How to check for habitual miscarriage? Three common inspection items

If patients with habitual miscarriage want to have a baby and want to see if this time it is still a habitual miscarriage, they can go to a regular hospital for genetic, endocrine, and immune tests.

1. Genetic testing

(1) For those suspected of having a genetic disease, both the husband and wife should undergo a chromosome karyotype examination, or further family genetics investigation and pedigree drawing should be conducted for the couple.

(2) Pedigree analysis: Through family investigation, analyze the impact of genetic diseases on future pregnancy.

(3) Karyotype analysis: The chromosomes of peripheral blood lymphocytes of both spouses are tested simultaneously to observe whether there are any numerical and structural abnormalities and the type of abnormalities, and to estimate the probability of recurrence.

(4) Molecular genetic diagnosis

2. Endocrine diagnosis

(1) Basal body temperature measurement (BBT): Basal body temperature can reflect the functional status of the ovaries and can be used to screen for luteal insufficiency. Because luteal insufficiency can cause habitual abortion, the basal body temperature of patients with luteal insufficiency is as follows: the high temperature phase is less than 11 days; the temperature rise in the high temperature phase is less than 0.3 degrees.

(2) Endometrial biopsy: The length of the menstrual cycle varies greatly among individuals, mainly due to the different lengths of the follicular phase, while the duration of the luteal phase and endometrial changes are basically consistent. An endometrial biopsy is performed in the late luteal phase. If the endometrium matures slowly, luteal insufficiency can be diagnosed. In addition to routine histological examination, it is best to perform estrogen receptor testing at the same time when performing endometrial biopsy. The content of estrogen and progesterone receptors in the endometrium is low. Even if the corpus luteum function is normal and progesterone is sufficient, the maturity of the endometrium still lags behind the normal level. This is called pseudo-luteal insufficiency.

(3) Hormone determination, including quantitative detection of estrogen, progesterone, human chorionic gonadotropin, etc. Serum progesterone determination: Progesterone in peripheral blood during the menstrual cycle mainly comes from the menstrual corpus luteum formed after ovulation. Its content gradually increases with the development of the corpus luteum. When the corpus luteum matures, that is, in the mid-luteal phase, the progesterone content in the blood reaches a peak, and then continues to decline, reaching the lowest level in the early stage of menstruation. The progesterone content in peripheral blood changes in a parabolic shape throughout the luteal phase. When the corpus luteum is incomplete, the secretion of progesterone decreases, so measuring the level of progesterone in peripheral blood can reflect the functional state of the corpus luteum. A serum progesterone level greater than 3 micrograms per milliliter (i.e. 3ng/ml) indicates that the ovary has ovulated. A mid-luteal progesterone level greater than 15 micrograms per milliliter (i.e. 15ng/ml) indicates normal corpus luteum function, and a level less than this indicates luteal insufficiency.

(4) Serum prolactin (PRL) measurement: Serum prolactin is secreted by the anterior pituitary gland and its main function is to promote milk secretion after delivery. At the same time, serum prolactin also plays an important role in maintaining normal corpus luteum function. Too low or too high serum prolactin can lead to corpus luteum insufficiency. A common clinical condition is hyperprolactinemia, which is excessive secretion of serum prolactin. The normal value of serum prolactin in serum is 4 to 20 micrograms per milliliter, and greater than 20 micrograms is considered elevated. Mild elevation of serum prolactin is closely associated with recurrent miscarriage. Excessive serum prolactin levels will seriously interfere with the function of the gonad axis, leading to anovulation and infertility.

3. Immunological examination

(1) First, the mixed lymphocyte culture reaction (MLR) and lymphocyte toxicity antibody assay are used to distinguish between primary and secondary abortion. Primary miscarriage often occurs within 20 weeks of pregnancy. The husband and wife share more human leukocyte B antigen (HLA) than normal spouses. The wife does not have B spouse immunity and shows a weaker mixed lymphocyte culture reaction to her husband. Her serum does not contain mixed lymphocyte culture blocking factor, and white blood cell therapy is effective. Secondary abortion: The spouses do not share human leukocyte b-type (HLA), the wife has complement-dependent or complement-independent anti-spouse lymphocytotoxic cells, and shows polyclonal antibodies to a group of cells. Heparin treatment is effective. The woman performs a monophasic mixed lymphocyte culture on the man and compares it with the antigens of an unrelated third party. If the woman shows a weak or absent mixed lymphocyte reaction to her husband, it indicates that the wife has no anti-paternal antibodies in her blood and has the same human leukocyte b antigen as her husband.

(2) Determination of anti-sperm antibodies: If the anti-sperm antibodies are positive, it indicates low fertility. High anti-sperm antibody titers and the presence of anti-sperm antibodies in cervical mucus have a great impact on fertility. Sperm agglutination test can be used to detect sperm agglutination antibodies, sperm braking test can be used to detect sperm braking antibodies, and immunobead test can be used to detect sperm binding antibodies.

(3) Antiphospholipid antibody (APA) determination: Patients suspected of having autoimmune diseases should be tested for antiphospholipid antibodies. Enzyme-linked immunosorbent assay (ELISA) can be used to directly measure the antiphospholipid antibodies and their titers in the female's serum.