Question for those who had RLP/immunological issues, etc.

nawlinsgrl

I'm looking for some answers for an IRL IF friend who is 40 y.o..  She recently had her second 1st Tri miscarriage.  Her first was at 9 weeks.  At almost 6 weeks this time, she was told she had a molar pregnancy and had a D&C at 7 weeks.  The RLP showed that it was chromosomally normal, and it was not a molar pregnancy, but the doctor said it was still not a viable pregnancy.  

So, in the interest of exploring other reasons for repeated miscarriages (these were both natural pregnancies, although they have done a few IUIs and were about to do IVF), I was hoping to get some feedback about those with immunology issues, particularly about how it is diagnosed and treated, as well as any other areas to explore as a cause for her repeat losses.  She is naturally a bit nervous about trying again, especially with no idea as to what is causing the pregnancies to end so early, and due to her age, time is running out.  TIA!

ETA:  She also is hypothyroid (recently under control with meds) and her endocrinologist is running a titer to check the effect of her autoimmune system on her thyroid.  She had some immunilogical testing done in 2012 (like Lupus) and was negative then.

luvboston

First you cannot do a repeated loss panel until two months after a m/c because the tests will come up with false positives. She is 40 so she could be having chromosomally abnormal embryos she and her partner need to be karotyped to make sure they don't have a genetic issue.

If she doesn't have any autoimmune diseases currently it is highly unlikely she has immune issues. She needs to have an ANA with Titer done to determine what her immune system is doing.
For me I have 3 autoimmune diseases so it wasn't brain surgery to figure out that my immune system was causing problems however it does take an actual reproductive immunologist to fix it. If your friend has immune issues or her Ana comes back high she needs to go directly to an RI. If not she could need to have cgh testing on her embryos to get normal ones or she may have a clotting issue or something else.

Some woman just need extra progesterone or baby aspirin and that magically does the trick.

Feel free to PM me I have been to almost every m/c specialist in the country so I know who is good and who is not. The biggest mistake we made was staying with the wrong re after several m/c. And OBs know nothing about repeated loss.

nawlinsgrl

Thanks LB!  Her only known immunological issue is that she is hypothyroid.  She's been working on getting the levels down and her most recent level was 2.2 (probably a little elevated due to her pregnancy).  She said her endocrinologist is running a titer test to check how severely her immune system is attacking her thyroid.

They just took out a loan for the IVF cycle they didn't do, so I know finances are an issues and I highly doubt they can/will travel.  We basically have two clinics in the area (New Orleans).  She saw my RE and I don't think it's a good personality fit (I personally loved her and was successful, but to each their own), so that leaves the other doctors in the clinic as well as the other, newer clinic in town, where mutual friends were also recently successful with IVF on the first try (same diagnosis of single tube, in her case due to an ectopic).   

 

I will pass all this info along to her now and follow up with any additional questions she has.  Thanks again!

luvboston

You don't have to travel to the Beer center they do everything over the phone.

itsmevkb

After my second miscarriage, and on the advice of my OB, I saw a reproductive immunologist.  She did testing that went above and beyond the RPL/clotting testing I had already had done.  All of my tests were normal with the exception of my natural killer cells.  Treating elevated natural killer cells is not widely accepted by docs but I went ahead and did receive IV intralipids in my next pregnancy.  I was also on a very high dose of progesterone, a daily baby aspirin and a steroid whose name escapes me at the moment.  I think maybe dexamethasone.

I saw Dr. Coulam in Chicago and although I traveled to see her, I believe she also does consultations by phone.

Both of my losses were determined to be chromosomally normal, however, a million docs chimed in to say that there can be microdeletions which make a pregnancy/embryo not viable and those are not things they are able to test for.