What tests should be performed to investigate whether there is a cause for recurrent miscarriage?

It should be noted that in around half of cases, all tests undertaken on the couple are normal.

Tests should aim to identify the recognised causes of recurrent miscarriage and include:

  • Karyotyping. This is a blood test that is used to determine a couple’s chromosomal makeup. It will identify whether abnormalities such as translocations are present.
  • Detailed examination of the structure of the womb. This will determine whether structural problems with the womb such as a uterine septum, submucosal fibroids or polyps might be present. A number of approaches can be used to study the womb including:
    • 3D ultrasound scanning
    • Saline Infusion Sonohysterography (SIS): Ultrasound scanning in combination with the instillation of saline solution into the womb cavity.
    • Magnetic Resonance Imaging (MRI)
    • Laparoscopy in combination with hysteroscopy: This allows direct visualisation of both the inner and outer surfaces of the womb. It also enables surgical correction of any abnormalities to be undertaken in a one-step procedure.
  • Testing for anti-phospholipid antibodies. This is a blood test for:
    • Lupus anticoagulant
    • Anti-cardiolipin antibodies
    • Anti-β2-glycoprotein I

    Tests for anticardiolipin antibodies should be repeated after 12 weeks.

  • Tests on the miscarriage tissue (or products of conception) to determine the chromosome makeup of the embryo.

For more details on tests for recurrent miscarriage, please refer to my recent paper.