Losing a pregnancy more than once is one of the hardest things a person can go through, and being told to simply keep trying is rarely an acceptable answer. Repetitive pregnancy loss is one of the areas both of our physicians have extensive experience in, and it is among the conditions we are most often asked about. This page sets out when we start looking for a cause, and exactly what that looking involves.
When we begin a workup
We begin a recurrent pregnancy loss workup after two spontaneous losses. We also begin one after a single loss if that pregnancy came from an embryo that had already tested normal on PGT-A — a chromosomally normal embryo that does not continue is reason enough to look further, and we do not ask those patients to wait for a second loss.
What the workup consists of
The evaluation looks at the uterus itself, at inflammation, at immune and metabolic factors, and at the chromosomes both partners carry. It includes:
- Evaluation of the uterine anatomy by saline infusion sonogram and hysteroscopy
- Sampling to check for inflammation of the uterine lining (endometritis)
- Bloodwork for autoimmune predisposition — anticardiolipin antibodies (ACA), lupus anticoagulant (LAC) and antinuclear antibodies (ANA)
- Vitamin D
- Hemoglobin A1C
- Karyotype, to look for reciprocal translocations
- TSH thyroid evaluation
- Prolactin
- Screening for endometriosis
Endometrial sampling of this kind is part of our wider diagnostic practice as well — an endometrial biopsy is done in select cases to evaluate inflammation or infection during a repetitive miscarriage workup. If you have not yet had a general fertility evaluation, see fertility testing and diagnosis.
When PGT-A is indicated
When the recurrent pregnancy loss workup comes back negative — nothing treatable found — PGT-A is definitely indicated.
When a treatable cause is found, which in our clinical experience is the case for about half of patients, PGT-A becomes elective rather than necessary. Some patients still choose it, because it adds a layer of safety against sporadic aneuploidy — a chromosomal error that can occur by chance in any embryo, independent of whatever cause we identified and treated. That is a decision to make with your physician, not a default.
Who you would be seeing
Both Dr. Paul Gindoff and Dr. Beth Hartog list repetitive pregnancy loss among their areas of expertise, alongside pre-implantation genetic diagnosis and poor ovarian reserve, and the practice has extensive experience helping older women, women with diminished ovarian reserve and women with repetitive pregnancy loss. You would see a physician at every visit.
If you have had two losses, or one loss after transferring a normal embryo, it is reasonable to be evaluated now rather than after the next attempt. Contact Chelsea Fertility NYC to arrange a consultation. You may also want to read our earlier post on recurrent pregnancy loss.