Testing for Recurrent Pregnancy Loss NZ
This can usually be achieved through your local LMC or GP. Some NZ Public Hospitals have a specialised area now for women’s health which can include RPL testing and treatment like Wellington and Auckland – the latter has the ‘Recurrent Pregnancy Loss Clinic’ or you may wish to consult a private specialist or a clinic where payment is required. See further on for more information.
The collation of test areas listed here for consideration may differ with each medical professional, facility or country and may not be offered to you or even be available in NZ for instance, but reading this information may help you and your partner participate in discussions with your LMC (Lead Maternity Carer). It gives you some understanding of the relevant options in your own personal situation and what may be medically involved. We have had contact with women with RPL (Recurrent Pregnancy Loss) who have gone to other countries when local testing wasn’t available or extensive enough.
(July 2007 in NZ, Section 88 Primary Notice [MOH 20070] stated that registration of women with a LMC may occur at any time from the diagnosis of pregnancy until 6 weeks after birth, so NZ Midwives are now more likely to care for women who may lose their baby in early pregnancy, although a GP will probably still be the medical professional with the most helpful advice about your options for testing if you do not wish to consult a specialist.)
- To assess the anatomy of the uterus and fallopian tubes, tests can include an hystersalpingogram or hystroscopy a laparoscopy or pelvic ultrasonography
- Ovum tracking with serial ultrasound scans and serial serum progesterone assays can help in diagnosing ovulatory factors (corpus luteum failure) – relative to a woman’s menstrual cycle.
- Complete Blood Cell count also known as Full Blood Cell count (CBC & FBC)
- evaluation for a hormonal deficiency in progesterone production (by either endometrial biopsy or blood tests)
- a maternal history which includes environmental and/or other toxin exposure
- analysis of the Karyotype, maternal and paternal chromosomes (by blood tests) for Down’s, Patau, Edwards and Turner’s Syndromes.
- mapping of chromosomes to detect genetic defects like cystic fibrosis, phenylketonuria and hyperthyroidism.
- a vaginal ultrasound and an endometrial biopsy 09.09
- testing for thyrotropin, antithyroid antibodies, prolactin, renal function and liver function
- lupus anticoagulant
- autoantibody screen
- thrombocytopenia (low platelets)
- thyroid – Hyperthyroidism or Hypothyroidism. (LMC will ask relevant questions before activating tests)
- screening for genetic blood clotting disorders (paphyria and haemophilia)
- TORCH screening which means Toxoplasmosis, others, rubella, cytomegalumia, herpes and sometimes Hep. B.
- hair analysis to detect mineral deficiencies and or heavy mineral content
- sperm testing
- sperm DNA fragmentation test
- testing for chromosomal abnormalities in miscarriage tissue when available
- megar dilator paternity test
The following is an example of a reasonably standard GP’s work-up in NZ;
- CBC (complete blood count)
- Liver Function Tests
- Thyroid function
- Glycaemic control
- Autoantibodies to ANA/ANF and dsDNA
- Anticardiolipin antibodies – IgG & IgM
- Thrombophilia Screen
- Chromosone Analysis (Karyotyping) – both you and your partner
- Antithrombin III
- Protein C
- APC resistance test
- Protein S
Additional suggestion (which costs to be tested for in NZ) is MTHFR – an enzyme responsible for methylation and many other health difficulties.
For further information and testing/pricing in NZ see http://www.fertilityplus.org/faq/miscarriage/rpl.html 09.09
Frustratingly, there will always be some cases of recurrent miscarriage that will still remain unexplained; however, the prognosis for subsequent pregnancies in the unexplained group is often better than it is for couples where a cause has been found. So, if there are no abnormal test results it can often be good news.