QuestionGood day I am writing from South Africa. After 3 ivf I fell pregnant with a frozen embryo but had a missed miscarriage .The fetus showed the growth of a six week old fetus when I was actually 10 weeks pregnant. I had a d%26c two weeks ago and they send the product in for testing . The test results showed that chromosome 16 split.According to the dr everything was fine with both my husband and me and it is not because of a poor embryo. They suggested that we should consider amniocentesis for chromosomal studies with future pregnancies.Can you perhaps explain this to me please . I had a natural pregnancy 6 years ago which also ended in a miscarriage at 7 weeks. I am 36 years old and suffer from rheumatoid arthritis , i also have stage 4 endometriosis and have anti bodies in my thyroid and I know my time is running out and my health problems don't make it any easier. What would you suggest, before we start our next IVF to maximize our chances?I read all your answers on this web site every day and got clarity on a lot of issues that bothered me. Thank you.
AnswerHello Vicky from South Africa,
Thank you for following me on All Experts. You might also want to look up my blog where I also have detailed questions and answers.
The embryo quality at transfer may not have been bad, but we do not have the technology to evaluate the internal quality of the embryo. The quality we assign is based on how it looks from the outside. Therefore, there could have been a weakness in the embryo that led to the chromosomal breakage when the embryo was dividing further. That is a "spontaneous" chromosomal abnormality and not based on any abnormal chromosomes that you or your husband might have. The rate of spontaneous chromosomal breakage/abnormalities increases with age, especially after 35 years old. Hence we see a higher miscarriage rate and lower fertility rate with age. In this case, however, statistics show that eventually patients will be successful, so you just need to keep trying. Keep in mind that you have this increased risk and expect it. If the fetus is normal, the pregnancy should be successful.
I think that you are on the right path. IVF is the treatment of choice for the disorders that you have. With RA, you are at risk for immune factors as well and might want to consider immunotherapy with your IVF. We use low dose heparin or lovenox, low dose aspirin and Medrol. You might even want to be on IVIG or an equivalent. You should discuss that with your IVF doc.
Good luck,
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
