What Tests Should I have done for Infertility, Recurring Miscarriages and Childbirth Losses (Stillborns, Deaths ect)

So clearly I'm not the only one who is living with infertility on this earth right?

A lot of times, us woman, we have to stick together...

We have to advocate for our health, and for our other woman's health out there...

Infertility is a tough topic for anyone to talk about, but a lot of times we are stuck wondering what tests a woman should get if she is experiencing multiple miscarriages and child loss and infertility...

Well, I've typed up a lovely document about a year ago, and I figure, since people may wonder this a lot, and want to know what to ask their doctors for, here it is...

Testing for Recurrent Pregnancy and Children Losses As Well As Infertility

A lot of testing can be offered but we have to have a bigger picture. Generally, a multiple pregnancy loss panel would conclude and consist of: 

1. Hormonal - FSH, TSH, progesterone, prolactin, estradiol, LH, DHEA-S, Testosterone, basically the whole work up hormone wise. The important thing here is to get the progesterone level. If progesterone is low, you can miscarry multiple times.

2. Physical/Uterine - saline sonograms or hysterosalpinograms may or may not be helpful in determining what happened/occurred. Woman experiencing multiple losses and infertility often are ordered these tests by a RE or fertility specialist.

3. Infections – Things like STD's. Yes it’s possible to get even if your partner does not have an STD, and you have not cheated. In the past, I tested positive for Chlamydia, and had to be put on antibiotics, my partner tested negative, it’s not an easy topic of choice, but may be something routine to look into to get a full STD check to ensure its not one of these bacteria’s that cause it. You can get bacterial infections like Chlamydia and gonorrhea from anywhere, but sexual is most common for these. Just something to cover, and most doctors will often end up testing for these just to be sure (HIV, HepB, HepC ect. ect)

4. Thrombophilias - These are a group of disorders that promote blood clotting. You stated you already had a full work up done on these, but I would say get it redone. You should be specifically checked for all factors. Factor I, II, V are the most common. The tests you should have run regarding Thrombophilias are:
PAI-1 levels and activity
Antithrombin III
Prothrombin II mutation
Protein C activity
Protein S activity
Factor V Leiden

5. Immune – This is a tricky one. I was initially tested for antiphospholipid antibodies, but nothing else. This would involve things like autoimmune and alloimmune issues, activated Natural Killer (NK) cells, among others. Many doctors do not believe in immune issues in regards to implantation dysfunction. However, lots of doctors do believe in it. From everything I’ve read and heard, this is an extremely complicated area of medicine and most REs simply do not understand it. Another reason for controversy is lack of studies. However, it’s hard to prove almost anything related to this field because there are so many factors. 

The most important testing here to run would be:
- Antiphospholipid Antibodies, which can be attributed to recurrent miscarriages.
- Lupus anticoagulant, which can also be attributed to recurrent miscarriages. This has nothing to do with testing for lupus, even though it has the name in its name, it’s a separate thing all together.

Most Hematologists (if you have not seen one yet, you should consider referral there for specialty testing in clotting/miscarriage area) WILL run the tests I listed in Thrombophilias, and immunology, because these are common causes for miscarriage.

6. Genetic – The typical test is for this is called karyotyping. This is essentially a picture of your chromosomes and tests all 23 pairs. It should be done for the female and male partner. It takes a little while to get the results, because the chromosomes have to be isolated, stained and examined under the microscope. Also, besides the standard karyotyping, there is micro-array testing that is more detailed. I think that it’s uncommon as its newer technology and probably more expensive. I recently got mine back and it showed no translocations, and no mutations, a normal female karyotype (see previous blog).

7. Egg Quality - Even if you get the karyotyping and you and your partner get good results, that doesn’t mean that your embryos will be genetically healthy. By yourselves, you’re fine, but when the egg and sperm get together, there can be problems and it’s usually because of the egg. This is sort of one of those normal abnormalities. Also, you doctor should be able to tell you whether he thinks your egg quality is good or bad. The best advice here is to keep trying and wait for that one good egg or you can move on to donor eggs or embryos.

8. Male Factor – Make sure your partner has a full semen analysis.

These are the tests I had done, and I've had 5 m/c, 1 chemical pregnancy and 1 stillborn were as follows:

Protein C Activity (Elevated due to FVL)
Protein C Antigen
Protein S Activity
Protein S Antigen
Factor V Mutation (Tested Positive for Heterozygous Mutation)
Homocysteine Level (normal, and hematologist passed off as nothing to worry about and no MTHFR because of this LOL WRONG!)
Factor II Mutation (often called prothrombin 20210A)
Methylenetetrahydrifolate Reductase (MTHFR)
LAC (Lupus anticoagulant)
ACA (anticardiolipin)
ANA (antinuclear antibody)
Fasting Blood Glucose
Antithrombin III Activity

I had that those tests started as soon as I possibly could.

I then had an HCG test where they insert saline dye into your vagina and watch it spread through your uterus and fallopian tubes looking for blockages, polyps, cysts, tears, scar tissue, etc. This is a very easy procedure (make sure your insurance covers it) and it literally took about 10 minutes. 

Don't let anyone tell you that it's VERY painful. It wasn't too bad. I had this done at CD9.

Then, I had my progesterone level drawn at 7DPO and it was a 9.3. 

The doc said that wasn't high, but it wasn't too low either - we planned on monitoring my progesterone level for the next month before determining whether to put me on progesterone/baby aspirin combo.

Then I found out about MTHFR and my other clotting disorders, through 23andMe, which is something you should consider getting done if you have not gotten done already. For $99 its a steal, and so I was automatically placed on Lovonox during pregnancy and baby aspirin daily. 

So those are the ones I'd recommend.... If you haven't had them done already...

And as a refresher to the reader who might be wondering what clotting disorders I do have, the following:

So as you can see, Green = Good, Red = BAD, Yellow = In between.
Actually, Green = no mutation. Red = Homozygous, and Yellow = Heterozygous...


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