Should Couples with Recurrent Miscarriages Get Genetic and Immunity Testing?

If a woman has experienced two consecutive natural miscarriages, is it necessary to check for immune factors and chromosomal abnormalities?

A year ago, I experienced a positive pregnancy test with two lines, but before the gestational sac was visible, I had bleeding and lost the pregnancy.
I estimated that it was around 4-5 weeks along.
Both my partner and I underwent infertility testing; the female results were normal, but the male had abnormal sperm morphology.
Since then, we have attempted artificial insemination twice, both of which were unsuccessful.
Now, it has been about a year since the last natural miscarriage, and I have discovered that I am naturally pregnant again.
At around 6 weeks, a gestational sac measuring 0.5 cm was detected, but a few days later, I experienced bleeding and naturally expelled the tissue.

I have the following questions for the doctor:
1.
Do both partners need to undergo immune testing and chromosomal analysis?
2.
Since the tissue from this miscarriage has been preserved, should it be tested?
3.
I have been testing with pregnancy sticks, and there is still residual HCG.
Should I conduct the immune testing now while there is still residual HCG, or should I wait until after the bleeding has stopped?
4.
Can immune testing and chromosomal analysis be done simultaneously through blood draws, or do I need to test one first and then return for the other?
5.
Is it possible to improve sperm morphology? What supplements do you recommend? Should I consider retesting to assess any improvements?
Thank you, doctor.

DoReMi, 30~39 year old female. Ask Date: 2021/10/18

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, habitual miscarriage is generally defined as having three or more consecutive miscarriages.
If you have not reached this threshold, it is advisable to monitor the situation for now.
In case of another miscarriage, please visit a medical center for a thorough examination.
Wishing you good health.

Reply Date: 2021/10/18

More Info

When couples experience recurrent miscarriages, it is essential to consider a comprehensive approach to understanding the underlying causes. In your case, given the history of miscarriages and the male partner's abnormal sperm morphology, genetic and immunological testing can provide valuable insights. Here’s a detailed response to your questions:
1. Should couples undergo immunological and genetic testing?
Yes, it is advisable for both partners to undergo genetic testing and immunological assessments. Genetic testing can identify chromosomal abnormalities that may contribute to recurrent miscarriages. Conditions such as balanced translocations in one of the parents can lead to embryo development issues. Immunological testing is also important, as certain autoimmune disorders can affect pregnancy outcomes. For instance, antiphospholipid syndrome (APS) can lead to recurrent pregnancy loss due to clotting issues.
2. Should the preserved tissue from the miscarriage be tested?
Yes, testing the preserved tissue can provide critical information. Histopathological examination can reveal whether there were any chromosomal abnormalities in the fetus or if there were signs of infection or other pathological conditions that might have contributed to the miscarriage. This information can guide future pregnancy planning and management.

3. When is the best time to conduct immunological tests?
It is generally recommended to wait until the HCG levels return to baseline before conducting immunological tests. This allows for a clearer interpretation of the results, as elevated HCG levels can sometimes influence immune responses. If you are still experiencing residual HCG levels, it might be prudent to wait until you have a regular menstrual cycle and are no longer experiencing bleeding.

4. Can immunological and genetic tests be done simultaneously?
Yes, both immunological and genetic tests can typically be performed through blood draws at the same time. There is no need to wait for one set of results before proceeding with the other. However, it is essential to consult with your healthcare provider to ensure that the appropriate tests are ordered and that they align with your specific situation.

5. Can sperm morphology improve, and what supplements are recommended?
Sperm morphology can improve with lifestyle changes and certain supplements. Recommendations often include antioxidants such as vitamin C and E, zinc, and coenzyme Q10, which can help improve sperm quality. Additionally, maintaining a healthy lifestyle—such as regular exercise, a balanced diet, avoiding smoking, and reducing alcohol consumption—can positively impact sperm health. It is also advisable to follow up with a urologist or a fertility specialist to assess the sperm quality periodically and determine if further interventions are necessary.

In conclusion, recurrent miscarriages can be emotionally and physically taxing for couples. A thorough evaluation involving genetic and immunological testing can help identify potential causes and guide future pregnancies. It is crucial to work closely with a healthcare provider specializing in reproductive health to navigate this process effectively.

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