QuestionQUESTION: Hello doctor,
I get conceived naturaly. But the baby's heart beat stops when it grows to 58-65 days and the doctor confirms it as Missed Abortions. I have already had 8 abortions till now all falls in the same period of 58-65 days. I have taken all the test like Antibodies, TORCH, LH, FSH, BOH Panel, TSH and even a laproscopy of my uterus. There are no abnormalities in any of the above reports. The doctor had even sent the Chorionic villi cells (POC) for chromosome test after they do the MT (Aboriton).But the result is cultures did not show any metaphases. i have takent he chromosomal analysis for both and the sperm count of my husband is more 70% (Motility. Please help me
ANSWER: Hello Priya from India,
If you have had 8 miscarriages in the early first trimester, you have a disorder called recurrent abortions and need to undergo a thorough evaluation. You have done a lot of this testing. You don't mention your age, but that could be a factor as well. The incident of miscarriages increases with increasing age due to spontaneous chromosomal abnormalities. It is too bad that the POC could not be cultured for the chromosomes because that would have been an important finding. Based on what you say, I presume your chromosomal testing and your husband's chromosomal testing were normal.
The only other testing that would need to be done is immunological testing. This would be a complete antiphospholipid antibody screen (21 points#.
In my patients, one they have recurrent miscarriages, I automatically use the following protocol:
Aspirin 81 mg daily beginning with the onset of the period.
Heparin 2000U injections twice per day beginning with the onset of the period
Medrol 16 mg daily starting with the beginning of the period then decreasing to 8 mg after ovulation.
Progesterone #Crinone or Endometrin) starting on cycle day#16.
The Medrol is stopped if the pregnancy test is positive, and the rest of the medications are continued until the pregnancy is 10 weeks gestational age. These are mainly treating immunologic causes for the miscarriage, so you have to make sure that it is not genetically caused.
That is what I would recommend for you to try.
Sincerely,
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
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QUESTION: Doctor,
Thanks a lot for your reply as all the doctors would give me a plain blank answer as Unexplained Infertility and would discuss this issue with my doctor. You had asked about my age. I am 28 years and my husband is 30 years old.Both our chromosomal reports show they are normal and no abnormalities. They have not used the above medicine for me. The Doctor has told that she would give me asprin once my pregnancy is confirmed. I am just waiting to check my pregnancy as i went through a follicular study and had a natural way of conception. I had tried IUI twice before but the result was same missed abortion. My doctor has told that she would try IVF once and then ET. Is there any chance that my baby would survive after doing an IVF or ET. Please help me. Can i try these medicines without my doctors consultation and just wanted to know are there any side effects for these medicines. Please help me....
ANSWER: Hello Again,
You will need to discuss your options with your doctor. Because you are young, your miscarriages are not the result of age related factors, so there could be something else going on. In my clinic, I would put you on the medications I mentioned previously.
You need to be monitored by a doctor if you take these medications so I do not recommend that you put them on yourself without a doctor's prescription.
IVF is the treatment of choice in your case, and you might want to proceed to that treatment level.
Sincerely,
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
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QUESTION: hello Doctor,
Thank you for your valuable suggestions that you had given me. Now i had got conceived again. The doctor did a follicular study and the size of the follicle was 2.4*2.5 before it got ruptured on 30the October. Is the follicular size a good one or it needs to be big. My LMP was on 15th October. She had asked me to take a Beta HCG test. The value on the first day(ie. 17th November) was 628 and again it was repeated on 19th November the value was 1175.How about this value is it Okay. She has also put me on the following medication since the confirmation
Asprin 75 mg (Daily 1.)
Progestrone 200 mg (Daily twice.) (Taken Orally)
HCG 2000IU (twice in week.) (HCG)
Dwandillin (twice daily )
Folinine (1 daily).
After whcih i had a severe pain in my abdomin on 26th night. The doctor had asked me to take the scan and they said that it is a early pregnancy and they could see the Sac and the Yellow Sac. But the baby's pole and pulse indications were not seen and they asked to report after 2 weeks so they could scan again and check for the pulse and heartbeat. After which the doctor has increased the dosage of
Progestrone 200mg to 4 daily. (Vaginal insertion)
HCG 5000 IU Injection twice Weekly.
Is these gona save my kid this time. Please help me in this regard and please tell me if the progestrone taken through vagina is better or taken orally is better because when done through vagina there is a lot of discharge that is coming out. Is the medicine helping me and please tell why the pole has't come and is it because of slow growth. Is there anything more that can be done in additional to this
AnswerHello Again,
Congratulations on your pregnancy. Your bHCG hormone tests look good. I would continue all the medications as your doctor as recommended at this point. Progesterone is best given vaginally rather than orally. It goes directly to the uterus where it needs to work.
At this point there is no way to predict how the outcome of this pregnancy will be. You will have to wait and see and trust in God. If it is meant to be, it will continue on just fine.
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
