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I've had four early miscarriages in 13 months. I'm 33 years…

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Hi, I've had four early...
Hi, I've had four early miscarriages in 13 months. I'm 33 years old and otherwise healthy. I have Hashimotos, normal FSH and low AMH. Available testing where I live is unfortunately limited and I am desperate to find a solution / set up a plan. I get pregnant easily, but the embryo does not survive after week 8. My doctor seems unsure if it's due to implantation difficulties or poor egg quality. He has suggested DHEA, which I am now taking (3 x 25 per day). He has previously suggested blood thinners, prednisolone and progesterone. I have had chromosome testing (normal) ++. Based on what I have read it seems likely that I have immunological issues that are working against a pregnancy, so shouldn't the focus been on this? As mentioned I'm taking DHEA, which I understand can improve egg quality. Is it safe for me to continue taking this and try out prednisolone (from day 1 or earlier?, reducing the dosage from 20 mg to 10 at ovulation and to 5 at a positive pregnancy test), fragmin (5000 daily from day 1) and crinone (from a day past ovulation) during my next cycle? And what is the recommended routine? My doctor is unclear (public healthcare). Thanks.
Submitted: 6 months ago.Category: OB GYN
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8/6/2017
OB GYN Doctor: Dr. K., MD replied 6 months ago
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OB GYN Doctor: Dr. K., MD replied 6 months ago
Your Dr should not be unsure if it is due to implantation issues. This is too late for those issues. Have any of the miscarriages been testing for genetic issues? Chromosomal testing. Has the father had chromosomal testing. Dhea is not going to help much. Taking a baby aspirin and prednisone could help. It would be more important to know the karyotype of the miscarriages.
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Customer reply replied 6 months ago
Hi. We've both had chromosome testing, but none of the miscarriages. The hospital where I live does not perform this kind of testing.
Customer reply replied 6 months ago
The miscarriages have been: week 4/5, week 8 (blighted ovum), week 7, and week 7.
OB GYN Doctor: Dr. K., MD replied 6 months ago
If you have had testing then the tissue from the miscarriages should have been tested. If the hospital does not do the testing then its very easy to send the specimen out if your Dr requests it. I'm really sorry but you have a diagnosis of recurrent miscarriage and the third time your Dr should have done this. You're missing a very critical piece of the workup and a critical piece of information from this error.
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Customer reply replied 6 months ago
The testing I had was a karyotype blood test of me and my husband at the hospital. The tissue from the miscarriages has not been tested as this is not offered in the country where I live. What are my options without this piece of information? If the miscarriages are due to chromosomal abnormalities, can these be prevented? Will DHEA improve egg quality and perhaps improve the result? Or is there nothing that can be done other than potentially IVF? Given that I have Hashimoto (my mom has three autoimmune diseases) doesn't this indicate a general activation of my immune system, which also can result in recurrent pregnancy loss?
OB GYN Doctor: Dr. K., MD replied 6 months ago
You dont have great options as you have not had the recommended workup so the information is incomplete. There's no way to prevent chromosome issues. No, dhea is not helpful though the internet would like you to believe otherwise. You should have a blood panel to test for causes of recurrent pregnancy loss which includes tests for autoimmune disease. Seeing an infertility specialist would help
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Customer reply replied 6 months ago
I am seeing a fertility specialist. What are the exact components of the workup that you recommend?
OB GYN Doctor: Dr. K., MD replied 6 months ago
Genetic causes
Perform karyotype of parents with family or personal history of genetic abnormalities.
Perform karyotype of the abortus in recurrent cases.
Provide genetic counseling for families with recurrent loss or familial history of genetic disease.
In patients with a high risk for recurrent, chromosomally abnormal conceptus, discuss the options of adoption, gamete donation, and PGD.
Immunologic causes
Perform APLA testing if indicated.
If APLA levels are elevated, counseling with a hematologist and a specialist in maternal fetal medicine is recommended.
Aspirin and heparin therapy may be given to patients who are diagnosed with APS.
Anatomic causes
Imaging may include HSG, hysteroscopy, ultrasonography, and/or MRI.
Surgical correction may be required.
Infectious causes
Cervical cultures should be obtained during the evaluation of infertility.
Empiric antibiotics should be given before invasive testing, such as HSG.
Environmental causes - Encourage life-style changes and counseling for preventable exposures.
Endocrine factors - Perform thyroid-stimulating hormone (TSH) screening in symptomatic patients.
Thrombophilic disorders - Aspirin and heparin therapy may be given for proven diagnoses.
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OB GYN Doctor: Dr. K., MD replied 6 months ago
Here's a summary of causes and the workup. I'm assuming your Dr should know this
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