Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses

Objective: To determine whether the frequency of abnormal results for evidence-based diagnostic tests differed among women with recurrent pregnancy loss (RPL) based on the number of prior losses (n = 2, 3, or > or =4) and to determine whether abnormal results for additional investigative diagnostic tests differed in prevalence among women with different numbers of pregnancy losses.

Design: Single-center, retrospective study.

Setting: Patients with RPL at a private practice.

Patient(s): One thousand twenty women who had two or more consecutive spontaneous pregnancy losses with the same partner.

Intervention(s): None.

Main outcome measure(s): Frequencies of abnormal results for evidence-based diagnostic tests considered definite or probable causes of RPL (karyotyping for parental chromosomal abnormalities; pelvic sonohysterography, hysterosalpingogram, or hysteroscopy for uterine anomalies; immunological tests for lupus anticoagulant and anticardiolipin antibodies; thrombophilic tests for the factor V Leiden mutation; and blood tests for thyroid-stimulating hormone [TSH] and fasting blood glucose). We also measured the frequency of abnormal results for nine additional investigative tests in the same patients (antiphosphatidyl serine antibodies, microbial infection, midluteal P, PRL, functional protein C activity, functional protein S activity, antithrombin activity, fasting homocysteine and methylenetetrahydrofolate reductase polymorphisms, and factor II mutation).

Result(s): The prevalence of abnormal results for evidence-based and investigative diagnostic tests did not differ among women with different numbers of pregnancy losses.

Conclusion(s): Evaluation of all couples with two, three, or more consecutive miscarriages is recommended.