The culprit--low estrogen, flu shot, lack of Lovenox, or something else?


1 Posts
Reply Posted on: Jan 26, 2013 at 9:32pm
Hello, Dr. Braverman,Thank you for being such an incredible resource. I have heard many great things about you. I am hoping you might be able to guide me in the right direction. I experienced my fifth miscarriage a few weeks ago. It was my first under immunological treatment. I have no living children. My losses have been at 7, 8, 7, 12, and 6.5 weeks. I have received immunology testing in Chicago last year which found high NK cell activity and high TNF. In addition, I am heterozygous for MTHFR A1298C and for HPA1a/b.I subsequently discovered that prednisone flares my NK cells and cytokines and instead looked to take the triggers out of my diet: sugar, gluten, and dairy. By doing this and other diet changes, I was successful in reducine all my NK cell and cytokine markers to normal ranges before conceiving. My overall protocol included Lovenox 40mg 2x/day, baby aspirin, Metanx, Vitamin E, Prometrium, Vivelle patches, calcium, fish oil, and prental vitamin, with the Vitamin E and Vivelle being added in later.Two days following my positive pregnancy test, I had light brown intermittent spotting. Ultrasounds did not reveal any abnormal uterine bleeding. However, my RI took me off the Lovenox and told me to continue the baby aspirin and add vitamin E to my protocol. Shortly thereafter, with my estrogen levels at 79 at 4 weeks pregnant, and then 172 at 5 weeks pregnant, Vivelle patches were added. My progesterone level was consistenly in the 40s.One week following my positive pregnancy test, I received the flu shot. My immunology blood work 1.5 weeks later showed increased NK cell activity at 20% and elevated IFN at 25.6. One week later, a heartbeat was detected at about 6.5 weeks, but it was slow (though they did not measure it). One week later, my immunology tests reflected normal NK cell activity and normal levels of cytokines. The following week, we learned the baby had died two weeks prior at about 6.5 weeks. Because I have already had 3 d&cs, and because there was unlikely sufficient tissue to test (as the fetal pole was no longer present on the ultrasound), I opted to take cytotec.I am trying to figure out what happened with this pregnancy. We can't rule out chromosomal issues, but we know that all of our previous that were previously tested showed normal karyotypes. Here's what I am wondering:1--could the low estrogen have been a culprit, even though my progesterone was at a good level? Also, I eat a low-grain, low-sugar diet, (but still lots of veggies, fruits, nuts, seeds, and meat). I know this theoretically could reduce estrogen levels. Regardless, could the low estrogen be the cause and/or my low-grain/low-sugar diet? My acupuncturist insists that my egg quality was good, but I understand that low estrogen can also be the result of a poor corpus luteum...2--could the flu shot be the culprit? Or, could my immune spike be separate, even though it was normal in tests two weeks before and two weeks after. Plus, I never had high IFN until then.3--considering my thrombophilia, could being off Lovenox for three weeks be the culprit? I also understand that Lovenox can buffer against immunological issues.Could any or all of these be an issue, in your opinion?My losses have clouded the last five years of my life. I hope for a happy ending, but I am growing weary. Can you please help point me in the right direction before my last try in this journey?All my best to you,Bridge

Dr. Braverman

2026 Posts
RE: The culprit--low estrogen, flu shot, lack of Lovenox, or something else? Posted on: Jan 27, 2013 at 11:19am
This is a complicated history , I am sure I can help you sort this all out, but best would be to call my office and schedule a consultation. We are going to need to go over all of your history and testing to date, then see if there is any additonal testing I may need. Sometimes you have to go back to the beginning on these cases and just peel away all the treatments until we see if you are on the correct ones.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.