immunolgical reasons for undiagnosed infertility?


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Reply immunolgical reasons for undiagnosed infertility? Posted on: Jun 28, 2011 at 4:14pm

I am a 36-year-old mother of a 4 1/2 year old daughter who is being followed by a Reproductive Endocrinologist following a miscarriage last May. My husband and I tried for years to conceive our daughter naturally, so were happy to become pregnant again after only 9 months the second time. My pregnancy ended in mc at 11 1/2 weeks, at which time I decided to seek the help of an RE, who detected hypothyroidism (now being managed with Levothyroxin) and made a dx of unexplained infertility. I have had 5 unsuccessful IUIs (4 on Clomid, 1 on Femara which I passed out while taking, which has never happened to me before in my life, so I won't be able to take again); we've also tried twice naturally during this time frame. My RE is generally pleased with the presentation of uterine lining, follicles, labs each cycle, though she recently prescribed progesterone to supplement during luteal phase. My husband's counts are excellent. I take a prenatal vitamin, receive accupuncture and take herbal supplements provided by my accupuncturist, and have done mind-body work with an LCSW.

I've been doing some reading on my own, and asked my RE about the possibility of immunological issues preventing me from conceiving (and possibly contributing to the mc); she kind of dismissed this idea, but went ahead and ordered two labs (antilupus antibody and anticardiolipin antibody) because she felt this was the most cost effective route and "to make (you) feel better"; while the antilupus antibody came back fine, the anticardiolipin was slightly elevated, so she wants to retest. I asked her if I could begin taking aspirin as a precaution during this next cycle, and she said that normally she would say yes and prescribes aspirin to all of her patients when they become pregnant, but that in my situation- since I have had some (minimal) blood my stool- 1-2 times a month, sometimes none- in the last 6 months or so she does not want me to start aspirin yet until I get results back from the gastroenterologist (RE thinks maybe ulcerative colitis, though general practitioner said small hemhorroid). I have stopped eating gluten this month on the outside chance that I may have an issue with this, and in general just feel confused, worried, and like I'm grasping at straws ...

I am traveling this month so won't be receiving any fertility treatments, but would like to try naturally. My concern is that if I have some kind of undetected/untreated immunological problem I could actually conceive and mc again. I wonder how taking aspirin would intervene with this if there is a problem? My RE wants to move ahead to injectables for my next cycle since I may have had a bad response to Femara. I definitely don't want to move on to more powerful treatments without knowing my immunological status and getting any treatment I may need to increase my chances of a healthy pregnancy.

My questions are:
What additional immunolgical testing would you recommend to have a complete picture? When I do get the go-ahead to begin taking aspirin, at what point in my cycle would I take it (all month long? if not, what part of the cycle?) and are there any drawbacks to taking aspirin when trying to conceive, specifically in my situation?

Thank you so much.

Dr. Braverman

2026 Posts
Re: immunolgical reasons for undiagnosed infertility? Posted on: Jun 29, 2011 at 3:52am
Deciding on which tests to order and that how to carry out treatments is a complicated process , that at a minimum requires knowing your detailed history. I would be happy to help you organize this and develop a correct protocol for you. But we have to spend some time together first going over your entire history. Please feel free to call my office and they will arrange a consultation for you . I can arrange for testing any where in the world and guide your management with your local MD.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.