Re: Reccurent miscarriagies-I ask for any advise for the
From: Mark Perloe (mperloe@ivf.com)
Sun Mar 17 14:27:14 2002
Would consider the following:
Thrombophilia testing: Factor V Leiden, Prothrombin gene mutation, Factor S
& C Activity, Antithrombin III antigen
Antiphosphoserine, anticardiolipin
Consider ovarian reserve testing: see http://www.ivf.com/ovarianreserve.html
Also consider: fasting insulin/glucose if the insulin is elevated that may
be a factor, and metformin therapy may reduce risk.
At 06:27 AM 3/17/2002 -0600, you wrote:
>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?
--
Mark Perloe, M.D. http://grs.ivf.com 404-843-2229
5445 Meridian Mark Rd, Suite 270, Atlanta, GA 30342
Live Chat Wednesday evenings 8:00-9:00 p.m.
ET http://infertility.about.com/gi/chat/cs.htm
