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Reccurent miscarriagies-I ask for any advise for the following case.From: y.n. (nickolidakis@geneticsunit.gr)Sun Mar 17 05:27:28 2002
My patient is 38 years old today. Her husband has azospermia due to hypogonadotrophic hypogonadism. In the past, he was tried with gonathotropins (Puregon+Pregnyl) but soon he got tired with injections and he stopped them. Both they decided to use husband’s brother sperm who has two healthy children. About 3 years ago, we started with IUI during physical cycle. Her cycle is always normal lasting 28-30 days. 1st pregnancy missed abortion (anembryonic untill 8th week) àD&C -no TORCH infection was found. 2d pregnancy missed abortion (anembryonic untill 8th week) àD&C -abortuses failed to be cultured for karyotyping. 3d pregnancy missed abortion (embryonic stuck were seen. Heart activity stopped in 8th week) àD&C -abortuses revealed normal 46XX karyotype. Testing for ANA, LLA and ACA was negative. Wife’s karyotype was normal. Another donor sperm was insisted, but they denied. 4th pregnancy biochemical pregnancy. b-HCG rised slowly up to 600IU and then felt to negative àno D&C. 5th pregnancy Everything get well untill 15th week. She was examined by ultrasound every week. Red bleeding was seen from vagina on 7th week and a large hematoma was seen in utero that absorbed during the following 20 days. Progesterone (Utrogestan 100mg three times daily) and low dose Aspirin (Salospir-A 80mg/day) per os was administered. Glucose intolerance was abnormal, slight up normal limits. Postpardial glucose was not above 125mg/dl after diet started. Nuchal translucency was normal on 12th week. Next visit on 14th week, it was thought that amniotic fluid was little less than expected. Next visit on 16th week, fetus has no heart activity and amniotic fluid was absent. No fluid coming through the vagina was seen during the previous days. Pregancy was discontinued. Pathologic examination of fetus and placenta is expecting. I look for any medical advise. I don’t believe that immunotherapy using 3d party lymphocytes or IV immunoglobulin has any positive role in these cases. What would you do in my case?
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