A general, physical examination should be performed on the patient, with any signs or symptoms related to endocrine and/or gynecologic abnormalities thoroughly documented and investigated.
Your specialist should obtain pertinent gynecologic history regarding previous pregnancies that were viable, history of uterine surgeries, history of irregular menstrual cycles, history of medical illnesses/endocrine abnormalities, and/or non-gynecologic surgeries.
- Karyotype blood testing of couples is done to rule out chromosomal abnormalities.
- Uterine evaluation to rule out anatomic abnormalities, either congenital or acquired, leading to RPL can be accomplished utilizing a hysterosalpingogram (HSG), Sonohysterogram (SHG), 3-D ultrasonography, or magnetic resonance imaging (MRI). At this time HSG and SHG represent the most cost-effective, simplest, and most accurate diagnostic testing.
- Blood testing: evaluation of thyroid function with a serum TSH level, evaluation of ovarian reserve utilizing a serum AMH level, and elimination of possible immunologic factors utilizing anticardiolipin antibodies and lupus anticoagulant.
- Screening for diabetes mellitus should be reserved for those women with clinical manifestations of the disease.
- Screening for infectious diseases such as toxoplasmosis brucella, CMV, syphilis and HIV and others.
The treatment of recurrent pregnancy loss is based upon clinical, radiologic, and laboratory findings. Couples in which one of the partners carries a chromosomal rearrangement or abnormality should be referred for genetic counseling to discuss the probability of viable pregnancy based on the chromosomes involved.
Women with a uterine septum, intrauterine adhesions, and uterine fibroids (especially submucosal fibroids) can choose surgical correction, which has been shown to be associated with a reduced risk of miscarriage.
If you have experienced more than one miscarriage, a second-trimester miscarriage, or a stillbirth, we understand that you may have concerns about your next pregnancy.
At Footsteps to Fertility Centre in Nairobi, Kenya, our team of reproductive endocrinologists and experts in ultrasound diagnosis work together to determine the cause of a previous miscarriage or stillbirth.
Our team also develops a care plan that can increase the odds of a successful pregnancy.