2 miscarriages in 5 months

kpitzner

0 Posts
Reply 2 miscarriages in 5 months Posted on: Dec 8, 2010 at 8:21am
Hi Dr. Braverman,

I apologize in advance for the length of this! I will be 36 years old this month and I've now had two early miscarriages. My first was in July of this year (first pregnancy). I went in for my first prenatal appointment at 9 weeks, 6 days but the embryo only measured 6 weeks, 6 days and there was no heartbeat. I was diagnosed with a missed miscarriage and given medication to complete the miscarriage. When I got pregnant my husband and I had not been actively trying to conceive. We waited one cycle after the miscarriage and then began actively trying in October. Our timing was a little off that month but we got it right last month and I got pregnant! I tested positive on CD28 (13DPO)...I know that is early! Unfortunately, this morning I miscarried at 5 weeks.

Before my prenatal appointment with my first pregnancy in July my OB at Kaiser ordered a blood clotting panel due to the fact that I had Proximal DVT in my femoral vein in 2003 (I was 28 years old then, very healthy and athletic with no known health problems). About 3 weeks prior to the DVT I had a Morton's Neuroma removed from my right foot and I was also on combination birth control pills at the time. I had a 6-day hospital stay, a month of Lovenox injections and then 6-months on Coumaden as a result of this. The standard tests that I had done at the time did not show an inherited or acquired clotting disorder. There was one test that my current OB at Kaiser ran that my doctor in 2003 didn't though - the MTHFR gene mutations. My results came back Compound Heterozygous. My Homosysteine was normal at 6.7%. I was told that these mutations had nothing to do with my first pregnancy loss and I was referred to Genetics. The first thing the Geneticist wanted to do was a medical family tree. I'm adopted but I've recently come into contact with my birth families as of last year. In gathering my paternal family medical information I was very surprised to find out that my great-grandmother, grandmother, aunt and uncle have all had DVT (my biological father passed away from lung cancer in 2008). My paternal grandmother has had DVT more then once as well as two PE's. She actually passed away from a brain hemorrhage last month. The Geneticist also ordered my FVIII tested (about 3 weeks after the miscarriage) and it came back elevated at 173% (50-150% was standard for their lab). This was tested again about 2 weeks later and the result was essentially the same at 175%. I've since found out that my biological mother is also Compound Heterozygous for MTHFR.

After my first miscarriage I started taking 4mg of L-Methylfolate, 200mg of B6, 1mg of B12, an 81mg baby aspirin and a pre-natal daily. I also asked for a referral to a high-risk OB at Kaiser. She agreed to prescribe Lovenox on my next pregnancy once a viable pregnancy was confirmed with a heartbeat via ultasound. She said I did not need Lovenox prior to that point as very early pregnancy is a "low oxygen environment." My first prenatal appointment with this recent pregnancy was scheduled for December 17th...

The Geneticist, a Hematologist that I've seen too, my OB and the high-risk OB all do not think there is any association between my MTHFR & FVIII test results, my personal/family history and my two early losses. I feel differently. They do not think I need any additional testing or that my husband should have a sperm analysis done (he's 37). I agree that I seem to get pregnant fairly easy but I'm not quite sure what good this does me if I can't hang on to it. I don't want to go through a third miscarriage before they'll listen me! I would greatly appreciate any advice you can offer me!

Thanks so much,

Kristen

Dr. Braverman

2004 Posts
Re: 2 miscarriages in 5 months Posted on: Dec 9, 2010 at 10:43pm
Hi Kristen,

there is so much for you still to do. First elevated levels of clotting factors 8,9 are associated with early losses I have seen this many times at our clinic. I would recommend lovenox if this is the only issue you find, but as always these workups need to be complete and immune rejection accounts for 30% of these type of losses. Feel free to contact me and I would be happy to guide you through the workup then I can recommend your treatment. I also dont think it is the MTFHR, but the factor 8 issues can run in families and I believe this alone could be your problem. Please however complete the workup as there are still so many other possibilities.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

kpitzner

0 Posts
Reply Re: 2 miscarriages in 5 months Posted on: Dec 10, 2010 at 7:30am
Thanks so much for your reply Dr Braverman! That's interesting that elevated FVIII can run in families...I thought it was crazy that even with the strong family history of blood clots/DVT on my paternal side no other family members have been tested for any clotting disorders! Anyway, I just filled out the questionnaire from your website. I just fax this in to your office and ask for a consult? I did show my high-risk OB some of the info from your website regarding how Lovenox possibly helps with implantation related issues and can help prevent early pregnancy loss....and she has now agreed to support me starting Lovenox at CD6! So thank you!!! I plan on starting the injections this Sunday. Would you advise waiting to try again until after I've talked further with you or had more testing done? I did do a phone consult with Dr. Matzner (RI) in So. CA last month...he thought I needed more testing but agreed there was more then likely a clotting issue. His office was going to follow-up with me regarding the additional tests that I would need but never did...and then I got pregnant again...

Kristen

Dr. Braverman

2004 Posts
Re: 2 miscarriages in 5 months Posted on: Dec 10, 2010 at 4:07pm
I think you have a couple of choices here, you can try again as you do have a reason for the losses in my opinion, but you have not had the complete workup yet and you cant choose on reason as the absolute cause until all others have been ruled out. Although your factor levels are high , Ive had much higher in my patients with these issues so Im not sure you can put all your eggs in that basket, however if nothing else is found I would then fill that basket with all the eggs you can carry. (LOL).
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

kpitzner

0 Posts
Reply Re: 2 miscarriages in 5 months Posted on: Dec 10, 2010 at 9:15pm
I have a phone consult scheduled with you on 12/15 at noon your time (I'm in No. CA)! I'm faxing the results of the tests that I have had done to your office today. I look forward to talking with you!

Thanks,

Kristen

Dr. Braverman

2004 Posts
Re: 2 miscarriages in 5 months Posted on: Dec 11, 2010 at 4:39am
I look forward to speaking with you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

kpitzner

0 Posts
Reply Re: 2 miscarriages in 5 months Posted on: Dec 17, 2010 at 11:14pm
Hi Dr. Braverman,

Thanks so much for taking the time to talk with me on Wednesday! I am officially 36 now! =)) Anyway, I just wanted to follow-up because I haven't received any calls from your office or the lab yet regarding the additional testing that you feel I need. Should I call your office on Monday regarding this? Or do you think I might be OK without further testing because I'm now on the Lovenox (and baby aspirin)?

Have a great weekend!

Thanks again,

Kristen

Dr. Braverman

2004 Posts
Re: 2 miscarriages in 5 months Posted on: Dec 18, 2010 at 5:14am
no you should get the testing, not sure why you havent heard yet the lab was notified, please call my office on monday and ask for Sandra or Linda.
Also this current issue of the Journal of Fertiltiy and Sterility has an article on elevated Factor XI and successful treatment of RPL with lovenox(similar to Factor VIII elevations) , so the literature is cathcing up with our expereince. Let me know if you want a copy of the article I can fax it to you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

kpitzner

0 Posts
Reply Re: 2 miscarriages in 5 months Posted on: Dec 22, 2010 at 5:58am
I found the article you mentioned but I wasn't able to open it without subscribing to the journal...if you wouldn't mind faxing it to me that would be great! My fax -- is 916-930-6113. I still haven't heard from the lab but I haven't had time to call your office and talk with Sandra or Linda yet either! I'm planning on calling tomorrow.

Kristen =)

Dr. Braverman

2004 Posts
Re: 2 miscarriages in 5 months Posted on: Dec 25, 2010 at 3:20am
Hi , sorry for the delay in answering I was away all week, call my office on Monday and we will get your results and Ill fax you a copy of the article.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.
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