Tests Done After Repeated Miscarriages

After two or more miscarriages, couples want answers. A structured set of tests can find a cause in about half of cases, and in many of those, treatment is possible. Here is what is usually tested and why.

Why is testing done?

The aim is to find treatable causes, such as thyroid disease, uterine abnormalities or antiphospholipid syndrome, and to give you an estimate of the chance of a successful next pregnancy. About half of couples have no cause found, which is also useful information.

What tests are recommended?

1. Antiphospholipid antibodies

Blood tests for lupus anticoagulant, anticardiolipin and anti-beta-2 glycoprotein antibodies. Antiphospholipid syndrome is a treatable cause. If positive, tests are repeated after 12 weeks to confirm. Treatment includes low-dose aspirin and blood thinner injections in pregnancy.

2. Uterine assessment

• Pelvic ultrasound, ideally 3D: Looks for a septum, fibroids and uterine shape.
• Hysteroscopy or saline sonography: Checks the inside of the uterus for polyps, adhesions or a septum.
• MRI: Used in complex cases.

Uterine septum and polyps can be corrected.

3. Genetic tests

• Parental karyotype: A blood test checking both partners' chromosomes. A balanced translocation is found in about 2 to 4 percent of couples.
• Testing of the miscarried tissue: Chromosome analysis of the tissue (products of conception) can show whether an error in the embryo caused the loss.

4. Hormone and metabolic tests

• Thyroid function (TSH)
• Prolactin
• HbA1c or fasting glucose if diabetes is suspected
• Vitamin D and B12 in some cases
• Ovarian reserve (AMH) if fertility is also a concern

5. Other tests

• Blood group and antibodies
• Complete blood count
• Infection screen when clinically indicated

6. Male partner tests

Semen analysis, and in selected cases sperm DNA fragmentation, as sperm DNA damage has been linked to early loss. Lifestyle review is also important.

Which tests are not routinely recommended?

Many clinics offer extra tests, but major guidelines do not support routine use of:

• Natural killer (NK) cell testing
• Routine thrombophilia panels without a personal or family history of clots
• Tests for HLA matching or other immune markers
• Routine tests for infections like TORCH when no symptoms are present

Your doctor can explain which extras apply to you.

How are results used?

• A treatable cause: for example, thyroid medicine, surgery for a septum, or aspirin and heparin for antiphospholipid syndrome.
• A genetic cause: counselling and options such as pre-implantation genetic testing with IVF or prenatal diagnosis.
• No cause found: supportive care, early scans, and reassurance. Many couples have a good outcome.

What is the best time to test?

Some tests, such as antiphospholipid antibodies, hysteroscopy and hormone tests, are done a few weeks after a loss, once the body has recovered. Your doctor will schedule them in a sensible order, not all at once.

What should you bring?

Bring all previous reports, scans, treatment details and, if possible, the pathology of the miscarried tissue. Write down dates of each loss and the gestation.

When should you see a doctor?

See a specialist after two miscarriages, earlier if you are over 35, have had a loss after a heartbeat was seen, have a second-trimester loss or have any medical illness.

What this means for you

A thoughtful, step-by-step approach saves cost and stress, and gives you the best chance of success. To plan your tests, consult Dr Malathi G. Prasad, a fetal medicine specialist at Trichy Fetal Medicine and Fertility Centre in Trichy.

If your doctor has suggested this, our recurrent miscarriages clinic page lists what is included and how to book; the team is happy to talk it through first.

Related guides

• How Many Miscarriages Count as Recurrent Pregnancy Loss?
• Before Trying to Conceive After a Miscarriage