Time to move on to Donor after 3 early miscarriages?

Mrs Thomas

1 Posts
Reply Posted on: Dec 30, 2012 at 2:57am
Hi Dr Braverman. I'm living in the UK and hoping you can advise me whether to continue trying to conceive with my own eggs or whether its time to move on to donor eggs.We have unexplained infertility and prior to immune testing I had 4 IUIs and 3 ICSIs and had never been pregnant.Since I started immune protocol including steroids, clexane, intralipids and high dose progesterone I have had a further 3 fresh ICSI cycles and 2 frozen cycles and had early miscarriages on 2 fresh and 1 frozen, the latest being at 5w5d.My local clinic believe that it's most likely due to my age (40) and low amh (5.1pmol at last test) resulting in genetically abnormal embryos. Please can you advise if you think the same, in which case I need to move on to donor eggs. We have made blastocysts which look great quality on most cyclesPlease let me know if you need any further informationMy immune results before I started the immunes protocols are as follows :Prothrombin time 14.4 (11.8-15.4)APT (APTT) 26.1 (24.4-34.3)Fibrinogen Titre 1.3* (2.0-4.0)Thrombin time 13.0 (11.0-15.0)Protein C Functional 112 (72-164)Free Protein S 91% (60-123)AT Functional Assay 57*iu/dl (76-120)APC Resistance 2.4 (2.1-5.0)DRVV test 38.2* secs(25-35)DRVV confirm 38.6DRVV ratio 0.99 (0.9-1.15)KCT 1:5 0.97 (0.9-1.3)Comment Lupus inhibitor not detected by KCT or DRVVTAnticardiolipin IgM antibody 2.6 & 3.2 on repeat
40 positiveAnticardiolipin IgG antibody 85.0 and 69.0 on repeat(Consistent with anti-phospholipid syndrome if not accompanied by an obvious infection 40 positiveKaryotyping 46, XX An apparently normal female karyotypeKaryotyping 46, XX An apparently normal female karyotypeMTHFR (C667T) Mutation Analysis No mutation detectedNK Assay Panel50:1 12.5 (10-40)25:1 7.8 (5-30)12.5:1 5.6 (3-20)IgG conc 12.5 50.1 11.3IgG conc 12.5 25:1 10.5IgG conc 6.25 50:1 13.4IgG conc 6.24 25:1 11.4%CD3 *89.9 (60-85)%CD19 2.4 (2-12)%CD56 4.9 (2-12)%CD19+cells, CD5+ *29.2 (5-10)LADFlowcytometry Negative[T-cells] IgM+ 1.4[T-cells] IgG+ 2.6[B-cells] IgM+ 20.0[B-cells] IgG+ 2.5 %TH1:TH2 intracellular cytokine ratiosTNF-a:IL-10 (CD3+CD4+) 21.5 (13.2-30.6)IFN-g:IL-10 (CD3+CD4+) 7.3 (5.8-20.)DQAlpha results, 1 matchMe 0103, 0105Husband 0102, 0103DQBeta Me 05,06Endometrial biopsy showing :1. Early secretory endometrium POD2-32. No CD57+ cells identified/high power field3. 3-6 FoxP3+ cells identified/high power field4. No evidence of inflammatory change seen5. No evidence of necrosis6. No evidence of hyperplasia or atypiaCOMMENT : No CD57+ cells are noted while adequate numbers of FoxP3+ cells are identified suggesting adequate stromal regulatory activity. Positive and negative control sections have been evaluated demonstrating appropriate tissue reactivity with the CD57 monoclonal antibodySaline scan of uterus normalMany thanks for taking the time to review my case

Dr. Braverman

2026 Posts
RE: Time to move on to Donor after 3 early miscarriages? Posted on: Dec 31, 2012 at 10:51am
this is quite a substntial history and there is much to discuss, Please call my office and we can arrange a SKYPE consultation and I can help you make some order from all this testing and recommend the correct management or at least help you make a decsiion on how to proceed.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.