When to consider testing after repeated miscarriages

When testing is warranted

After two or three consecutive losses is the usual threshold, and many Indian obstetricians investigate after two.

Earlier, regardless of number, if: the loss was after the first trimester, you are over 35, cycles are irregular, there is a known uterine abnormality or previous uterine surgery, there is a family history of clotting disorders or recurrent loss, or there is any suggestion of tuberculosis exposure.

Also earlier if a previous loss was associated with a fetal abnormality, or if there is a known genetic condition in either family.

The tests worth doing

Antiphospholipid antibodies — lupus anticoagulant and anticardiolipin — repeated at least twelve weeks apart, because a single positive is not diagnostic.

Thyroid function, blood sugar and HbA1c, prolactin, and a full blood count.

Uterine assessment: pelvic ultrasound, and hysteroscopy or 3D ultrasound where a structural cause is suspected.

Karyotype of both partners, and testing of the pregnancy tissue after a loss where the hospital can arrange it — this last one gives the clearest answer available and is under-used because nobody offers it in the moment.

Tuberculosis screening where the history or picture suggests it.

Vitamin D, and thrombophilia testing in specific circumstances your doctor identifies.

Tests and treatments to question

Broad immunological panels — natural killer cell testing, extensive cytokine panels — are widely sold for unexplained recurrent loss and are not supported by good evidence for routine use. They are expensive and they lead to expensive treatments.

Routine thrombophilia screening in every case, when it is only indicated in specific situations.

Wide food-intolerance panels, which produce long false-positive lists and have no bearing on miscarriage.

And the treatments that follow from them: intralipids, IVIG, routine steroids, and packages combining several. Ask what trial evidence supports each one, and what it costs — this is an area where distressed couples are charged a great deal for very little.

In the public system, government medical colleges investigate recurrent loss and the core tests are available at a fraction of private prices. Ask for a referral rather than assuming private is the only route.

When to see a doctor

Go to hospital immediately for: bleeding that soaks a pad an hour or more, severe or one-sided abdominal pain, dizziness or fainting, shoulder-tip pain, fever with chills, or foul-smelling discharge. A positive pregnancy test with one-sided pain and bleeding needs assessment the same hour — an ectopic pregnancy is life-threatening. Call 108 if you cannot travel quickly.

Ask for referral to an obstetrician with an interest in recurrent loss, or to a maternal-fetal medicine unit, after two or three losses. Bring every previous report, scan and discharge summary in date order — the history is the most useful diagnostic tool there is.

Grief after a pregnancy loss is real grief, at any number of weeks. If you are struggling — persistent low mood, hopelessness, panic, an inability to function, or any thought of harming yourself — that deserves help rather than endurance. Tele-MANAS on 14416 is free, confidential and answers round the clock in Indian languages.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: How much does the full workup cost? — In private practice the core tests typically run into several thousand rupees; government medical colleges do most of them at nominal cost. The expensive part is usually the panels you did not need.

Q: Should the tissue be tested after a loss? — Where it can be arranged, yes — chromosomal testing of the tissue frequently explains the loss and changes what happens next. Ask about it at the time, because afterwards is too late.

Q: Do we test the man too? — Yes, karyotype for both partners, and a semen analysis. Male factors are part of recurrent loss and are routinely skipped.

Q: Everything came back normal. What now? — Supportive care in the next pregnancy — early scans, close monitoring, treating anything borderline — plus the reassurance that the majority of couples with unexplained recurrent loss go on to have a baby.