The most frequently asked questions on the website and in the clinic are: 1) What caused the miscarriage, and 2) Why did I miscarry when I had a lot of tests and no problems? It is hard to draw a conclusion when I am asked to answer all at once. In fact, there are many causes of miscarriage, and the doctor can only help you find the cause by asking a detailed medical history, menstrual history, fertility history, family history, past history, and a series of tests.
Causes of recurrent miscarriage and examination methods.
1. Chromosomal abnormalities.
I. Embryonic chromosomal abnormalities (in case of unavoidable miscarriage, the embryonic villi are taken for chromosomal examination when clearing the uterus, fresh villi tissue is needed, many small hospitals do not have this examination, but our hospital has this examination).
II. Chromosomal abnormalities in couples (taking venous blood from couples, not affected by dietary menstrual cycle, our hospital can check anytime from Monday to Friday).
2. Endocrine abnormalities.
Ⅰ. Polycystic ovary syndrome (blood will be drawn from the third to the fifth day of menstruation for sex hormone measurement, monthly basal body temperature measurement and gynecological ultrasound will be performed after menstruation)
Ⅱ. Hyperthyroidism or hypothyroidism (thyroid hormone test, not affected by menstrual cycle)
III. Hyperprolactinemia (can be measured by sitting still for 15 minutes without fasting around 9:00 a.m., not affected by menstrual cycle)
IV. Diabetes mellitus/insulin resistance (fasting blood glucose and insulin, oral glucose followed by blood glucose and insulin)
V. Luteal insufficiency (self-measurement of basal body temperature each month)
VI. Ovulation disorder (ultrasound monitoring of follicle development to follicle expulsion after day 12 of menstruation)
3. Reproductive system anatomical abnormalities
Ⅰ. Uterine adhesions (ultrasound, hysteroscopy, hysterosalpingography, which can be performed immediately after menstruation)
Ⅱ. Uterine malformation (ultrasound, hysteroscopy, and hysterosalpingogram)
Ⅲ. Cervical insufficiency (cervical dilatation test, ultrasound, imaging, etc.)
4. Infectious factors
Ⅰ. Mycoplasma, Chlamydia, etc. (taking cervical mucus, non-menstrual period)
Ⅱ. TORCH, HIV, RPR, etc. (blood can be drawn at any time)
5. Thrombotic factors
Ⅰ. Congenital pre-thrombotic state (coagulation factor V mutation, prothrombin gene mutation, protein C defect, protein S defect, homocysteine, prothrombin III activity. (examined by the Department of Hematology, Shanghai Ruijin Hospital)
II. Acquired pre-thrombotic state (anticardiolipin syndrome: requires repeated blood sampling about 3-5 times, each time about one month apart, no fasting; platelet aggregation requires fasting)
6. Immune factors
I. Autoimmune type (anticardiolipin syndrome: requires repeated blood draws about 3-5 times, each time with an interval of one month, independent of menstrual cycle)
7, uterine blood supply factors
Ⅰ. Pregnancy: uterine artery at 6-7 weeks of early pregnancy / 12 weeks of middle pregnancy; ultrasound examination of umbilical artery at 20 and 30 weeks of pregnancy
8. Male side examination: complete set of semen (3-5 days of abstinence to check semen)
In addition to the above factors, there are many uncertainties that cannot be detected by medical means at present. After so many examinations, we can find the cause of the disease for each patient and give the right treatment for the cause.