What to Do After a Miscarriage
Almost 15% of pregnancies will end in miscarriage, most often during the first few weeks of pregnancy. Even knowing the statistics, miscarriages are heartbreaking.
The sorrow often comes with questions – why did it happen and what can be done to prevent it from happening again?
Tests Performed After a Miscarriage
After a miscarriage, your doctor may want to investigate why it happened through several clinical test procedures. Testing for the root cause is even more important after multiple miscarriages.
Tests that your doctor orders may include:
- Hysterosalpingogram: an x-ray with contrast to check the structure of the uterus.
- Hysteroscopy: an examination of the uterus with a fiberoptic telescope.
- Saline sonohysterogram: an ultrasound of the uterus filled with saline.
- Vaginal ultrasound: examines the uterus, ovaries, and fallopian tubes.
- Endometrial biopsy: looking for infection in the endometrial tissue
- Uterine lining testing: an endometrial biopsy on cycle day 21 to test for thickness of the uterine lining.
- Hormone tests: usually checking prolactin, progesterone, and thyroid levels
- Antibodies testing: looking for lupus antibodies or antiphospholipid antibodies.
- Genetic testing of either the parents or the fetus: 50-70% of early miscarriages are due to genetic abnormalities of the embryo. (study)
Not all of these tests are necessary for every woman after a miscarriage.
But what do you do if all the tests come back negative? If your uterus is structurally perfect and your hormone levels are within range – what next?
This is a frustrating situation that many women face, especially after age 35!
Digging deeper into miscarriage risk
As women age, it becomes more and more important to optimize for a healthy pregnancy.
But what is “healthy” and how do you know if your health is optimal when trying to conceive?
Several common blood tests can help you to quantify – to actually KNOW – what your levels are for several important biomarkers.
Your doctor can order these tests. Many of the tests mentioned below are covered by insurance but check first so you don't get an unexpected bill.
If you have a high deductible, it may make more sense to pay out-of-pocket for blood work and submit your receipt to the insurance company to see if your expenditure can count towards your deductible.
If you don't have insurance or you have a high deductible, you can order and pay for your own blood tests to quickly get the information you want.
In most US states (except NY, NJ, RI), you can order your own blood tests online. Note that health insurance will not cover the lab tests that you order online, but you may be able to use your HSA or FSA account to pay for the tests.
The links provided below for online tests are with the company I work with who I found to have the best prices. They offer tests at a fraction of the cost that insurance would charge.
The testing process is simple. Using my affiliate links (full disclosure: I get a commission) provided below, you add the test to your shopping cart. After you pay for the test, you will get an order form to print out and take to a local blood draw location at Quest Diagnostics. Then you go to get the blood draw done whenever it is convenient for you. The test results are sent to the company, which notifies you via email when your results are available to print out. It normally takes a couple of days to get the test results.
You can take the results to your doctor for advice or share them with your fertility coach.
Testing for Autoimmune Thyroid Diseases:
A TPO (thyroid peroxidase) antibody test looks for indications of autoimmune thyroid diseases such as Hashimoto’s or Grave’s disease.
You can order a TPO antibody test here.
A full thyroid test panel is recommended to get a more complete picture of your thyroid function. That can ordered here.
What can you do about TPO antibodies?
While TPO antibodies can be present without thyroid disease, a positive TPO antibodies test is something that you should discuss with your doctor. Further testing may be needed to determine if you should be prescribed thyroid medication.
Adopting a healthy diet is helpful in managing autoimmune thyroid conditions.
Look into environmental or dietary triggers for TPO antibodies such as mold, iodine excess, and heavy metals. Make sure you are getting an adequate amount of selenium in your diet. (study)
Homocysteine is an important marker for increased risk of heart disease. High homocysteine levels are also associated with increased risk of fertility problems. Women with high homocysteine are at an increased risk for placental abruption, recurrent miscarriages, and high blood pressure during pregnancy. (study)(study)(study)(study)
A simple blood test can tell you if you have a high homocysteine level. Order here.
Solutions for high homocysteine levels:
Diet plays a big role in homocysteine levels. Make sure you are getting plenty of folate, vitamin B6, and vitamin B12.
If you aren’t getting enough of these vital micronutrients via your diet, consider taking a good prenatal vitamin that contains the active forms of these B-vitamins: methylfolate, methylcobalamin, and P5P. For more information about folate and vitamin B12, click here.
Vitamin D testing:
Many studies have shown that women with low vitamin D levels are at a higher risk for miscarriages. Women undergoing IVF are more likely to get pregnant if their vitamin D levels are “sufficient”. (study)(study)(study)
How much vitamin D do you need? Vitamin D deficiency is defined as having a 25(OH)D level less than 20 ng/ML, and vitamin D insufficiency is defined as having levels between 20-32 ng/ml. Normal levels in sunny countries are between 54-90ng/ml. (study)
Instead of guessing, a simple 25(OH)D test can tell you what your vitamin D level is. The test can be ordered here.
Solutions for low vitamin D:
Your body makes vitamin D through exposure to sunshine on your bare skin. The best time of the day to get plenty of sunshine is between 10 am and 2 pm. If your test results show that your vitamin D levels are less than optimal and you can’t get enough sunshine, you can also supplement with vitamin D. Look for a brand that includes the vitamin D with a good source of fat.
Testing for Inflammation:
C-reactive protein (CRP) is a biomarker that shows your overall inflammation level. CRP is an inflammatory marker that is released by the liver. If it is elevated, it indicates inflammation, but it doesn’t tell you what is causing the inflammation.
When ordering a CRP test, the high sensitivity CRP test is your better option. Order here.
Solutions for high CRP:
Talk with your doctor about low dose aspirin therapy if you have high CRP levels. A recent study showed that for women with high CRP daily aspirin brought their miscarriage risk back down to normal. (study)
Testing for Iron Deficiency:
A simple blood test for anemia can tell you if you have low iron levels that could be affecting your ability to conceive. Order online here.
Solutions for iron deficient anemia:
Iron-deficient anemia can be reversed by eating foods high in iron, such as liver. Iron supplements are also available, but if you are taking a prenatal vitamin, check the label first to see if it already has iron in it. Lactoferrin is a good alternative to iron supplements, especially for women with clotting disorders. (study)
Testing for Clotting Disorders:
Blood clots can be a cause of recurrent miscarriages. More about that here.
If you have a family history of clotting disorders, such as a first degree relative who has had a deep vein thrombosis or pulmonary embolism, you should talk with your doctor about testing for clotting disorders.
A PTT (partial thromboplastin time) test and PT/INR test can tell you if your blood clots slowly or quickly. Many doctors and fertility specialists can do this test in the office for you. You can also order here.
A low PT result shows that your blood clots more quickly than normal. Your doctor or fertility specialist may want to investigate further to see if you carry genetic variants that cause clotting disorders such as factor V Leiden.
An antiphospholipid antibodies (anticardiolipin antibodies) test can tell you if you have an autoimmune condition that causes your blood to clot more rapidly. Your doctor can order this test for you, or you could order it through an online lab company ($147 from Walk In Lab).
Solutions for clotting disorders:
Your doctor should determine if the clotting disorder is serious enough to warrant anticoagulant medications.
If you aren’t in need of prescription medications, add natural blood thinners to your diet. Fish oil is a natural blood thinner. Adding more fish to your diet is great when trying to conceive. Just make sure to choose fish that are low in mercury. Or a high quality fish oil supplement is an easy addition to your daily routine.
Taking steps to optimize your health can be powerful in recovery from a miscarriage!
Testing can help you map out a plan to move forward when you are ready to try again to conceive.