4 miscarriage....planning conception

lennasingh

6 Posts
Reply 4 miscarriage....planning conception Posted on: Oct 6, 2011 at 9:08am
Dear Dr. Braverman,
I am from India and need your advise as I am planning to try for a baby again. It has been a difficult and painful journey for me so please help me if possible. My email will be long so I apologize in advance but I do not want to leave out any details.
Firstly, my brief history: Age - 36. Trying to have a baby since 2008. I have suffered 4 early miscarriage (heart beat was detected only the first time, the later ones grew in size but no heartbeat and all stopped growing around 6-7 weeks), the latest one being April 2011. The last fetus was chromosomally normal. My husband and my karyotyping is normal. My husband's sperm analysis is normal except for a slight DNA fragmentation for which he is on various vitamins and supplements.
I have high nk cells and no blocking antibodies for which I underwent LIT therapy and had intralipid infusion for my last pregnancy. The LIT did not help it seems because my blocking antibodies never improved. I was advised to conceive without further treatment which I promptly did as I do not have a problem conceiving, only keeping a pregnancy is a challenge. Once I conceived I was given intralipid infusion which did not have any effect on my natural killer cells and I had a missed abortion and had to undergo a D&E for the 4th time. It was a devastating experience and I do not wish to ever go through it if somehow I can help it.

Currently I am undergoing LIT therapy to increase my blocking antibodies from an established RI and to decrease my TNF-alpha which was sky high when I tested just after my miscarriage. I got tested again after 4 rounds of LIT and things were moving in the right direction. I have one last round of LIT next week. After I complete my LIT, I have been advised by my RE to have Bharglob injections twice a week for 1 month. (My RE's explanation on Bharglob: Bharglob is an immunoglobulin and helps to boost your immune system i.e reduce the NKcells and TNF.)
After Bharglob, I will be cleared to conceive and once I conceive my RE will give me G-csf, progesterone suppositories and lovenox.
I am also on multivitamins, folic acid, fish oil (1500mg), baby aspirin 75 and thyrox 25mcg. My TSH level is 1.5 and I have no anti-thyroid antibodies or abnormal T3 and T4 levels. Blood clotting tests does not show up anything but since taking fish oil, i have had non-clotty periods.
I would be grateful if you can advise if I am following the correct protocol. Is my treatment plan enough or do I need to add something more. Is it okay to start neupogen after conception or should i insist on starting earlier. What about lovenox and progesterone? Please advise.
Thank you in advance.
Lenna

Dr. Braverman

2024 Posts
Re: 4 miscarriage....planning conception Posted on: Oct 7, 2011 at 7:14pm
I would start the neupogen prior to conception / have they tried steroids such as prednisone? I would love to have the chance to review all of your results and maybe give you a better plan of management. Please call my office and schedule a telephone or skype consultation, I would be happy to assist you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

lennasingh

6 Posts
Reply Re: 4 miscarriage....planning conception Posted on: Oct 9, 2011 at 5:17am
Dear Dr. Braverman,
Thanks for your response. I will try to schedule a skype consultation with you. Would appreciate if someone from your team can advise me on the costs involved. Money is scarce as have been pouring money into my treatment for the last 4 years from out of pocket.
I have never been advised prednisolone...I was told by my previous RE that intralipids would do the trick...obviously it didn't.
Thank you.
Lenna

Dr. Braverman

2024 Posts
Re: 4 miscarriage....planning conception Posted on: Oct 9, 2011 at 1:33pm
when you call ask for Kim or Judy they will go over all the fees with you. Look forward to speaking with you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.