Three Consecutive Miscarriages in One Year

jackiemc0423

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Reply Three Consecutive Miscarriages in One Year Posted on: Jan 12, 2011 at 6:57pm
Dr. Braverman,
Thank you for reading my question. I have had three miscarriages this year and had almost lost hope of having a successful pregnancy. I found an online Reproductive Immunology group, and one of the members suggested that I contact you.

I am 37 and became pregnant the first time in May 2010. I happened to have an OBGYN appointment the day after taking a home test, and the doctor confirmed it and brought me in to date the pregnancy with the sonogam. It was a little smaller than where I thought I was, but there was a good heartbeat. Two days later I miscarried. That was 6 w5d according to the sonogram. I saw a nurse practioner soon after, and begged her to do bloodwork so I would not have to repeat the episode (I read a book about common causes of miscarriage). I did test abnormally for lupus anticaogulant. We had a follow up with the doctor, and he was a little annoyed that these tests were ordered after only one miscarriage and said we're likely to see a false positive. They repeated the test 8 weeks later, and everything appeared normal. I know they tested for blood clotting, sugar, and thyroid issues. We were give the okay to try again.

I am fortunate that it doesn't take us long to get pregnant, and at the end of August I was pregnant again. I had a bit more spotting this time (I had some the first time, but not too much) and the doctor had me get a sonogram to see if the pregnancy was viable. Again it was small (I know when we conceived) but there was a heartbeat so we had hope. A few days later I miscarried.

I had planned to wait a month before getting pregnant again, but discovered I was pregnant 5 weeks after the second miscarriage. The doctor put me on 100 mg Prometrium once per day as soon as I told them I was pregnant (I was probably about 5 weeks). Everything went perfectly, and I had every symptom in the book for pregnancy (especially fatigue). I had a sonogram that measured me at 8w1d with a good heartbeat. At 11w5 days we heard a strong heartbeat on the doppler, and the doctor told me the chance of miscarriage was very low so we shared the news. A few days later I had quite a bit of bleeding but no pain. They brought me in for a sonogram and we saw the little one kicking his/her arms and waving his/her legs with a good heartbeat. They could not find the source of the bleeding on the sonogram and told me it was likely from the cervix. Later that night I started passing clots (also painless) and then passed the fetus. We were devastated.

My regular OBGYN does not seem to know the issue and keeps telling me it's bad luck. I will have a sonogram of my uterus to rule out any physical issues. He said perhaps a baby aspirin might help next time. I asked him about NK cells, but he said he doesn't really believe that theory.

So my question is: Is the fact that I tested high for lupus anticoagulant immediately after pregnancy --1 possibly indicate that I have blood clotting disorder only in pregnancy? Also I have heard that progesterone can suppress NK cells. Since I was on them for pregnancy --3 is that how I got to 12 weeks?

Thank you again for your time to read my lengthy story.

Dr. Braverman

2024 Posts
Re: Three Consecutive Miscarriages in One Year Posted on: Jan 13, 2011 at 2:43am
Hi Jackie, I am sorry for your losses

The testing you do must always be interpreted in the context of the clinical picture. Yes for a diagnosis of lupus the LAC should be positive after a repeat test, but LAC is simply a phospholipid antibody and in the context of recurrent losses must be looked at as a sign that there are other immune issues at work that may be rejecting these pregnancies. The work up for this is quite detailed and never as simple as just measuring LAC and yes NK cells along with many other cells do play a part in these types of losses.
Progesterone does decrease NK cell activity through the release of PIBF(prog induced blocking factor) that is released from T cells that come in contact with prog and PIBF turns off NK cell activity. There are many other cells involved in immune rejection and prog is important as a treatment but if there is immune activity you would require much more than prog.
Feel free to call my office and I would be happy to organize a detailed work up for you and help you choose the correct management
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Ellie

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Re: Three Consecutive Miscarriages in One Year Posted on: Feb 3, 2011 at 5:36pm
Hello Jackie,

I am so sorry for your losses too, the exact same thing is happening to me only I have had four consecutive miscarriages in one year. I live in Italy and the doctors just keep saying "these things happen, keep trying" but it is heartbreaking everytime it happens as I am sure you already know.

On all four pregnancies I was told I conceived later and like you I knew they were wrong but it was always small. Like you I was given progestrium but I was given 200g, it did not help. The only difference I have is that each pregnancy last less and less time.

I wish I could tell you that I am now a mother but I am still in the process of argueing with the doctors here to have tests done.

Let me wish you all the luck in the world and if you hear of any new ideas as to why this keeps happening then please let me know.

Dr. Braverman

2024 Posts
Re: Three Consecutive Miscarriages in One Year Posted on: Feb 12, 2011 at 4:51am
there is still so much for both of you to do . Please call me and let me at least guide you to the correct diagnostic testing and treatments. do not give up hope at all.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.