing hormone (GnRH). Both of these hormones are responsible for helping your eggs to develop and mature in the ovaries, so that they can be released during ovulation. When you have excess prolactin in your bloodstream, ovulation is not triggered, and you will be unable to become pregnant. Prolactin may also affect your menstrual cycle and the regularity of your periods.

Normal prolactin levels in women are somewhere between 30 and 600 mIU/I. If your levels measure towards the high end of this spectrum or above, you may be suffering from a prolactin irregularity.

e. Thyroid Stimulating Hormone (TSH)

There are two main types of thyroid problems that can affect fertility:

* Hyperthyroidism (over-active thyroid): hyperthyroidism is often hereditary. Symptoms include fatigue, increased heart rate, weight loss and light or absent periods. It occurs most frequently in menopausal women. Its impacts include an increased risk of miscarriage. Treatment options include drugs, radioactive therapy and surgery.

* Hypothyroidism (under-active thyroid): hypothyroidism is also usually hereditary. Its symptoms include fatigue, lack of concentration, muscle aches, constipation, weight gain, very long menstrual cycles and heavy periods. In some people the thyroid gland (which is in the throat in front of the windpipe) may be enlarged. Treatment will be lifelong and takes the form of thyroxine tablets, with a likely increased dose during pregnancy.


  1. OH my lordy that is a long list. *hugs*

  2. How do you feel now that you have taken these tests?

    If you don't mind me asking, are you ready to start trying again?

    I have heard so many stories where doctors say one thing or another, and the woman goes on to (naturally) conceive a healthy baby.

  3. Hi, 12:27,

    I am RELIEVED. They also found a genetic mutation (I'm homozygous for the C677T MTHFR mutation), but my homocysteine level is normal, so it does not seem to be a major issue. I am so grateful that there is nothing seriously wrong with my body. Also, knowing that the last miscarriage was caused by a genetic defect made a big difference in my mind because it was a question of probability, was unavoidable, and does not indicate a necessarily recurring problem.

    We are trying again -- and for me, that has made all the difference. It made me hopeful again, which I couldn't feel when we were not trying.

    I have a good feeling about it! We'll see what happens.

  4. Ugh - looking at that test brings back memories. I've had a total of four miscarriages and all of those tests (I had two unexplained losses, two genetic losses, and also have the single MTHFR variation), but now have two healthy little boys (3 and 1). I don't know if you've read Coming to Term, by Jon Cohen, but I found it to be the best/most substantive/only book on multiple miscarriages (at least it was in 2003-2005 when I was dealing with them). His book traces the history of miscarriage treatment and clarifies a bit why it seems so slipshod. Although I can't truly argue with the results of taking a baby aspirin a day... Anyway, he says that some significantly high percentage of women with up to four miscarriages will go on to carry a healthy baby to term without medical intervention. That MUST go up even further with medical intervention, I thought, so I know I found that very comforting.

    I am also a lawyer (8th year associate, larger firm), and the lawyer personality seems to struggle with the uncertainty inherent in multiple miscarriage treatment. I've just found come across your blog today (linked from abovethelaw), and remember your previous story from the Wall St. Journal coverage. You've had a heck of a year. I hope it gets better for you soon.

  5. Hi, 7:14,

    Thanks for stopping by. I have read Jon Cohen's book and really appreciated his perspective on this whole miscarriage thing. The statistic you mention changed my outlook -- and gave me an assurance that I hadn't had before. It's a great book. I wish he would update it with the latest research.

    I am so happy to hear that you have two healthy boys. It must be so wonderful.

    My past year has been interesting. But it's been quite good -- I really appreciate where I am and the experiences I've had. It has also pushed me in directions that I may have been too timid to take on my own.

    Best of luck to you and hope to see you here more often.


  6. This is the information I've been looking for all these days, ever since I had a miscarriage at 6 weeks pregnancy. My ob/gyn didn't prescribe even a single test, since "one miscarriage is so (damn) normal". I really don't want to take a risk next time, but my ob/gyn would obviously not allow me to take any of the tests mentioned here. Did your ob/gyn advice you on these tests? Do you think going to a fertility doctor would be of any use? I'm guessing, the fertility doc would not consider miscarriage as a "normal" event. Advice me pleaae.. I live in California too, and I really really want to have this blood work done.

  7. Hi, Anonymous at 10:20,

    I didn't demand the tests after my first miscarriage, although I think my doctor would have allowed them had I insisted on them. When I had my second miscarriage, I was really angry with myself for not having insisted on the tests. I think you should demand that you be tested. It's really not that complicated from the patient's point of view. About 16 viles of blood. That was about it. In my case, I would have been willing to pay for them on my own had I had the foresight to think ahead. If your ob-gyn will not let you take the test, despite your insistence, then find another ob-gyn. I know my doctor would have permitted them had I pushed. Advocate for yourself as much as you can. If you want to email me directly (, I can share the name of my ob-gyn with you.

    I am so sorry to hear about your miscarriage. I was thinking about mine the other day, and it brought tears to my eyes again. It's a devastating experience... Hang in there.

  8. I am about to have my second miscarriage (I think) and am asking my doctor to administer as many tests as possible. I read in a book that excessive amounts of prolactin can cause miscarriage, but my doctor does not want to test for prolactin because the levels might be affected by my current pregnancy. At what point did you test for prolactin?

  9. Hi, Taryn,

    I'm so sorry to hear about your miscarriage(s). With me, I had most of my tests about 6 weeks after my miscarriage. My doctor said that the results would be screwed up by my pregnancy hormones, so I had to wait until my body returned to its "normal" state. I believe most of the blood work was done 6 weeks after the miscarriage, and then I had a couple more about two weeks later. I hope you get all the results you are looking for.