Reccurent Pregnancy Loss (RPL)

To rule out antiphospholipid syndrome:

1.Anticardiolipin antibodies

a. Ig G (0-15 GPL) - better predictor of fetal outcome;

b. Ig M (0-15 MPL) ;

c. Ig A ;

Positive in medium or higher titer or >= 2 occasions six weeks apart;

2.Lupus anticoagulant ; Sample must be taken uncuffed and to be centrifuged within 1 hour

a. dRVVT ( dilute Russel Viper venom test);

b. Activated partial thrombin time ;

c. Kaolin coagulation time.

A panel of assays should be done ; If single test is to be done , it should be dRVVT.

Thrombotic complications are more with lupus anticoagulant positive than patients with positive anticardiolipin antibodies .

To rule out polycystic ovarian disease :

1. LH:FSH ratio (>3:1) ;

2. Hyperinsulinemia

Fasting glucose : fasting insulin < 4.5 indicated insulin resistance ;

3. S.testosterone (may be increased or normal)

Total testosterone - 20-80ng/ml , free testosterone - 100-200 pg/dl ;

4. Serum androstenedione (increased in PCOD , normal 60-300 ng/dl);

5. DHEAS (increased in 50-60% patients , normal 80-350μg/dl).

Rule out luteal phase defect (in early loss):

1.Serum progesterone level (