What are the tests for recurrent miscarriage?
- Blood tests to test for hormone problems or PCOS
- Ultrasound of uterus
- Hysteroscopy or HSG (dye test) to look at the uterine cavity (womb)
- Chromosome testing of the husband and wife to test for genetic abnormalities
- Sonohysterography (saline ultrasound)
- Other specific testing for immune problems
If any of the above tests should come back indicating an underlying reason for the problem, then treatment is directed at the cause – e.g. genetic counseling, removal of fibroids, cervical stitch. If all of the above have been excluded (as they will do in many cases), the diagnosis is recurrent miscarriage of unknown cause. The only intervention to have demonstrated benefit is serial ultrasound scans in the early months of pregnancy. It is certainly not unreasonable to expect this psychological support to improve outcome given the close interaction between the higher areas of the mind and the delicately balanced hormonal system.
Most patients who have no known causes are encouraged to take a baby aspirin (80 mg) to improve uterine artery blood flow and also help treat a possible undiagnosed immune problem. Some patients are given heparin (blood thinner) to treat immune problems (such as antiphospholipid antibody syndrome). Progesterone supplements have been evaluated in clinical trials and have not been shown to be of any benefit to most people. Some patients will truly benefit, but it’s hard to determine which patients will improve. Therefore, sometimes progesterone is prescribed with the hope of success (realizing it may not be any better then placebo).