QuestionHello DOCTOR
I live in BHOPAL city in INDIA.
I am a 37yr6month old housewife. 10YRS back I had features of PID WITH CYSTITIS which was cured in a WEEK.After 8yrs of infertility in JULY 2010 I had a laproscopy,hysteroscopy and T.B.PCR .All the reports were normal.I have had 5 failed I.U.I.[3 before lapro and 2 after lapro].Surprisingly i conceived on my own 5 months after lapro i.e in DEC 2010 .
T.V.S at 6wk5days showed cardiac activity
T.V.S at 9wk2days didnot show cardiac activity
and the gestation age was only 6wk5days so i had suction evacuation .The karyotype report of P.O.C was normal.
Thereafter in DEC 2011 i had a complete antiphospholipid test
DRVV confirm PLASMA
DRVV CONFIRMATORY [TEST]was HIGH 39.30 referance range is [27.59-34.55]
DRVV CONFIRM RATIO was HIGH 1.18 referance range is [0.93-1.17 ]
LUPUS ANTICOAGULANT WAS ABSENT
ANTIPHOSPHOLIPID ANTIBODY SERUM WAS NORMAL
CARDIOLIPIN ABS
CARDIOLIPIN IgG WAS NORMAL
CARDIOLIPIN IgM WAS NORMAL
SO I started taking ASA 50mg[BABY ASPIRIN] twice a day and productive f[MULTIVITAMIN].
I have BETA THALASSAEMIA TRAIT BUT husbands report is normal.
IN MAY 2012 THE APLS TEST was repeated the report is as follows;
PTT[TEST] was in range 34.9 REFERANCE RANGE 30.0-43.0 SEC
PTT CONTROL WAS IN RANGE 33.1 REFERANCE RANGE 30.0-43.0 SEC
DRVV SCREEN TIME,PLASMA
DRVV SCREEN [TEST]WAS IN RANGE 38.50 REFERANCE RANGE 32.82-48.90 SEC
DRVV SCREEN CONTROL WAS IN RANGE 37.70 REFERANCE RANGE 32.82-48.90
LUPUS ANTICOAGULANT WAS ABSENT
ANTIPHOSPHOSPHOLIPID ANTIBODY SERUM WAS NORMAL
CARDIOLIPIN ABS
CARDIOLIPIN IgG WAS NORMAL
CARDIOLIPIN IgM WAS NORMAL
I had an H.S.G in NOV 2011 which was NORMAL
IN JUNE 2012 I had a natural cycle ovulation study.i was given[UROFOLLITROPIN] folimon75inj on day 6 andday 8.THEN had inj ovuteig 10000[h.c.g] on 11 day when endo was 8.8mm and
follicle size was 20x17.
the follicle ruptured on day 13 wnen the size of endometrium was 9.2mm.In this cycle I CONCEIVED again.
from 4wk3days i started
INJ FRAGMYN 2500u[lOW MOLECULAR WT HEPARIN]
PROGYNOVA 2MG [ESTRADIOL VALERATE]
ASA 50 MG TWICE A DAY [BABY ASPIRIN]
DUPHASTON 10MG[DYDROGESTERONE],SUSTEN200MG[PROGESTERONE],MCBM69[FOLVITE 5MG;METHYLCOBALAMIN500MCG;PYRIDOXINE HYDROCHLORIDE 10MG]
ROXID 300MG[ANTIBIOTIC] FOR 4 DAYS
T.V.S at 7wk1day recorded cardiac activity on M mode as 137/min.regular
no evidence of sub chorionic bleed seen
T.V.S at 11wk1day cardiac activity was absent.
the gestation age was 8wk3days so had a suction evacuation on 30 aug 2012.
The karyotype report of p.o.c is normal
The other test i have had which are all NORMAL ARE; AMH-3.6;ATA;ATPA;GAMAINTERFERON;
VITAMIN D AND B12;HOMOCYSTEINE;HIV;HCV;PROLACTIN;FSH;LH;VDRL;GLUCOSE FASTING AND POST MEAL;
URINE ROUTINE;COMPLETE BLOOD PIC;
I live in bhopal[INDIA] THE Doctors are not able to diagnose the cause of my repeated miscarriages.It wud be very kind of you if you could pls help me and tell me
what you think is causing the repeated miscarriages and whats the treatment for it?when can i try again for pregnancy?
AWAITING YOUR REPLY EAGERLY
THANK YOU
NAQUIYA
NAQUIYA
AnswerHello Naquiya from India,
Since your immunological and genetic testing were negative, and you have been given adequate hormonal support, then the other possibilities are infectious diseases and anatomical. However, I don't think that this testing will yield an abnormal result based on how your previous pregnancies were. In each of the pregnancies you got pretty far and the most common reason is spontaneous genetic abnormalities (aneuploidy). This is where there is chromosomal breakage at the time of egg division to form an embryo. This problem is the most common reason for miscarriages prior to 8 weeks and the incidence increases with age. At your age, the risk for miscarriage due to this problem is as high as 50% per pregnancy. There is no treatment for this because it is due to weak or abnormal eggs, which become more common with increased age. The only option you would have is to keep trying, knowing that you would still be at risk of a miscarriage but eventually will be successful, or to do IVF and have preimplantation genetic screening done so that only genetically normal embryos are transferred.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate
