At the BCRM Recurrent Miscarriage Clinic, we offer an extensive panel of advanced specialist tests and investigations for recurrent miscarriage

More importantly, these will be highly individualised and based around your specific case, history, and circumstances

The following list is not exhaustive but outlines some of the investigations we offer for recurrent miscarriage:

• 2D pelvic USS
• 4D pelvic USS
  • A 2D scan will be performed as part of every first appointment in the recurrent miscarriage clinic. However, a 4D scan of the womb allows us to make a much more detailed assessment of the womb for potential causes of miscarriage such as abnormalities in the shape of the womb (uterine anomalies), uterine fibroids and scarring within the womb lining.
• Hysteroscopy
  • This involves a very thin camera only a few millimetres across being passed very gently through the neck of your womb to carefully check the lining of your womb and shape of your womb cavity. Please see following for more information https://www.fertilitybristol.com/hysteroscopy-information-for-patients/ (BCRM hysteroscopy link)

• HyCoSy
  • This is a special ultrasound test that allows us to check if your tubes are open and more importantly, to make sure there is no swelling in your tubes that increase your risk of a miscarriage. Please see the following page for more information https://www.fertilitybristol.com/hycosy-ultrasound-fertility-test/ (BCRM page for HyCoSy)
• Chromosome analysis – karyotype (parental and pregnancy tissue)
  • In 2-5% of couple with recurrent miscarriage, one of the parents has a chromosomal problem called a translocation. This is where part of one chromosome has moved to another chromosome. This doesn’t cause any problems for the affected parent as there is no more or less genetic information in total. However, when the affected parent tries for a pregnancy, there may be an increased risk of miscarriage as this balanced translocation can result in an unbalanced translocation in the embryo. Parents chromosomes can be checked for a balanced translocation. Alternatively, we also offer chromosome testing of your miscarriage, which can also be very useful in trying to understand the reasons for miscarrying that pregnancy
• Antiphospholipid screen
  • Antiphospholipid syndrome is an acquired thrombophilia, meaning it is a condition that develops later in life and is not inherited. Patients with Antiphospholipid syndrome may have blood that is more ‘sticky’ than normal. As a result, they are at an increased risk of miscarriage with each pregnancy
• Thrombophilia screen
  • A thrombophilia is an inherited condition that means you have an increased tendency to forming blood clots. Most people with thrombophilia don’t have any symptoms. However, this increased clotting tendency can increase the risk of miscarriage as it can reduce the blood supply to the developing placenta in early pregnancy
• TSH & Thyroid antibodies
  • An over or underactive thyroid can be associated with in increased risk of miscarriage and other pregnancy related complications, as can the presence of antibodies to the thyroid gland (an autoimmune problem)
• Comprehensive coeliac screen
  • Some studies have found that women with Coeliac disease (gluten intolerance) may be at increased risk of miscarriage as well as other pregnancy complications. This is detected by the presence of certain antibodies, which may be present even if you have no symptoms of the condition
• Autoimmune profile
  • Certain autoimmune conditions such as Systemic Lupus Erythematosus (SLE) and Sjogren’s syndrome are associated with an increased risk of miscarriage. We are able to perform a screen for antibodies that may suggest an underlying autoimmune condition.
• Hormone profile – FSH/ LH/ Testosterone
  • Polycystic ovarian syndrome (PCOS) is a very common condition amongst young women and can be associated with difficulty in conceiving as well as an increased risk of miscarriage
• NK cell testing
  • NK cells or Natural Killer cells are cells that form part of a normal healthy immune system. They are found in both the blood (peripheral NK cells) as well as directly in the womb lining (uterine NK cells). They play a critical role in determining how the mother’s immune system responds to and receives a new pregnancy as well as being involved in early development of the placental blood supply
  • Studies have shown that an increase in the proportion of these immune cells in both the blood and lining of the womb can be associated with an increased risk of miscarriage
• Th1/Th2 cytokine ratio
  • These are immune cells involved in determining the mother’s immune response and tolerance to a fetus.
  • Th1 cells generally release inflammatory molecules (cytokines) whilst TH2 cells release anti-inflammatory cytokines which are very important for the ongoing development of the fetus and placenta. Th2 cells are involved in protecting the early developing fetus and placenta from the inflammatory effects of the Th1 cells. As such, an improper balance of these cells has been associated with an increased risk of miscarriage
• TNF-alpha cytokine
  • This is an inflammatory protein released by Th1 cells that has been found to be in higher concentrations in patients with recurrent miscarriage
• Endometrial biopsy for chronic endometritis.
  • Chronic endometritis is a low-grade inflammation of the endometrium (womb lining) and often doesn’t cause any symptoms. However, it has been linked to an increased risk of recurrent miscarriage. A diagnosis can be made with a biopsy of the lining of the womb and treatment is simple with antibiotics
• Sperm DNA fragmentation
  • There is good evidence that having a high percentage of sperm with damaged DNA or DNA fragmentation is associated with an increased risk of pregnancy loss. This is often associated with lifestyle factors in the male such as smoking and obesity as well as occupational and environmental exposures.
  • See https://www.fertilitybristol.com/why-sperm-quality-counts-in-fertility-success/ and https://www.fertilitybristol.com/male-fertility/ for more information
• Sperm aneuploidy
  • Sperm aneuploidy refers to sperm with an abnormal number of chromosomes. Fertilisation of an egg with these sperm can result in an embryo with abnormal chromosomes. Studies have shown that sperm with a high rate of aneuploidy are associated with recurrent pregnancy loss, even when a semen analysis is normal. This test involves directly testing hundreds of sperm from one ejaculate for the 5 chromosome anomalies in sperm most associated with miscarriage
• Sperm reactive oxygen species
  • The excessive production of ROS might have serious implications on sperm structure and functionality, because spermatozoa are particularly susceptible to damage induced by ROS, because their plasma membranes contain large quantities of polyunsaturated fatty acids, their cytoplasm contains low concentrations of scavenging enzymes, and sperm have a limited capacity to repair its DNA
  • See https://www.fertilitybristol.com/male-fertility/ for more information

Further, more bespoke testing may be advised in certain cases based on your specific circumstances and findings