Reproductive Immunology?

alleycat39 · June 2014

I know I may be a little ahead of myself here, as we have not been given the final verdict on where this pregnancy stands, however we are realistic that this will end in loss after a HR of just 60 yesterday and now measuring over a week behind. After doing some research on where to go after 3 losses, I found some information on Reproductive Immunology (Beer Center in CA and Dr. Braverman in NY). Just curious if anyone looked into this and if so, did you try it and have success? If not Reproductive Immunology, what therapies/protocols did you turn to after 3 losses? My RPL panel has come back with nothing, however I believe there is still some testing that hasn't been done such as AMH.

I love this LO inside me right now, but I have to face the facts here. Any input or advice is welcome about next steps!

KMW08 · June 2014

I'm not much help with your question, but what meds/protocol are you currently doing? Prog supps? Aspirin? Met?

ETA: have you ever had any of the fetal tissue tested chromosomally? And have you & yh had karyotyping?

Mom2anAngel2 · June 2014

First I am very sorry for what you are dealing with right now. DH and I turned to Naprotechnology to help us. I feel it was a bit more of a natural approach as to finding what was wrong and fixing it, instead of just pushing to become pregnant. It has worked very well for us, but I do know that it is not for everyone.

((HUGS)). You and you family will be in my T&P's.

jess123456 · June 2014

I am so sorry. Did you have pathology done on your lossed pregnancies and what protocol have you been on so far?

I don't have experience with the centers you mentioned. However, we sought the help of an RE after two losses and then went on to have three more losses. OBs are great but in my experience don't understand recurrent loss as well as an RE. Two of out of the three pregnancies we had tested including my daughter were due to chromosomal abnormalities. We had all the testing done and nothing came up except thyroid antibodies (thyroid plays a huge part in fertility and after loss after loss especially I found) and MTHFR. Karotyping of our chromosomes also revealed no translocations so it just happened to be a fluke all those times. I was put on extra folate (it's easier to absorb for those with MTHFR than folic), a vitamin d supplement and a prenatal and b complex with folate and baby Asprin. I also took progesterone after ovulation.

I always ovulated late (days 22 or more) and always suspected that my late ovulation had something to do with it but of course the only way to look at the eggs was through IVF. We were one step away from doing IVF for the PGD when we decided to try Clomid with timed intercourse (using constant monitoring) and a trigger shot first. The Clomid pushed my ovulation up a week and I'm finally in my 20th week of pregnancy with a seemingly healthy baby boy. Did the Clomid do the trick? There is no way to know but I do believe that it triggered something to work out correctly. I also took co enzyme q 10 at least three or four months leading up to trying again and there have been studies that it could potentially help with egg quality. I know that there are lots of people who hate Clomid for various reasons because of the side effects. There are other options available like Femera etc. I didn't experience the side effects from Clomid and if we ever have the courage to try again after hopefully our rainbow is here I will do Clomid again in a heartbeat.

I am not sure what you have had already for testing but here is what I did:

Hysteroscopy
Sonohystrogram
-HSG
Karotyping (looks at chromosomes of you and DH)
-Lots of bloodwork like thyroid, natural killer cells, etc. (I think there is a full list on the blog)
- Semen analysis (there is also something called semen dna fragmentation - we didn't have that done)

I really hope that things turn around for you this pregnancy. I know how it seems like there is no hope and after five losses trust me I felt completely hopeless but I encourage you to keep going. If I stopped trying (trust me I wanted to a million times) there is no way I would be here now. You are in my thoughts and prayers. If you ever want to private message me please
feel free. Big hugs to you.

Rachaeleigh · June 2014

Ygpm :-)

alleycat39 · June 2014

@KMW08, @ Rachaeleigh, @jess123456, and @Mom2anAngel2 -Thank you ladies for your responses! I guess I should have put in the post what tests have already been done…I was under the care of a RE for last pregnancy and this current one

-Hysteroscopy and MRI (DX with uterine septum, had resection 6/13 and cleared via SIS in 8/13)

-Chromosomal testing on 2nd loss: results- 46xx, so we can't rule out that it wasn't my own tissue that ended up being tested

-DH and I have both had karyotyping- both normal

-Blood work so far has been:

-BETA 2 GLYCOPROTEIN I AB (IGG,IGA,IGM)

-DRVVT SCREEN W/REFL DRVVT

-TISSUE THROMBOPLASTIN INHIBITION

-CARDIOLIPIN AB(IGA,IGG,IGM)

-progesterone

-TSH

-karyotyping

All bloodwork came back within normal ranges. Is there other bloodwork that it seems like I am missing??

For this pregnancy, I was taking Femara CD3-7 and had CD12 u/s, showing 2 mature follies. I did not use a trigger to

ovulate, but O'ed on my own at CD16 (much earlier than my CD21 last pregnancy). I started progesterone

suppositories 4DPO, however no aspirin. I had put a call into my RE about the aspirin and the nurse said they

do not have patients take it unless there is a clotting disorder (in hindsight I wished I pressed them on this

issue and fought to take it).

chicagojackie · June 2014

Blood panel additional: Factor v Leiden, Apc resistance, homocysteine, mthfr , lupus anticoagulant, tpo antibodies. Just a thought.

alleycat39 · June 2014

chicagojackie said:

Blood panel additional: Factor v Leiden, Apc resistance, homocysteine, mthfr , lupus anticoagulant, tpo antibodies. Just a thought.

I had thought the DRVVT was the lupus anticoagulant? Its so frustrating because you trust your RE to do all necessary testing, but they don't cover everything out there. So important to be your own advocate.

KMW08 · June 2014

I know you didn't ovulate late this time around, but I also want to add that late(r) ovulation doesn't always mean weak ovulation. I'm prime example of this right now. I typically ovulate days 19-22 and for whatever reason I had a super whacked out cycle and didn't ovulate until CD32/33 for this current pregnancy.

Also, has YH ever had any testing besides the karyotyping? I would maybe have him looked at as well, sperm wise. See if there's anything abnormal there. I know there's not really any good studies out there that support sperm being a factor in RPL, but it wouldn't hurt looking into this area IMO.

jess123456 · June 2014

chicagojackie said:
Blood panel additional: Factor v Leiden, Apc resistance, homocysteine, mthfr , lupus anticoagulant, tpo antibodies. Just a thought.

All of this plus thyroid antibodies (is that the same as TPO antibodies?)
-TISSUE TRANSGLUTAMINASE ANTIBODY, IGG and IGA
- Vitamin D
- FSH
- ANA screen (antibodies)

I honestly don't remember what some of those are but I copied and pasted them from my online testing records.

So true what @KMW08‌ says about late ovulation. I think my luteal phase was borderline too.

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