Recurrent miscarriage: understanding the testing process

Written by: Miss Elaine Scott
Published: | Updated: 12/07/2023
Edited by: Cal Murphy

Miscarriage can be a sad, distressing and scary experience. This is even truer if it is not the first one a person has had. Unfortunately, as many as 1% of couples trying to have a baby are experiencing recurrent miscarriage. As upsetting as this can be, it is important to identify the cause to see if there is a possible solution. Here,  distinguished consultant obstetrician and gynaecologist, Miss Elaine Scott, explains more about recurrent miscarriage. 

When should I have tests to find out the cause of recurrent miscarriage?

Most of the tests are done when the patient is not pregnant. This is because pregnancy can affect the results of some tests or make them difficult to interpret. However, if a miscarriage occurs in hospital or the patient requires a surgical procedure due to the miscarriage, genetic testing of the pregnancy tissue can be performed at the time. Your doctor will be able to advise you on this further.


What kind of tests are recommended?

The most useful tests include:

  • Genetic testing of the failed pregnancy tissue to exclude chromosomal abnormalities (e.g. Down’s syndrome)
  • Parental karyotype to exclude balanced reciprocal or Robertsonian translocation
  • Antiphospholipid screening: anticardiolipin and lupus anticoagulant screening (these can cause blood clots and associated problems)
  • Anti-thyroid antibodies, e.g. thyroid peroxidase antibodies (these are markers for autoimmune thyroid disease)
  • Assessment of the uterus with 3-D vaginal ultrasound, hysteroscopy or saline transvaginal ultrasound to exclude scar tissue (adhesions within the uterus) or an abnormally shaped uterus (uterus with a dividing septum) or to exclude intracavity fibroids (fibroids within the lining of the uterus)


There are also a number of other tests that the doctor may run.

A full thrombophilia screen can exclude inherited blood clotting disorders, such as:

  • MTHFR gene deficiency
  • PT and aPTT test
  • Protein C
  • Protein S deficiency
  • Factor V Leiden
  • Prothrombin gene mutation
  • Antithrombin III deficiency


There are also a series of investigations known as natural killer cells testing. These involve screening for a specific group of lymphocytes (white blood cells, which form part of the immune system) called natural killer cells (NK cells). Elevations in the total number of NK cells have not been shown to cause recurrent miscarriages, but elevated levels of CD-69 (a subgroup of activated NK cells) have been shown to be attributable to poor pregnancy outcome or poor outcomes in IVF.


The doctor may also order an ovarian reserve test, checking the levels of the anti-mullerian hormone. Finally, the cervix may be assessed for weakness. This is only useful in women who had late miscarriages (miscarriages between 13-23 weeks). Assessing the cervix for weakness or shortening is done by performing an ultrasound on the cervix in the second trimester of pregnancy on a fortnightly basis. Women with suspected cervical weakness may be offered a cervical stitch in a subsequent pregnancy by their doctor or ultrasound scans to exclude cervical weakness in the second trimester.


What kind of tests should I avoid?

Depending on when your miscarriage happens (early miscarriage or late miscarriage) some tests may not be useful in diagnosing the cause. Your doctor will be able to advise you on tests to avoid.


What are the chances of finding out the cause?

In approximately 50 per cent of cases, a cause or contributory factor can be found. Unfortunately, in the rest, it may continue to be unclear as to why the patient has had multiple miscarriages.


To book an appointment with Miss Elaine Scott, simply head on over to her Top Doctors profile today. 

By Miss Elaine Scott
Obstetrics & gynaecology

Miss Elaine Scott is an experienced Consultant Obstetrician and Gynaecologist, who was appointed to her NHS consultant post (at the Royal Free, which is a prestigious London teaching hospital)  in 2000 and worked there full time until 2017. Since then, Miss Scott has chosen to focus on her private practice.  Miss Scott provides care for a wide range of obstetric and gynaecological conditions, with a special expertise relating to all aspects of pregnancy (both normal pregnancies and higher risk pregnancies with complicating factors). 

Miss Scott is pleased to help prior to pregnancy with pre-pregnancy (pre-conception) counselling and can then follow through with antenatal care, delivery either normal childbirth or Caesarean, and post natal care. Whilst she was at the Royal Free, Miss Scott was Labour ward lead and Obstetric lead. Her experience allows her to quickly recognise any developing problems in pregnancy and manage them as safely as is possible, with the aim of a safe delivery of a healthy baby  and, of course, a healthy mother. She believes in the importance of good communication and rapport and tries to ensure that each woman has all the information necessary to be able to make good choices about her own care. 

Miss Scott also has a significant general gynaecological practice and deals with a variety of problems including menstrual disorders (irregular bleeding or periods), miscarriage, hormonal disturbances, contraception, hormone replacement therapy and the menopause.  She is also happy to see women for well-women checks and for cervical smears.

Miss Scott trained and qualified as a doctor at University College Hospital.  Her specialist training in Obstetrics and Gynaecology included posts at many other prestigious teaching hospitals including Chelsea and Westminster hospital, St Mary's hospital, Queen Charlotte's hospital, Addenbrooke's hospital (Cambridge) and the John Radcliffe Hospital (Oxford).  She carried out research relating to preterm labour which led to the award of a Doctorate of Medicine, as well as publications in peer reviewed journals.  Whilst in her consultant post, she oversaw the development of an upgraded labour ward, as well as the introduction of a midwifery birthing unit. She introduced a joint specialist clinic caring for women with renal transplants in pregnancy. She was also the College Tutor and, as such, was responsible for overseeing the training of the junior doctors within the department. 

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