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An evaluation for known causes of recurrent pregnancy loss is
usually initiated after 2 or 3 consecutive pregnancy losses. The
tremendous emotional impact of each loss may encourage an evaluation
sooner than later. A full evaluation includes
- demonstration of a normally shaped uterine cavity (by either
hysterosalpingogram or hysteroscopy)
- evaluation for a hormonal deficiency in progesterone production
(by either endometrial biopsy or bloodwork)
- analysis of both the maternal and paternal chromosomes (by
bloodwork)
- laboratory testing for immunologic causes of pregnancy loss
(by bloodwork)
- taking a history for maternal disease states, environmental
or other toxin exposure
If a full evaluation is completed on couples with either 2 or
3 consecutive losses there will still be about 50% (1 of 2) of
couples with "unexplained" recurrent pregnancy loss.
That is, roughly half of couples seem to have a reason for recurrent
loss that is beyond modern medicine's ability to diagnose this
cause. This can be frustrating for both the couple and the physician.
In this situation, the couple will at least know that potentially
repairable pathology has been ruled out. The couple can then elect
to enroll in experimental protocols designed to further our knowledge
of recurrent pregnancy loss. In my experience, these experimental
treatments often result in reproductive success despite limited
knowledge on why they work.
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