Biochemical Pregnancies

joyM

0 Posts
Reply Biochemical Pregnancies Posted on: Nov 4, 2010 at 6:11pm
I am going to try to be brief...we are confused on a next step.

I am 31
Husband 29

I have Stage II endo, done uterine biopsy (clear), HSG (tubes fine), did pregnancy loss panel (came back fine)
Husband has mild/medium male factor (all areas)

We have done 2 IUI's failed, 2 IVF's failed, 2 FET's both biochemical pregnancies (1st chemical were low numbers -12 on first beta, 2nd chemical I had 119 for my first beta (12dp5dt) and then it dropped).

We are starting to think our embryos are genetically off. Do you think this should be our next step (PGD)? RE is currently testing both of our blood for Genetic abnormalities.

I also have high histamine levels in my body...I don't know if there is a test for immunologic issues related to this?

Dr. Braverman

2005 Posts
Re: Biochemical Pregnancies Posted on: Nov 5, 2010 at 2:59am
Hi Joy,

Endometriosis is most likely the problem here and there are many ways it affects your ability to both concieve and hold a pregnancy.
As discussed on the website endometriosis is an autoimmune disease and we know these facts about it.
1. It requires high levels of the inflammatory cytokine TNF to implant in the abdominal cavity and these high levels cause oxidative stress to the eggs and one of the reasons we see poor egg quality with endometriosis. Studies have shown that oxidative stress leads to high levels of ROS(reactive oxygen species) in the follicular fluid where the egg develops and this leads to poor genetic division and when the egg is released in this condition it either does not fertilize or leads to biochemical pregnancies.
2. With IUIs the ROS build up in the follicle and abdomen affects the sperm as it travels to the egg and affects its ability to fertilize the egg as ROS attaches to the head of the sperm.
3. The immune systems attempt to erradicate endometriosis from the abdominal cavity fails because there are substances in the abdominal fluid that deactivate the immune cells that come to attack the endometriosis. Most notably Natural Killer Cells. The body responds by making more NK cells and sending them out to attack the endometriosis . in the abndominal cavity the NK cells are inhibited by the fluid in the belly, but when they arrive in the UTERUS there is nothing there to inhibit them so these increased number of NK cells attack anything there and in your case thats the embryo and this leads to failed IVF cycles or biochemical pregnancies.
4. Patients with endometriosis make antibodies against there own endometrium and other antibodies that when present significantly decrease pregnancy rates in untreated patients.
whenever there is a mild male factor a "healthy " egg can usually correct simple defects but if the egg quality issue is not treated and there is even a mild male factor it can lead to the same poor outcomes.

So you can see there is quite a bit to treat in these cases which we have done successfully many times.
But without treatments your failures are likely to continue. I do not recommend PGD for you as this will only eliminate embryos that might have otherwise become normal pregnancies and does not address your true problem.

I hope this helps, feel free to contact me if you would like me to help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

joyM

0 Posts
Reply Re: Biochemical Pregnancies Posted on: Nov 5, 2010 at 6:35pm
Thank you Dr. Braverman for your prompt and indepth response. I have asked my RE about the endometriosis on several occasions and have been told it has little to do with it, but as you explain and what my gut has told me for a long time, it must have more to do with it than we are giving credit for. I am in the process of filling out the paperwork so I can have a consultation with you in regards to this. Thank you again!!!

Dr. Braverman

2005 Posts
Re: Biochemical Pregnancies Posted on: Nov 5, 2010 at 10:01pm
my pleasure speak to you soon.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.