Recurrent miscarriages

nicolettc

15 Posts
Reply Recurrent miscarriages Posted on: Nov 28, 2011 at 4:17pm
Dear Dr Braverman,

Thank you for giving me an opportunity to ask you a question. I have heard so much about you!! I am not sure about my path at the moment whether I should continue my baby dream or stop it all together. Been TTC for 6 years, 3 early pregnancy losses (never passed 12 wks). Classed as unexplained infertility. I am now over 40, indeed, my time is running so low. May you please shed some light regarding my recent blood work results. I am just about to give up my hope!!

Test: Lymphocyte Subsets
White cell count 6.60x10*9/L (Range: 4.00-11.00)
Lymphocytes 31.8% 2099x10*6/L (Range: 1500-4000)
CD3 (T-cells) 65.5% 1375x10*6/L (Range: 600-2400)
CD4 (T-helper cells) 31.6% 663x10*6/L (Range: 500-1400)
CD8 (T-suppressor cells) 30.4% 638x10*6/L (Range: 200-700)
CD4/CD8 Ratio 1.00 (Range: 1-3.20)
CD16/56 (NK Cells) 18.3% 384x10*6/L (Range: 40-500)
CD19 (B-cells) 17.7% 372x10*6/L (Range: 100-500)

Anti-Gliadin IgG 3 units NEGATIVE
Anti-Gliadin IgA 4 units NEGATIVE
Tissue Transglutaminase IgA 2 units NEGATIVE

Thyroid Function (Serum)
Thyroid Peroxidase A: > 1000 U/ml (Range: 0-35)
Strongly positive TPO consistent with auto-immune thyroid disease and increased risk of progression to thyroid failure.

Immunoglobulins (Serum)
IgA 1.5 g/L (Range: 0.7-3.1)
IgG 14.2 g/L (Range: 6.4-13.5)
IgM 1.2 g/L (Range: 0.6-3.5)
Anti-dsDNA 3.4 IU/mL (< 4.2)

Immunology
ANA POSITIVE 1:40 Pattern: Centriole
ANA titres < 1:160 are probably not clinically significant, except in patients aged < 20 yrs or patients receiving therapy for known autoimmune disease.

ENA: NEGATIVE
This assay tests for antibodies to Sm, RNP, SS-A, Ro52, SS-B, Scl-70, Jo-1, PCNA, PM-Scl, ribosomal P Proteins and centromere

ACL Total Antibody (IgG, IgM, IgA): NEGATIVE

I don't have thyroid disease, so I am a bit surprised to hear I have a high TPO, could this be the cause of early pregnancy loss (recent loss at week 10).

Dr Braverman please accept my sincere thanks for your kind understanding. You are our hope!

Warm regards,
Nicole

Dr. Braverman

2005 Posts
Re: Recurrent miscarriages Posted on: Nov 29, 2011 at 5:29am
what treatments have you recieved to try and prevent these losses and what is your most recent AMH or FSH?
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

nicolettc

15 Posts
Reply Re: Recurrent miscarriages Posted on: Nov 29, 2011 at 6:12am
Dear Dr Braverman,
My 3rd early pregnancy loss was 2 mths ago (conceived naturally). All 4 doctors I have worked with thought my age was the cuprit!! hence no investigation to date (since 2005) to prevent these losses. I was just about to give up hope due to the recent miscarriage, then a friend of mine strongly suggest I should look into immunse tests which I did early this month.

No treatments given to prevent these losses.
Most rcent tests:
April 2011
TSH 2.56 mU/L (Range: 0.5-5.0)
Free T4 16 pmol/L (Rane: 11.0-21.0)
AMH <1.0 (Range: 14-30) Yes I am old.

8 Nov 2011
TPO > 1000 (Range: 0-35)

I have read an article below. What is your view on a normal TSH, with positive test for Thyroid antibody causing infertlity/recurrent miscarriage?

Thank you so much Dr Braverman. Your kind advice will help me to determine which path to take on my infertility journey. I do hope this post helps other to understand TSH and anti-thyroid antibody. My sincere thanks and my warm regards, nicole

------------------------------------------
Thyroid antibody:

"Many doctors believe that antibodies alone are NOT reason to treat someone with thyroid hormone. This is despite the fact that the presence of antibodies alone can cause thyroid-related symptoms, and have been shown to affect fertility or the ability to maintain a pregnancy. (An article in the Journal of Clinical Endocrinology and Metabolism, August 1997 states, "the risk of miscarriage is twice as high in women who have antithyroid antibodies than in those who do not..." and Obstetrics and Gynecology 1997 Volume 90:364-369, states "the risk of miscarriage is higher when a woman is positive for antithyroid microsomal antibody...")

Dr. Vliet says that symptoms, along with elevated thyroid antibodies and normal TSH, may be a reason for treatment with thyroid hormone. Here's a quote from her book:

"The problem I have found is that too often women are told their thyroid is normal without having the complete thyroid tests done. Of course, what most people, and many physicians, don't realize is that...a 'normal range' on a laboratory report is just that: a range. A given person may require higher or lower levels to feel well and to function optimally. I think we must look at the lab results along with the clinical picture described by the patient...I have a series of more than a hundred patients, all but two are women, who had a normal TSH and turned out to have significantly elevated thyroid antibodies that meant they needed thyroid medication in order to feel normal. This type of oversight is particularly common with a type of thyroid disease called thyroiditis, which is about 25 times more common in females than males...a woman may experience the symptoms of disease months to years before TSH goes up..."

Dr. Braverman

2005 Posts
Re: Recurrent miscarriages Posted on: Nov 30, 2011 at 4:08am
We have many patients in our center with elevated ATAs and normal TSH who respond well to treatment, new literature suggests the antibodies themselves may cause complement activation at the site of embryo implantation. Our patients have responded well to lovenox, IVIG and even prednisone in these cases.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

nicolettc

15 Posts
Reply Re: Recurrent miscarriages Posted on: Dec 16, 2011 at 2:17am
Dear Dr Braverman,

I have thought about your reply in past few weeks. According to my Lymphocyte test results, do you think CD 8 is elevated (close to max. limit)? Since the tests indicate highly elevated TPO, ANA (1:40) together with CD8 would you say I have autoimmune issue and order a uterine biopsy? With Braverman's practice, under what circumstances you would do a uterine biopsy? What does the biopsy confirm/verify and validate?

I can never thanks enough to all your answer. You has helped us and we thank you for that.

Best regards,
nicole

Dr. Braverman

2005 Posts
Re: Recurrent miscarriages Posted on: Dec 17, 2011 at 3:13am
No I dont think a biopsy is imperative. I think you should call me and allow me to direct your treatment, not sure you need to walk away from this.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

nicolettc

15 Posts
Reply Re: Recurrent miscarriages Posted on: Dec 17, 2011 at 2:30pm
Dear Dr Braverman,
Would it be okay if I email you? This is just to introduce myself and my concerns.
Best regards and sincere thanks
Nicole

nicolettc

15 Posts
Reply Re: Recurrent miscarriages Posted on: Dec 18, 2011 at 3:31am
Dear Dr Braverman,
I am a non-US citizen. I would love to email to further discuss if I have your permission. Then we can take it from there. We am about to walk away from our infertility journey. It is sad to speak about this at this time of the year. But We would like to be realistic about our circumstances.

We look forward to hearing from you.

Our best regards,
nicole

Srani

0 Posts
Re: Recurrent miscarriages Posted on: Dec 24, 2011 at 6:27pm
Dear Dr,

I'm writing to you to ask you for your professional opinion. I'm 35 yes old and have been undergoing infertility treatments rather aggressively for the past 1.5 years. My husband stored samples before he started chemo ad tat is why I consulted with our RE to start ivf. I had 1 natural pregnancy which ended in miscarriage at 5 weeks, 1 chemical pregnancy, and just now experienced another loss at 4 weeks after a frozen embryo transfer. To date I have had 1 Iui, 3 ivf, and 1 FET. I have 2 very good quality embryos left and o ly 2 semen samples left. My first 2 ivf resulted in average quality and the 3rd had good to very good quality blastocysts. All were icsi.

Iv been repeatedly told that I am the picture of health and that I should not have issues getting pregnant. I had all tests done- and the only abnormal result is cardiolipin at 13.5. I'm on baby aspirin and was on dexamethasone during my FET. I'm devastated regarding my recurring losses- my highest hcg first beta was 35 and highest beta was only 79 before decreasing.
My question to you is whether or not I may behaving an immunological respOnse that is causing my miscarriages? My father is an md and feels that I am & that I should see someone in your field before I continue on with FET. I would greatly appreciate your thoughts.

Best,

Dr. Braverman

2005 Posts
Re: Recurrent miscarriages Posted on: Dec 25, 2011 at 3:05am
Yes , I agree that this has a high likelihood of having an immunologic component. I would be happy to help you. Please call my office and they will schedule a skype or telephone consultation with me. Once I get a detailed history I can have my lab get full immune testing on you anywhere in the world. I look forward to speaking with you .
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.
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