Recurrent Pregnancy Loss (RPL) Testing

       Pregnancy loss alone is devastating. Not knowing why it occurs even once is heartbreaking. To continue to experience loss after loss causes anxiety, depression and fear. Recurrent pregnancy loss is typically defined as 3+ consecutive losses, while some practitioners may Dx RPL as 2 consecutive losses.
       One thing I ran into personally, was I had two early miscarriages and then an ectopic- some doctors may not consider this RPL because ectopics are either flukes or caused by tubal factors, not necessarily in the same department as another type of loss. My old OB did not feel as though I need RPL testing, whereas my current OB and RE did.  Depending on the types of losses you’ve had, your doctor may order a couple, a handful or all of the testing listed below.
       Bottom line is you need to advocate for what you feel is right. RPL testing can be very expensive (I’ve listed prices my insurance was billed FYI, but obviously prices and benefits will vary), emotionally exhausting and may still not provide you with answers. Below are some tests you may request or discuss with your medical practitioner. I decided not to include normal lab values because one lab’s ‘normal’ may be another lab’s ‘abnormal’.

  • Hormonal Factors Tests (prices may vary from $50-300 per test): This includes prolactin, thyroid and progesterone. Other hormones that may be checked (as part of an IF work-up, some tests may be cycle day sensitive) are estradiol, testosterone, LH and FSH. 
    •  An imbalance with one or more hormone may warrant treatment depending on the Dx. Depending on hormonal imbalance an ultrasound may also be ordered to make a firm Dx (PCOS, DOR)  
  • Blood Clotting Disorders- typically treated with some type of blood thinner (baby aspirin, heparin, lovenox)
    • homocysteine/MTHFR
    • Prothrombin gene
    • Protein C&S
    • Antithrombin III
    • Factor V Leiden
    • Fibrinogen
    • PT/PTT (INR)
  • Structural Factors Tests: These tests are conducted to determine the size and shape of your uterus as well as checking the uterine wall in hopes it is free of scarring, polyps, fibroids or a septum- all of which can affect implantation. Tests to check the integrity of your tubes may also be ordered if one or more of your losses were ectopic, or if you are at higher risk for one. 
    • SHG (sonohysterogram) ($300-ish): This test is conducted by inserting a catheter through your cervix to push saline into the uterine cavity. Simultaneously, your doctor will also be performing a transvaginal ultrasound to get a visual of your uterus. This test can identify if there’s abnormalities in your uterus (listed above). If there are concerns about the uterus, a hysteroscopy or laparoscopy may be performed to fix and further Dx the issue.
    • HSG (hysterosalpingogram) ($500-ish): This test is typically performed in your local hospital’s X-ray lab by an X-ray tech, and sometimes your doctor depending on how their practice handles this procedure. Similar to an SHG, a catheter is inserted through your cervix, except this test requires dye to get an adequate picture of your tubes. Sometimes, simply performing this test may unblock tubes if there’s a blockage while other situations may require surgery. 
  •  Uterine Lining Test/ Endometrial Biopsy: While this test is considered obsolete by some in the medical community (results may vary from tech to tech reading doing the biopsy, which may not give accurate results), it can still be an important piece of the puzzle, especially if you’re dealing with possible luteal phase defect (LPD) or spotting for more than a couple days during your LP. 
    •  This test is typically performed in the office after CD 21 (be SURE you have ovulated, as this test is checking your uterine lining for implantation). To get an accurate and reliable reading, it is typically recommended for this test to be performed two cycles for comparison to make a firm Dx. 
    •  If the uterine lining is ‘out of phase’ (2+ days… meaning you’re 7dpo and your biopsy is showing 9dpo, your body may not be adequately using hormones to build your uterine lining) treatments of clomid/femara, hCG trigger and/or booster and progesterone supplementation may be used for Tx. 
    •  I do want to mention that if the endo biopsy does leave you with a LPD Dx, to ask your doctor about what type of defect it is. Click HERE to read more about the different types and causes.  LPD is a controversial Dx in the medical community, about 50/50- if you are concerned about your LP and your doctor does not believe it’s an issue, seek a second opinion.
  •  Tests for Chromosomal Causes
    • Pathology from D&C/D&E ($480- pathology only): this will show if the cause of your loss was from a chromosomal abnormality or not. Most chromosomal abnormalities found are not typical to repeat in the future. 
    • Genetic testing (saliva testing $960 for MH and I) on one or both partners- This may consist of blood or saliva tests. Some cultural groups may be at higher risk/genetic carriers for certain chromosomal defects. 
    • Karyotyping ($2300 for MH and I): Blood test to be performed on you and your partner to check for translocations (normal number of genes, but are joined together abnormally) Tests for 
  • Immunologic Causes: This is one area that seems to not have as much research on all areas of testing, some are controversial and some are routine- and that I admittedly do not know much about. If you have more information I can add to this section, please feel free to leave a comment, message me on the bump or page me on TTCAL
    •  Anti cardiolipin antibodies (ACA) 
    • Anti-nuclear antibodies (ANA) 
    • Anti-thyroid antibodies (ATA) 
    • Anti-Ovarian Antibodies (AOA) 
    • Anti-Sperm Antibodies (ASA) 
    • Anti-phospholipid antibodies (APA) 
    • Leukocyte Antibody Detection (LAD) 
    • Lupus anticoagulant (LAC) 
    • Embryo Toxic Factor (ETF) 
    • NK activation assay (NKa) 
    • reproductive immuno-phenotype (RIP)

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s