testing for RPL

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
• anticardiolipin
• 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
• AIDS

• CBC (complete blood count)
• Liver Function Tests
• Renal
• 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

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.

RPL Referrals for Auckland, NZ;

Medical

Public
If you meet the criteria for the Auckland District Health Board’s ‘Recurrent Pregnancy Loss Clinic’ at Greenlane and live in Auckland ask your LMC for a referral.

Contact details and the criteria to attend the clinic are as follows;

The Recurrent Pregnancy Loss Clinic
Fertility Plus, Greenlane Centre,
Gate1, Building 4, Level 5,
Greenlane West Rd, Greenlane,
or Private Bag 92 189, Auckland.
Ph: (09) 630 9988
Fax: (09) 631 0728
Web: www.adhb.govt.nz

Clinic criteria:

• Maternal age < 40 years at referral
• Three consecutive first trimester pregnancy losses/two second trimester pregnancy losses - these losses need to be medically verified.
• Residents in Auckland, Waitemata and Counties Manukau District Health Board areas are eligible.
• Both partners are involved
• Waiting list possible
• The nurse in charge will talk by phone to anyone who lives outside of the Auckland area who fit the criteria above

If you are not eligible for public funded treatment, perhaps because of the age criteria e.g. over 40 years, or prefer and can afford it, try the private clinics or other gynaecologists/obstetricians who specialize in managing difficult pregnancies (see our Links & Contacts) where similar programmes to the public ‘Recurrent Pregnancy Loss Clinic’ are available.  Most consultants now have websites that will give you an indication of their abilities, qualifications and sometimes the length of time they have been in practice. This is not necessarily a guarantee they are any better than anyone else but quite a few Gynae and Obstetric specialists in this field in Auckland are very qualified and have been around for a while. It is your choice who you would like to see, not your LMCs’ but it is preferable to be referred by them and before you conceive if possible.  This is so that you can have the benefit of the pre-pregnancy care that is usually offered. However, if you are already pregnant, you can still be referred or even self-refer to most private practices. It is helpful to have medical confirmation of previous miscarriages and any other relevant information when seeking treatment. Re-current miscarriage is a couple problem so it is advisable to take your partner with you when consulting with your chosen specialist as he will be needed anyway.  You may like to seek up-to-date reference information from our ‘Forum’ ladies for Auckland and other NZ areas.

1. At the time of making an appointment; make sure their focus is on recurrent miscarriage
2. Ask what costs are involved, what medical or other information will be required and whether both parents/parents-to-be will need to be present at this first appointment
3. If not, a support person is always advisable as two people listening means a double check on information given
4. Prior to the visit, write down your goal for your appointment e.g. the tests available to you (see ‘Testing for RPL’) and any other questions – ask the most important one first.
5. Arrive early to fill out any forms that may be required. 
6. Have insurance information, medical records and any other required documentation and dates ready and a list of any drugs or supplements currently being taken.
7. Let the consultant know if you don't understand any of the terms being used, if the information is being given too fast for you or if you're simply overwhelmed by it.
8. Ask for written information to take away.
9. Make sure you know exactly what is required of you before you leave the office. You will be expected to follow the consultant’s instructions afterwards.
10. If you have further questions after your session call the office right away and be aware you may be charged
11. Do extra research on the internet if you feel you need to know more.

Alternate

For those considering alternative treatment, see your own local areas’ naturopath/acupuncturist/dietician/ hypnotist/ professional counsellor and find ones who specialise in pregnancy problems, particularly miscarriage, and you can again ask on our ‘Forum’ (see also ‘Subsequent pregnancies’ information). Most practitioners also have websites that will give you an indication of their abilities, qualifications and sometimes the length of time they have been in practice. This is not necessarily a guarantee they are any better than anyone else. Confirmation would be good.

The suggested people/organisations under our ‘Links & Contacts’ heading are ones that we know of where women have been treated successfully however they are just a guide to start your search for assistance.  There are others.  Aside from ‘Subsequent pregnancies’, there are also recommended ‘Websites’ and ‘Books’ and further information including specialised diets.  Seeking professional counselling or advice from a medical practitioner for mental health may be an option that you would like to consider especially if you experience prolonged intense emotion or depressing thoughts and behaviour that makes functioning difficult. It is often only with hind sight that we realise how bad things were and advice given at the time can be worth listening to. It may also give you more confidence for a positive outcome to know that you have done the best you could for yourself and your baby.