QuestionQUESTION: Me 26yrs old female pt had tow times missed abortion within8months. the two times before at fetal ages 7 wks.my RHpost toxoplasma neg.My hormonal assay within normal TSH LH FSH PRL.PLease prescibe me which best drugs or strategy to follow up.my doctor advised me aspirin OD with next pregnancy.IS it alone enough?.is it teratogenic?Can i taKE HEPARINE WITH ASPIRIN WITH NO COMPLICATION?When i should start this ttt if you advised?AT LAST THANK U FOR HELPING ME
ANSWER: Hello Monna from Saudi Arabia,
Of course, I can only suggest a treatment, but ultimately it will be up to your doctor to decide how to treat you (since you are under his/her care).
In your case, I would prescribe the following, which is what I use for recurrent miscarriages:
1. You need to have chromosomal testing in you and your husband first, to rule out any underlying chromosomal disorders that might be passed to the fetus. Most miscarriages occur because of spontaneous chromosomal abnormalities, but a few are because the parents are carrying an abnormality.
2. You need to have a Factor V leiden checked, which can be associated with early miscarriages.
3. I would recommend Aspirin 81 mg daily beginning with the onset of your period and continue until you are 10 weeks pregnant.
4. I would recommend Heparin 2000U twice per day beginning with the onset of your period and continue until you are 10 weeks pregnant.
5. I would recommend that you take Progesterone (Crinone, Endometrin, Prometrium) beginning on cycle day#16 of your cycle and continue until 10 weeks pregnant.
6. Make sure you are taking a prenatal vitamin with folate 1 mg each day.
I hope this helps,
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 facebook and twitter with me at @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: hello doctor
i got pregnant this month i started urs prescribed ttt but i want to ask u about progesterone 10mg should be od or bid? i should follow up ultrasound weeekly or monthely?supose i completed 10 weeks should i stop ttt suddenly or gradually?keep in mind im now fifth week pregnant
thank u
AnswerHello Again,
If you are on Progesterone 10 mg, then you are probably on medroxyprogesterone, which is a synthetic progesterone. That type is not recoomended for pregnancy. You have to switch to a natural progesterone such as Crinone 8% taken vaginally each morning, or Prometrium 100 mg taken vaginally twice per day, or Endometrin 100 mg taken vaginally twice per day. You would then use this until you are 10 weeks pregnant (gestational age) by ultrasound. Then you can stop.
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 facebook and twitter with me at @montereybayivf
