Unexplained infertility and enlarged lymph nodes


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Reply Unexplained infertility and enlarged lymph nodes Posted on: Oct 15, 2010 at 2:53am
I have had two miscarriages (one at approx. 61/2 weeks). On my first pregnancy the u.s. showed the sac seemed to be collapsing and the fetal heartbeat was low. 3 days later at the follow up there was no heartbeat. Genetic testing of the fetus showed no abnormalities. My OB was very optimistic that I could get pregnant again right away.
After over a year I didn't conceive again and had a full workup with a reproductive endocrinologist. Everything tested "normal" for me and for my husband. The RE believes my irregular cycles may cause unhealthy ovulation so we used clomid and trigger shots. I responded well to both-got pregnant again on my first cycle, but with low numbers...it took about a month for my numbers to stop going up.
About a year before my first pregnancy my doctor thought I might have mono due to cold like symptoms and enlarged lymph nodes (cervical and underarms). When they didn't go around-the referrals began. After going to an oncologist, endocrinologist, allergist and infectious disease specialist a biopsy was done and they were found to be "reactive" with an unknown origin. I was told to go ahead and try to conceive because perhaps I just have an overreactive immune system. My bloodwork showed no signs of lupus, rheumatoid arthritis or any of the other dozens of things they tested me for. I am struggling to believe that my (still) enlarged lymph nodes are unrelated to my miscarriages. What tests are they missing?

Dr. Braverman

2026 Posts
Re: Unexplained infertility and enlarged lymph nodes Posted on: Oct 15, 2010 at 3:46am
Any viral infection can cause reactive lymph nodes , most viruses are difficult to test for . The fact that your immune systme reacted to the virus with the enlarged lymph nodes makes it likely that many of the cells have remain activated. We have seen with many other long standing infections and the NK cells and T cells remain in the 'activated" state and it is very likely this is playing a part in your pregnancy losses, as these acitvated cells make it difficult for the embyro to create immune tolerance and they break through any attempts by the embryo to turn off the maternal immune system. We can test for this by looking at the T and NK cells activity as well as look at the current state of inflammatory cytokines your T cells are making. This can all be treated but simply looking for autoimmune causes of lymph node enlargement as your current REs have done(and I do agree with that part) will miss the diagnosis.
Feel free to give me a call if you would like to discuss this further , Im sure I can help you figure this out, as this clearly has all the signs of immune mediated rejection.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.