• 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.

Alternative Medical Practitioners, New Zealand;
For those considering treatment, we have a NZ ‘Alternate medical practitioners’ list, mostly for the Auckland area in our ‘Resources’ section under ‘Useful Contacts’. For your own local area’s naturopath/acupuncturist/dietician, find one who specialises in pregnancy problems. General naturopathic advice is to take Folic Acid, Omega 3 and pre-natal multi vitamin & mineral formula to help your body to be at its optimum condition before trying to conceive. (see ‘Subsequent pregnancies’)

There are also recommended ‘Websites’ and ‘Books’ for further information under ‘Resources’, including specialised diets. It may give you more confidence for a positive outcome to know that you have done the best you could for yourself and your baby.

Seeking counselling or help 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 make functioning difficult. It is often only with hind sight that we realise how bad things were and sometimes advice given at the time is worth listening to.

Medical Referrals for Auckland, New Zealand;
If you meet the following miscarriage criteria ‘3 or more early miscarriages (before 13 weeks), not necessarily consecutive, but all pregnancies must be by the same partner, or 2 late miscarriages (13 - 20 weeks)’ and live in Auckland, ask your doctor for a referral to either the Auckland District Health Board’s Recurrent Pregnancy Loss Clinic at Greenlane (which has a waiting list), or if you are not eligible perhaps because of the age criteria (over 40 years) and prefer and can afford it, try the private clinics where similar programmes are available: suggestions for Auckland are - Auckland Obstetric Centre, Fertility Associates, Dr Lynda Batcheler

There are also several other gynaecologists who specialize in managing difficult pregnancies. (It is your choice who you would like to see, not your LMC’s.) It is preferable to be referred to their clinic before you conceive so that you can have the benefit of the pre-pregnancy care these private clinics usually offer. However if you are already pregnant you can be referred, or even self-refer to most clinics. It is helpful to have medical confirmation of previous miscarriages when seeking help. Re-current miscarriage is a couple problem so it is advisable to have your partner with you when consulting with your chosen specialist.