Fertility tests after miscarriage

Firstly, I’m so sorry that you’re even having to search for what fertility tests you might need after a miscarriage. This is a shitty experience and one I wouldn’t wish on anyone. I’m sorry this is happening to you. I’ve been there too. I wrote a book about my experience if you’d like to learn how I worked towards healing. But also I hope that this post helps you to find some answers in an experience that often gives you none.

Why am I writing this article about fertility tests?

Firstly, let it be known that I have no medical degree in fertility. I am a yoga teacher who works in the fertility space and I’ve been through my own journey with multiple losses. No, this does not qualify me to speak accurately on the medical tests YOU should be having after having a miscarriage.

However, I’ve also been in your position, looking for answers and getting wishy-washy answers from a range of sites. So I thought it would be helpful to compile a big list of all the possible tests you might want to consider so that you have somewhere practical to start.

It can be confusing and overwhelming to wade through all the information on the internet. I hope this list becomes a helpful place for you to reference. But PLEASE, seek your own medical advice around what fertility tests are right for you.

When will you be offered fertility tests after miscarriage?

Fertility tests are usually offered after you’ve had 3 or more miscarriages in a row (because this is the official definition of recurrent miscarriage). I know. This is an infuriating fact to hear. I remember hearing this in the early days after my second loss. I couldn’t fathom how I could possibly go through another loss and survive? How could they expect me to go through another before they looked for answers?

The good news is that you can start asking for fertility tests earlier than this. Here in Australia, this often means that the tests won’t be covered under medicare (check how this works in your country). I ended up paying for testing earlier and I thought it was worth it (even just for peace of mind), though I understand this isn’t possible for everyone.

Where do you go to get fertility tests done?

Most tests will just need a referral from your GP (your general doctor). If they aren’t able to order the tests themselves, they will be able to refer you who a doctor who can – so they are still the best place to start.

I also recommend working with a naturopath or TCM doctor (Traditional Chinese Medicine) because they usually take a more holistic look at your results and are interested in whole body well-being (rather than just focusing on your reproductive system – which, in my opinion, seems quite a flawed way to work).

What fertility tests to ask for after a miscarriage?

The following tests may or may not be relevant to your situation. Use your doctor (and your intuition) as a guide for things you might want to investigate.

Bloods tests

Blood clotting disorders

A blood test can look for antiphospholipid syndrome (APS), which can impact the embryo’s ability to embed properly in the womb.

Thrombophilia is another condition that is also tested for as it is a group of genetic conditions that effects how the blood clots. It has been linked to miscarriage, fetal growth restriction, stillbirth and pre-eclampsia.

I know, I know. This is all HEAVY stuff. I’m trying to lay it out without too much horrible detail, but I also want you to be informed. None of this may be the reason why your baby died. Or perhaps one of these is the answer for you. I’m sorry you’re even having to read this, but I also think it’s important for you to know where to start. Okay, back to it.

Chromosomal abnormalities

Karyotype tests on both yourself and your partner will show if any chromosomal abnormalities may be causing miscarriage.

Hormones

Tests for progesterone, FSH (follicle stimulating hormone) and LH (luteinising hormone) can give you an indication of the health of your menstrual cycle. If these hormones are out of balance it can be an indication of high stress, poor egg health, nutritional deficiency or other menstrual conditions that might be causing miscarriage.

You may also want to consider testing for AMH (anti-Mullerian hormone). This shows you the health of your egg stores. Personally I found this result somewhat unhelpful. My naturopath said this number is often used as a reason for why you might need to undergo assisted reproductive treatment. I received a low AMH result after my 3rd loss (which put me in a negative spin). However after our break we ended up conceiving on the first try. So while it may be important for you to get an indicator of egg health, don’t let this result destroy all hope.

Thyroid blood tests (or TSH) are drawn first thing in the morning. They are looking at whether your thyroid is working effectively. High TSH levels are associated with an increased risk of miscarriage.

The MTHFR gene mutation can impact the body’s ability to absorb folic acid and may be linked to recurrent miscarriages. You can read about me finding out I had this gene mutation here. Or what MTHFR might mean for your fertility here.

Pelvic inflammatory disease is a term used for variety of conditions affecting a woman’s reproductive organs. This condition often causes inflammation and scarring in the Fallopian tubes. This can impact pregnancy and makes ectopic pregnancy more likely (as the egg struggles to move through the tubes freely).

Testing the baby

This one is very much a personal decision. You may or may not want to have testing done on your baby. The thought of this was always too much to bear for me at the time of miscarriage. Although I sometimes wonder whether it’s something I should have looked at.

I think this testing will also come back to how this process unfolds for you. If it’s a natural miscarriage or a miscarriage at home, you will have to try and catch the baby or “pregnancy products” to take into hospital for testing. If you’re having a D & C it can feel easier to opt to have what is removed sent off for testing. In most cases they are testing for common chromosomal issues that might explain why you have miscarried.

If you’ve had a late miscarriage and given birth, you might be asked if you’d like a post-mortem on your baby. I know when I gave birth to Orion I couldn’t bear the thought of that. But I do think this is an incredibly personal decision. You will know what feels right to you.

Ultrasound

An ultrasound (usually given vaginally) can be helpful to look at shape of uterus (which can impact implantation) or whether you might have any fibroids, polyps or uterine growths that might be causing you to miscarry.

Swabs

Immediately after a miscarriage, you may be offered a vaginal swab to test for infection. Usually you will be asked about symptoms that might indicate infection before they put you through this sort of testing, during what is already an extremely difficult time.

Uterine tests

A hysteroscopy is a procedure where they look into the uterus via a long thin camera through the cervix. Your doctor might suggest this to look for fibroids, polyps, scar tissue or other uterine conditions.

At the same time as undergoing a hysteroscopy you could ask them to perform a endometrial biopsy. In this procedure they will remove a small piece of tissue from the lining of your uterus to test for infection, fibroids, irregular cells or polyps.

Another test that may be relevant is a hysterogram (HSG). This is where your doctor injects dye into the uterus through a small catheter. They will then use an X-ray to create an image of the uterus and Fallopian tubes. A HSG checks for issues that can block the fallopian tubes (like endometriosis) and is often recommended after an ectopic pregnancy.

Naturopath testing

I personally found naturopaths approach fertility more holistically than general doctors, which I appreciated. My naturopath was interested in ensuring that I had no nutritional deficiencies which could affect my body as a whole (and therefore my fertility). While my GP did order basic screening of iron and other nutritional levels, my naturopath was looking for more optimum results, rather than just ‘average’ which is determined through statistics of a general population (and therefore isn’t overly helpful).

Similarly, I felt my naturopath took a more in-depth look at what my hormone levels throughout my cycle. She sent me for bloods at different stages of my cycle, and again was looking for optimum results not just the average.

Your naturopath will likely also look for inflammation in the body and evidence of autoimmune conditions which can be a higher risk factor for miscarriage.

What happens if the tests show up nothing?

I know what it’s like to receive the result “unexplained infertility”. It can feel both positive (nothing is wrong!) and disheartening (something must be wrong why did I miscarry!). In my opinion, I think it’s a good step to have things ruled out. If there is no obvious reason for your miscarriage; stay hopeful.

Put your energy into living your happiest, healthiest life. Spend your time tending your broken heart after your loss. At some point I think you need to stop looking for answers and decide that you’re going to be okay. However it turns out.

Want support to move towards healing after a miscarriage? I offer 1:1 virtual sessions. Book in here.