Costly tests for Recurrent early preg loss

What is seronegative aplA(anti phospholipid antibody) ?? What other costlier tests??   Tests that have to be done in view of RPL :( evidenced based in cases of RPL-(i.e. tests which are worth spending) are 1) Screening for antiphospholipid antibodies
2. Peripheral blood karyotyping
3. Screening for inherited Thrombophilia, (one should remember that APLA panel include following parameters e.g.  B2glycoprotein-drVVT, dry Vat
Lupus anticoagulant ( apt, DRW screen ) ,ACA ( Anti cardiolipin ab)  (Ig &IgM ab)-Negative means the legal is < 10 GPL units /ml But if persistently the leabel is high to 40 GPL that has a real significance.
Cardiolipin antibody,=IgM ab (ACA):- may also cause IUFD, RPLm Unexplained subfertility, )
4. Referral to a clinical geneticist
5. Cytogenetic analysis of the products of conception, Foetal/POC chromosome   & Paternal chromosome=any translocations??  6) Tests for APL, One may ask what step to be adopted if only DRVTT positive? I feel that under such circumstances one should be give LMWH and (LDA).  May proceed for tests for secondary APLA or other autoimmune probality ( ANF, anti-ds DNA antibody  ,  or inherited thrombophilia unless one  work up completely we will not know or 80 percent of times we  may get negative results . Simplest trial is preconception folic with Vit B 12 and ecosprin with UPT positive itself start heparin may b diff in such cases to reach ideal time to start heparin. There is an entity called seronegative aplA.

Class 3 tests (contd):-Not evidence based tests for RPL but people quite often in insist on such, possibly meaningless, clinically irrelevant tests? Therefore such tests are optional :- 1) serum homocysteine (normal level is 6-14 µmol/Lit, , Serum Vit D & B12 level, 2) Anti-mitochondrial ab & Anti Neutrophil cytoplasmic ab(ANCA) , Anti smooth ms ab  

3) To relentlessly search for Chr. Nonspecific infn of uterus –Chlamydial screening,  Mycoplasma culture,, Brucellosis, CMV screening, 4) Sperm-for polyspermia( per sperm less DNA share à resulting into  Post implantation disorders),

5) Class 3 tests (contd):-Not evidence based tests for RPL but people quite often in insist on such,  Tests for hypercoagulability-like less Protein C,(normal range of Pro C is 70-130 %of normal biological range- and Pro C is a cofactor for proteins, But this  range will be altered while someone is on Heparin  Ry ) ::

 Protein-S deficiency (these two proteins C & S - are natural anticoagulants) –Normal value of Protein S is 55-122%of biological value   & raised ANTITHROMBIN III,

 5) Class 3 tests (contd):-Not evidence based tests for RPL but people quite often in insist on such,  T Hysteroscopy for synechiae, anatomical defects of ut e.g. - small septum, polyp, slight duplications of ut, unicornate ut. Hysteroscopy also help us to rule out Koch's 6) Any subtle Endocrinopathy: - –autoimmune thyroiditis, PCOS women with androgen excess milieu, Poor Ov reserve (AFC, AMH), ERA tests-poor endomeruial receptivity. Etc. 

C)  What are the treatment modalities which are not agreed upon by most Int authorities?? Such Treatments which, as I mentioned are   less evidence based though, admittedly many advocate such procedures (not talking if tests):- cervical cerclage may be associated with a high risk of minor morbidity but no serious morbidity.
• Heparin can be associated with maternal complications including bleeding, hypersensitivity reactions, and heparin-induced thrombocytopenia and, when used long term, osteopenia and vertebral fractures. Two prospective studies have shown that the loss of bone mineral density at the lumbar spine associated with low-dose long-term heparin therapy is similar to that which occurs physiologically during normal.