Hello. Last week I received a phone call from a Dear patient that had a tubal reversal not too long ago. It seems that the reversal is working because she has achieved three pregnancies since. Unfortunately, she has miscarried all of them in the first trimester. She lives in a rural area and expressed some frustration that her local physician has not suggested an evaluation for recurrent pregnancy loss. I explained that the most common cause of an early miscarriage is that there has been a chromosomal number problem in the fetuses. These problems increase with age so that someone in her 20s has a risk of miscarriage of about 15% while someone at 40 can miscarry more than 50% of early pregnancies. There is a standard evaluation for patients experiencing miscarriages. The outline of the evaluation is:1. Anatomic evaluation of the Uterus ( Saline sonogram, HSG, or Hysteroscopy) to rule out fibroids, polyps, and congenital anomalies of the uterus.
2. Blood Chromosome analyses on both partners in order to rule out a chromosomal translocation in the parents. Please review the genetic section of our web site www.geneticsandfertility.com
3. Antiphospholipid antibody tests and Lupus anticoagulant.
4. A general health screen to rule out diabetes, medical problems, or thyroid problems.
5. An endometrial biopsy to rule out chronic inflammation of the womb.
6. Luteal phase progesterone levels.
Despite a thorough evaluation, many patients’ tests do not identify a specific causes. These patients may benefit from IVF with pre-implantation genetic screening of the embryos prior to implantation or reassurance that all that can be tested has been tested.
Best wishes to all.
