RPL Testing ? (m/c mentioned)

Jezebell26 · September 2011

Hi ladies. I know its been a while since i've posted. Long story short IVF#2 also ended in m/c. This time everything was right on track which makes this harder to accept.

I was wondering if anyone else had a similar experience or could guide me in a direction. I am seeing the RE in two weeks for a post op appointment where im sure we will discuss next steps. I have a list of a few things I should ask to be tested for but would like to hear anything else that I should research or ask about. I feel so clueless about this and just want answers. Also, if you did testing and found another issue, what was the treatment for it in order for you to move forward? TIA ladies!

lilredj · September 2011

I am so sorry to hear of your loss! I do not have any experience with this, so no words of advice. Just wanted to send my thoughts and prayers to you.

ecleptic · September 2011

I would definitely request an RPL panel if your doc doesn't bring it up- IVF is simply too expensive to wait for three losses. Every doc has a different cocktail of tests they prefer but most will have the big stuff: Clotting, MTHFR, Factor V. I would request immunology and karyotyping as well if they're not offered- but a lot of places put those on the list standard.

They pulled 19 vials of blood and it took about 2 weeks to get the full panel of results (karyotyping took the longest- some stuff was back in a day or three)- my panel was very big though- number of vials/time varies widely based on the tests ordered.

My testing uncovered only 2 minor issues, neither of which my doc was prepared to say had certainly caused my miscarriage. That's something to be prepared for as well- sometimes there aren't going to be any definitive answers.

MTHFR: I have one C mutation. This is not a yes/no test- 30-40% of the population has 1 or 2 of the A or C mutation. So XXXX is normal, AXXX, XCXX, ACXX, AXAX, XCXC, ACAX, XCAC, ACAC are all possibilities. You get one set of AC from each parent. 2 copies of the C mutation is linked to recurrent miscarriage via clotting issues. Anything other than 2 copies of C can be (but is not always) linked to clotting issues. Anyone with a mutation absorbs folic acid a little less effectively than someone without a mutation- but that's not linked to miscarriage- it's linked to an increase in neural tube defects. My treatment: Take two prescription folic acid. Combined with the second issue- I also take a baby aspirin.

ACLA IgM: I have very slightly elevated anticardiolipin antibodies. If normal is 10 and aggressive treatment with blood thinners is required at 20- I have a 12. Which most docs wouldn't recommend any treatment for. My doc took a look at that combined with the single MTHFR and decided that an over the counter baby aspirin therapy would be acceptably cautious.

I'm so sorry for you loss- it's a special kind of hell to make it through IF only to have a loss. I hope they find something that can be easily treated.

baloneydisc · September 2011

I hope you don't mind me replying. I never made it as far as IVF, my only problem was lack of ovulation. Anyhow, after my second m/c my RE sent me for RPL testing. She also had the lab run a bunch of other tests. Due to all of the additional testing that was done I can't tell you exactly how much blood was taken just for the RPL. My husband and I also had chromosomal testing done at the same time. The only things that turned up in my testing was MTHFR one copy and slightly low P4. The RE told me to take extra Folic Acid (just OTC, however much extra I anted to take) and prescribed progesterone suppositories to start at 3dpo. After the second m/c and losing a lot of weight I began ovulating on my own again and we were told to try on our own for 6-cycles. We would resume treatment if needed at that point. I got pregnant again on cycle 6 and everything has been great so far. We still have a long ways to go, but I really think the extra Folic Acid and progesterone helped us get to this point.

Aegis2005 · September 2011

I am so sorry that you're going through this. ***hugs***

Kitttkattt · September 2011

I had 2 chemical pregnancies. After that I had extensive RPL testing as well as a hysteroscopy. Nothing was found. I went on to have 2 real pregnancies after that, one made it out of the first trimester, this current one I'm 10 weeks. I am sorry for your loss.

KGS2003 · September 2011

Our IVF ended in mc at 12 weeks. We saw the baby the day before everything was perfect and right on track as well. We had all the testing done before IVF and it was about 20 vials of blood as well. After my mc we had more testing done and they could find no reason for my loss. Be prepared for that too. It's been very hard not to have answers even after testing. We go for IVF#3 Friday and are hoping for a better outcome. GL to you.

RovinChick · September 2011

So sorry for your loss. I would definitely ask for a RPL panel before moving forward. I only had one loss, but it was in the 2nd trimester, so my RE was more concerned and ordered a RPL. She also ordered a diagnostic hysteroscopy to determine if there is a physical reason for the loss.

For the RPL, I think they took about 14 vials of blood, testing for celiac disease, anticardiolipins, and various clotting factors. I was positive for 2 copies of MTHFR, but she was not too concerned because I had normal homocysteine levels. I was also positive for the Lupus Anticoagulant, which she was concerned with. I have to get test for it again to confirm (it can be transient, and you need to test 12 weeks later) If the 2nd test is positive, she said I will need lovenox (blood thinner) injections if I get pregnant again.

The hysterocopy revealed some small polyps, which she did not think was the cause of the loss, but could make it difficult to get pregnant in the future, so I had them removed. She said if there are large polyps or fibroids, that can cause m/c.

I hope you find some answers and I wish you the best of luck!

Jezebell26 · September 2011

Thank you all for your replies. We had extensive testing before starting treatment. Before IVF we had the HIV panel run on both of us. I have family with Factor V Leiden so i was tested for that already in the beginning, and even so, he had me on a baby aspirin during treatment. I was also taking enough folic acid since that had come back low before. He does an HSG before each cycle to look for polyps. I had a lap done in Dec that removed endo and polyps and havent had any more since.

He definitely wants to run the RPL panel and ive done some reasearch and hope we can find an answer because i can not go through number 3 without some sort of answers. I guess based on my research i feel like certain things have already been eliminated because of prior testing or that we were already doing something to prevent it (like baby aspirin and folic acid). I am willing to hear him out but am also researching genetic counselors as well to see where we are with that. Thanks for all of your help. I am prepared for no answers as well, but pray that wont be the case. Thanks for all of your help!