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TESTING FOR RECURRENT MISCARRIAGETREATMENT PLANS
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NHS Recurrent Miscarriage Clinic Testing (free). Standard criteria for a referral is 3 consecutive MC, although they may refer after 2 if you have other factors against you, like age or fertility issues. You might also be able to get your gp to do some of these tests if you can't get a referral or if your rmc don't do them.
There is no standard treatment, but you may be prescribed some or all of the following:
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You might have some or all of these tests:Progesterone(to support the womb lining, either from day 21 or from bfp)
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clotting tests(thrombophilia, lupus anticoagulent, antiphospholipid antibodies) You normally need to be about 6 weeks post MC for the clotting tests.Aspirin(new research suggests this should not be used 'just in case', but may still be prescribed for diagnosed clotting issues).
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uterine anomaly scan (to check for septums or different shaped uterus ie arctuate, unicornuate, bicornuate)Heparin(either for clotting issues, or its cytoprotective effect on the placenta, prescribed either from bfp or following an early location scan).
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karyotyping of both parents (to test for genetic issues such as balanced translations not standard on NHS now, unless results from testing of the embryo showed an issue, but may still do this test in some circumstances)Steroids(if high uNK cells, >5%)
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thyroid function (some places also do thyroid antibodies)
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blood glucose(diabetes test)TH1:TH2 ratio abnormalities
Possible treatment includes steroids, aspirin, heparin and intrlipid intravenous immunoglobulin.
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full blood countMTHFRActivated folic acid - Metafolin
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coeliac screen
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progesterone levels(day 21)
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Some clinics may suggest, for certain patients:
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Hysterosalpingogram(fill uterus and tubes with saline and take pics to check for issues)
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Hysteroscopy(stick camera up there to look for adhesions and septums, normally treated at the same time. Can be done under local or general)
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RESULTSResults for simple blood tests are around 1-2 weeks from gp. Main rmc testing take 4 to 6 weeks, or longer in some areas and for the karyotyping.
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Private Testing (not available on the NHS)
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Uterine Natural Killer Cells (uNK) Testing
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Location ContactCost
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Thornbury Hospital, Sheffield0114 267 4477£315(This is just for the uNK cells biopsy, no scan)
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Implantation Clinic (University Hospital, Coventry)call 02476967528 or email Kerri.Geraghty@uhcw.nhs.uk£360
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What you can expect from a visit to Coventry?
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Consult with Prof Quenby or Prof Brosens
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Vaginal scan (and measure lining thickness)
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Uterine biopsy also known as 'the scratch'. Has additional benefit of improving the lining for 3 months
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Lab testing for uNK levels and results email
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phone consult with one of the Profs to discuss results
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letter (via email) recommending treatment plan
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they can also provide private prescriptions if you need it
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Other info about Coventry
You need to be 2 cycles post MC before you book in. After 2 cycles, phone for an appointment on the day you get a positive on an ovulation kit you will be booked in 7 to 10 days later. Appointments are Mondays and Fridays.
This is classed as NHS self funded, so it's a non profit research project and funded by the fees of the patients. saying it's NHS might help your own consultant approve/prescribe treatment plan.
They advise to take paracetamol/ibuprofen before you go for the biopsy. gas and air is also available if you need it
Pain responses range from a bit ouchy to bloody painful!
Results take 3 to 6 weeks.
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Thromboelastogram (TEG) (sticky blood) testing
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St Mary's, London
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Blood NK Testing / Immune Causes Testing
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The Lister
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Various other private clinics
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Dr Shehata
CARE fertility (Sheffield, but many clinics around the country)
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Initial consultation £250. Testing priced as belowInitial consultation £180
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1. Immune Tests - The immune system has been linked with failed implantation and delay in falling pregnant as well as a cause of recurrent miscarriage and failed IVF attempts
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HS5 - £350Test for Tumour Necrosis Factor (TNF alpha) also known as TH1/TH2 cytokinesTH1:TH2 ratio abnormalities£590altered systematic inflammatory immune responses
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HS10 - £300This test includes the NK Cells (CD15/56 and CD69 count), Antinuclear Antibodies, Gliadin Antibodies and the Thyroid AntibodiesC4/M2 variant£155
a new genetic marker that predisposes couples to the risk of early or late miscarriage.
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HS11 - £530This test is a very complex test where the NK cells are put in a pregnancy like state to reflect their reaction during pregnancy and different medications are added to ascertain the treatment needed to reduce the activity level of NK cellsMTHFR£160related to blood clotting
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TB Quantiferon Gold Test - £100Your TB status is required prior to the medications being administeredPAIP Gene Polymorphism£176
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2. Full Thrombophilia Screen - This test is to ascertain if there is a tendency in your blood to be sticky and cause miscarriagesAuto Antibody Profile 1£108Includes antinuclear and Thyoid Peroxidase Antibodies
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HS1 - £370This test includes Protein C, Protein S, Antithrombin 111, Prothrombin Gene Mutation, Factor V Leiden, lupus anticoagulant and Anticardiolipin antibodies NK Panel £670nk blood cells rather than biopsy
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3. Hormonal - There is a link with abnormal hormonal function and recurrent miscarriages and delayed fertility or failed IVF attempts
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TFT3 - £100There is a link with abnormal thyroid enzyme function and recurrent miscarriages and delayed fertility or failed IVF attempts
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Prolactin - £50There is a link with abnormal serum prolactin level and recurrent miscarriages and delayed fertility or failed IVF attempts
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4. Ovarian Reserve test - This test is to help assess ovarian reserve and fertility success potential. These hormones may also help in diagnosis of polycystic ovarian syndrome. The test includes FSH, LH, E2 and AMH
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HS8 - £160This test is usually done between days 1-3 of menstruation
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5. Ovulation - This test is to help detect confirmation of ovulation. It is
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Progesterone - £50This test is usually done 5-7 days prior to menstruation
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Greek Hidden Infections / Lifecode
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Serum Clinic, Athens, Greece (by post or in person) info@ivfserum.com
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You send off a sample of menstrual blood in the post (contact them through the website for full details), which is tested for various infections high up in the vagina that wouldn't be diagnosed by normal vaginal swab, but can cause inflammation and problems with implantation. They do several tests:
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Locus Medicus €100(Their specialist test for chlamydia)
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Lifecode 7 in 1 €170(ordinary chlamydia test, bacterial load, ureaplasma, 2x mycoplasma, 2x bacterial vaginosis)
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Lifecode 10 in 1 €270(7 in 1 test, plus hsv1, hsv2, cmv)
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They suggest you have the locus medicus as well as one of the Lifecodes.
Results are in 5 to 8 working days after they receive the sample. If any infections identified, they will prescribe strong antibiotics (€100 for the prescription unless you are a patient at the clinic), which you get in the UK (normally privately)
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