Early Miscarriage w/ Immune Support

LaneCA

0 Posts
Reply Early Miscarriage w/ Immune Support Posted on: Nov 29, 2010 at 8:58pm
Hi Dr. Braverman,
I called today to set up a phone consult, but found out phone consults are not covered by insurance. My husband and I may make the trip from CA to NY to visit with you in person.

I recently got pregnant for the first time on my 3rd IUI. Sadly, my betas never doubled and I had an early miscarriage at 5 weeks. My question is...can I learn anything from this early miscarriage? Can Beta HCG numbers tell me anything? My first was 43, then went to 58, and then went to 22. Does this show an immune response moreso than a chromosomal issue? I am 29 and have endo (stage 2), PCO-like ovaries, mild Psoriasis, homozygous MTHFR (A1298C), high NK, high CD56. I have had 6 Intralipid infusions over the past 3 months, and was put on Dexamethasone and Folgard during my last IUI (both started on CD13). I also started Lovenox when I got my positive HPT.

My next step is IVF, where I'm sure I'll get answers on my egg quality/ embryo quality questions, but can't help wondering if I have a 'sperm meet egg' issue, or an implantation issue. I did have a sore throat and fever the entire (short) time I was pregnant. I've also had a sore throat/fever during many other luteal phases.

Thank you so much,
Carolyn

Dr. Braverman

2024 Posts
Re: Early Miscarriage w/ Immune Support Posted on: Nov 30, 2010 at 1:57am
Hi Carolyn, Im very sorry for your losses. You have quite a few issues that merit looking into, but cleary there are implantation problems. These could be a result of the endometriosis(see the website for explanation) . Endometriosis has an autoimmume component, which may account for the elevated NK cells. Intralipids may not be the answer here, there may be better therapies for you. . The Psoriasis is another sign of immune involvement. There needs to be a more detailed workup and still much you can do to treat this. I would be happy to see you if you come to NYC, you might want to call the office so we can help with any hotel reservations. Are you coming to NY just for the consultation? It might be less expensive even without insurance to have a phone consultation. Either way Im happy to help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

LaneCA

0 Posts
Reply Re: Early Miscarriage w/ Immune Support Posted on: Nov 30, 2010 at 4:39am
Thank you so much for your reply. I would be coming to New York just for a consultation. Do you work with Dr. Zouves? I am starting IVF with him next month.

I had my endometriosis removed in July 2010, but understand there is still an underly immune response. Intralipids did lower the NK assay, but not the CD56 cells. I'm wondering if the Dexamethasone started to lower the CD56, but was not taken in time for successful implantation. I am going to try and get on Humira for Psoriasis.

Thank you again for responding so fast.

Dr. Braverman

2024 Posts
Re: Early Miscarriage w/ Immune Support Posted on: Nov 30, 2010 at 6:57am
There are more important tests than just the NKa assay. You may require more than just the intralipids. Was your TNF level elevated? Some with PCO ovaries still have better response when on Metformin. I work with RE's all over the country, most simply follow our treatment protocol for non stim related treatments. It doesnt make sense to fly you here to NY for only the consultation , you should fill out the questionairre and book a phone consult. If you decided to cycle with us here the consult will be absorbed with the cycle fee.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

LaneCA

0 Posts
Reply Re: Early Miscarriage w/ Immune Support Posted on: Nov 30, 2010 at 7:14am
My TNF was not elevated the first round of testing, but was slightly elevated on the second round of tests. I have also been on Metformin (500mg) for 6 months.

I have already started the IVF process with Dr. Zouves, but desperately want to understand my immune issues (for conceiving now, and in the future). I agree that I need more treatment than just Intralipids.

I will be in touch soon if I can afford it -- we are already OOP for IVF, acupuncture, hypnotherapy, etc. Thank you so much for taking the time to chat with me

Dr. Braverman

2024 Posts
Re: Early Miscarriage w/ Immune Support Posted on: Dec 1, 2010 at 4:52am
my pleasure good luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.