Possible Autoimmune issues

Jess09

3 Posts
Reply Possible Autoimmune issues Posted on: Dec 8, 2011 at 10:39pm
Sir,

I have a few questions about the possibility of my autoimmune issues causing the blighted ovum during my last IVF cycle. I have only gone through one IVF, but I know that is my only option as both tubes have been removed due to severe adhesive disease and an ectopic. I am 24 years old with a history of Hashimoto’s.

My history:
When I was 12 years old I had a ruptured appendix (for 5 days) and three major/1 minor surgeries to remove all infection. Upon my last laparoscopy (minor surgery) it showed the only scarring to be behind my liver and my colon and the cul de sac and lower abdomin had no scarring visible. Fast forward to my freshmen year in College, when one night I woke up with severe lower abdominal pain which was diagnosed as a ruptured ovarian cyst (Rt) with large amounts of free fluid and blood in the cul de sac. About three weeks after this event, I was still having severe pain and the u/s showed "excessive amounts of free fluid and blood" and "little resolution of the cyst". After 6 months of dealing with the pain (so much so I was put in a wheel chair...mostly due to the pain meds knocking me off balance) I was finally referred to a GYN, who told me it was probably just cystic ovaries. Well two years later, after many painful menses, I was referred to another GYN for a second opinion...he diagnosed me with endometriosis...just based on history alone (no Lap). I was started on Lupron Depot which did help with the pain. I was on this for 1.5 years and then switched to Depot Provera for 6 months, which at this time I stopped all meds and started ttc. This brings us to Sept 2009. I started having regular cycles (although much lighter than before the lupron) about two months after stopping the provera. So by January 2010, we were charting and officially ttc with TI. In May 2010, I had severe abdominal pain again (consistent with ovulation) and another large cyst was found. At this time my GYN recommended a lap which we did in Aug 2010. The Dr. discovered severe adhesions and a complex cyst, but no endometriosis. Recommended tubal reconstruction and referred me to an RE. In Dec 2010, I had a laparotomy and my rt tube was removed and the left was reconstructed and left fully open. We ttc with TI for another three months before deciding it was time to try IVF. In Mar 2010, I was told I had to wait for my cysts to decrease and become inactive before we could move on to a cycle.
I started bcps in May and continued them through July. I started Lupron on 1 Aug 11 and stimming (with Bravelle) on 10 Aug with a retrieval on 27 Aug (really slow development of the follicles) and a transfer of two HIP no-frag embryos. Only 10 eggs were retrieved out of the 25 follicles and only 6 fertilized, but all 6 were really high quality. Both embryos ended up implanting, but one was ectopic in the left tube and one was a blighted ovum.
During the testing for the IVF, I had a thrombophilia panel and an autoimmune panel completed. I have ATAs one is over 3000 and one is over 1300, my TSH was 10.98 at its highest. I have tested positive once for ANA titer (mixed speckled homogenous), but the ds-DNA was only 2. I have also had a borderline RF of 13.1. During the IVF cycle, I started a light bleeding (with large clots) at about 13 DPO for three days and then continued to lightly spot after than for about 5 more days. I was also diagnosed with a light Protein S deficiency (made worse by pregnancy) and a MTHFR gene mutation (A1298C).
Based off of all of this, what other testing, if any, would you recommend before starting my FET/next IVF cycle? I don’t want to keep going through this if I am not in the best possible place in regards to my health. Also, I am stationed in MA right now and am wondering when your clinic is open for appointments?

Thank you so much,
Jess

Dr. Braverman

2024 Posts
Re: Possible Autoimmune issues Posted on: Dec 9, 2011 at 7:31pm
Hi Jess, it certainly seems that there is an immune component involved as the root of your difficulties, very common in patients with Hashimotos. Please call my office we can do a telephone or skype consultation and I can guide your management from here. There is quite a bit more testing for you to do. I am sure I can help you. I look forward to speaking with you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Jess09

3 Posts
Reply RE: Possible Autoimmune issues Posted on: Jan 5, 2012 at 12:00pm
Dr. Braverman,

I recently started having pain again in my lower abdomin and was diagnosed as having a 6X5.5 cm cyst on the right ovary and 4 or 5 smaller cysts on the left (all just under 2cm). My m/c (by methotrexate) was on 29 Sept, and since then I have had very light or spotting only cycles. Could this be due to the m/c or the cysts?

Also, I would like to start getting ready for an FET and I know I need follow-up testing, but I am not sure what to ask for. I have TRICARE for insurance and they cover almost all testing (but I would have to check with your lab). I had the APA expanded panel done in July 2011 and it came back negative for all (Lupus Anticoagulant, APhL, aCL, aB2GPI, aPE, aPS, aPA, aPG, and aPI). I also had APTT drawn which was 27.6 sec, Antithrombin activity was 101%, Factor V was 2.70, Protein C was 114%, Protein S was 67%, and I tested negative for the Prothrombin 20210A Mutation and Positive for the A1298C MTHFR mutation. So the only thing that is slightly abnormal is the Protein C and the MTHFR.

Like I said previously, my ATAs are both elevated way above normal (>2000 and 687). I am being medicated with 0.112mg of Synthroid.

Is there anything else that you think I should be tested for...or should any of these tests be completed again since I have had the m/c since they were tested? I know my only option for getting pregnant now is IVF, since both tubes are completely removed. I don't want to keep trying unless I know I am giving myself the best opportunity for success! Thank you!

Dr. Braverman

2024 Posts
RE: Possible Autoimmune issues Posted on: Jan 6, 2012 at 10:30am
Please call me for a consultation and I will get you ready.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.