Testing for Recurrent Pregnancy Loss (RPL)
Understanding common miscarriage tests and what they assess.
Why Testing Matters
If you’ve had one or more miscarriages, you may be wondering: Should I get testing? What tests are available? How do I know what’s necessary?
Recurrent Pregnancy Loss (RPL) testing is often recommended after two or three consecutive miscarriages, though some providers will begin testing sooner based on your history. The goal of testing is to identify potential causes—whether they’re genetic, hormonal, clotting-related, or structural—so that future pregnancies can be supported accordingly.
Personally I started testing after two losses and am so glad I did as I found out I had Antiphospholipid Syndrome, which I was able to address in future pregnancies.
In today’s post, we’ll walk through common tests, what they assess, and how to use this information to advocate for yourself.
None of this is medical advice. I am not a doctor. I provide this information so that you can take it to your doctor or other healthcare provider to assess what is appropriate for you :).
🔒 For paid subscribers: You’ll also get access to the Lab Tracker download, a tool to help you keep track of test results, normal ranges, and follow-up actions.
Common RPL Tests & What They Assess
🧬 1. Genetic Testing (Assessing Chromosomal Factors)
Karyotype Testing (Parental Chromosome Analysis) → Checks for balanced translocations or genetic abnormalities in either partner.
Products of Conception (POC) Testing → If tissue is available from a miscarriage, this can determine if chromosomal abnormalities were a factor.
💡 When is this recommended? If multiple miscarriages occur with no obvious cause, genetic factors may be explored.
🔬 2. Hormonal & Endocrine Testing (Assessing Thyroid, Progesterone, & More)
TSH, Free T3, Free T4, Thyroid Antibodies → Rules out thyroid dysfunction, which is linked to miscarriage risk.
Progesterone Levels → Assesses luteal phase deficiency, which can make it difficult to maintain pregnancy.
Prolactin, DHEA, and Androgens → Related to PCOS and hormone balance issues.
💡 When is this recommended? If you have irregular cycles, previous implantation failure, or known hormonal imbalances.
🩸 3. Blood Clotting & Autoimmune Testing (Assessing APS, Factor V Leiden & More)
Antiphospholipid Syndrome (APS) Panel → Detects blood clotting disorders that can impact the placenta.
Factor V Leiden, Prothrombin Mutation, MTHFR → Genetic clotting risks that may contribute to miscarriage.
ANA Panel, NK Cell Testing, Inflammatory Markers → Screens for immune system dysfunction, including overactive immune responses.
💡 When is this recommended? If you’ve had second-trimester loss, unexplained loss, or suspected immune-related pregnancy issues.
🏗 4. Uterine Structure & Implantation Testing (Assessing Fibroids, Septum, & Endometritis)
Hysterosalpingogram (HSG) or Saline Sonogram → Evaluates uterine shape, fibroids, or polyps.
Endometrial Biopsy or Receptivity Testing (ERA/EMMA/ALICE) → Screens for uterine lining health, infection, or inflammation.
💡 When is this recommended? If miscarriages are occurring in the second trimester or implantation failure is suspected.
🔬 5. Sperm & Male Factor Testing (Often Overlooked but Critical!)
Semen Analysis → Assesses sperm count, motility, and morphology.
Sperm DNA Fragmentation Testing → Identifies DNA damage in sperm, which can contribute to early miscarriage.
💡 When is this recommended? If miscarriages are recurrent with no identified female factors, or if the male partner has a history of infertility concerns.
This list is a starting point but by no means comprehensive. There is general bloodwork panels that are not included above and there is always more testing that can be done, but that does not always mean more testing should be done, especially if it will not impact how you precede with future pregnancies moving forward.
The important piece is to have conversations with your doctor on testing, what is appropriate for you and your partner and what is not appropriate and why/ why not.
I know all of this testing can be overwhelming and I will be addressing this in upcoming post. Until then, know that you are going through a lot so be gentle on yourself. You are not alone. I’m sending so much love.
Allison
P.S. Remember our paid subscribers have access to a free lab tracker, at the very bottom of this post.
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🌿 Resources 🌿
Use the links below to help support the work we do at Miscarriage Hope Desk.
🌿 Pre & Post-Natals 🌿 RD-formulated prenatal supplements, here. They also have postnatal supplements, here. After a pregnancy loss, I recommend either continuing with a prenatal or considering a postnatal, to help replenish.
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🌿 Proov- Provides an array of at-home fertility testing. The "Predict & Confirm" kist provides valuable LH & PdG (a urine metabolite of progesterone) information to help know when ovulation occurs. They also have individual tests specific to testing PdG & FSH (ovarian reserve). Use this link or code MHD to receive 20% off at checkout.
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