Recurrent miscarriage: tests
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
First-line tests (away from a pregnancy)
Fasting laboratory tests
- Lupus anticoagulant (off anticoagulant, away from an infection)
- Anticardiolipin antibodies IgG and IgM
- Anti-β2-glycoprotein I antibodies IgG and IgM
- TSH
- Anti-TPO antibodies (if TSH > 2.5 mIU/L)if neededTSH > 2.5 mIU/L in a woman with a history of miscarriages who wishes to conceive: HAS then recommends anti-TPO antibodies, which guide the treatment decision between 2.5 and 4 mIU/L [2].
- Fasting plasma glucose
- Serum prolactin
- Folate
- Vitamin B12
- Serum homocysteine (not reimbursed in France)if neededRecommended by the CNGOF (grade C) but not routinely recommended by ESHRE; outside the fee schedule, paid by the patient [3,4,5].
- Constitutional karyotype of both partners (one sample for each; from 3 miscarriages according to CNGOF)if neededThe CNGOF recommends the couple's karyotype from 3 miscarriages (grade A) [4]; ESHRE no longer recommends it routinely, only after an individual risk assessment [3]. An abnormality requires genetic counselling [3]. To be discussed with the gynaecologist or geneticist.
- Anti-Müllerian hormone (AMH), ovarian reserve (according to gynaecological opinion)if neededThe CNGOF recommends looking for diminished ovarian reserve (antral follicle count on day 3 ultrasound and/or AMH measurement, grade C) [4]; ESHRE does not recommend routine assessment of ovarian reserve in recurrent pregnancy loss (strong recommendation) [3].
- Pelvic ultrasound (uterine malformation or acquired abnormality) and gynaecological opinion.
Do not order
- Inherited thrombophilia (factor V Leiden, factor II mutation, proteins C and S, antithrombin): do not test unless as clinical research or with an associated thrombotic risk factor, and no antithrombotic treatment on this ground alone [3].
- Insulin, plasma glucose with a search for PCOS, LH, androgens to improve the prognosis of the next pregnancy: not recommended [3].
- 25-hydroxyvitamin D: no argument for a role of vitamin D status in miscarriage, measurement not recommended [3].
- NK cells (blood or endometrium), anti-HLA antibodies, HLA typing, cytokine polymorphisms: not recommended in clinical practice [1,3].
- Anti-TPO antibodies if TSH < 2.5 mIU/L, anti-thyroglobulin antibodies as first-line: not recommended by HAS [2]; anti-thyroglobulin antibodies are reimbursed only after hypothyroidism without anti-TPO (code 1484) [5].
Positive antiphospholipid antibodies: recheck at 12 weeks
At least 12 weeks after the first sample
- Lupus anticoagulant
- Anticardiolipin antibodies IgG and IgM
- Anti-β2-glycoprotein I antibodies IgG and IgM
- State any anticoagulant treatment on the request (type, dose, time of last dose).
Sources (10)
- ESHRE Guideline Group on RPL; Bender Atik R, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss: an update in 2022. Hum Reprod Open. 2023;2023(1):hoad002.
- Haute Autorité de santé. Prise en charge des hypothyroïdies chez l'adulte. Recommandation de bonne pratique, décembre 2022 (mise en ligne mars 2023), chapitre 11 « Femme ayant un désir de grossesse en cas de troubles de la fertilité, d'antécédents de fausses couches ».
- ESHRE Guideline Group on RPL; Bender Atik R, Christiansen OB, Elson J, et al. ESHRE guideline: recurrent pregnancy loss. Hum Reprod Open. 2018;2018(2):hoy004.
- Collège national des gynécologues et obstétriciens français (CNGOF). Les pertes de grossesse. Recommandations pour la pratique clinique (texte court), 2014. Version anglaise : Huchon C, Deffieux X, Beucher G, et al. Pregnancy loss: French clinical practice guidelines. Eur J Obstet Gynecol Reprod Biol. 2016;201:18-26.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 0901 (caryotype), 1020 (anticoagulant lupique), 1460 (anticorps antiphospholipides), 1484 (anti-thyroglobuline), 1487 (anti-TPO) ; absence d'acte pour l'homocystéine et l'anti-β2-GP1.
- Haute Autorité de santé, Centre de référence du lupus, SAPL et autres maladies auto-immunes. Protocole national de diagnostic et de soins (PNDS) : Syndrome des anti-phospholipides de l'adulte et de l'enfant. Octobre 2022.
- Regan L, Rai R, Saravelos S, Li TC; Royal College of Obstetricians and Gynaecologists. Recurrent Miscarriage: Green-top Guideline No. 17. BJOG. 2023;130(12):e9-e39.
- Practice Committee of the American Society for Reproductive Medicine. Recurrent pregnancy loss: a committee opinion. Fertil Steril. 2026;125(6):1023-1041.
- Nederlandse Vereniging voor Obstetrie en Gynaecologie (NVOG). Richtlijn Herhaalde Miskraam (adaptatietraject internationale richtlijn), adaptation néerlandaise de la recommandation de l'ESHRE, modules sur les examens, publication du 18/07/2023. Richtlijnendatabase.
- Toth B, Bohlmann M, Hancke K, et al. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022). Geburtshilfe Frauenheilkd. 2023;83(1):49-78.