Since most early pregnancy losses are induced by chromosomal factors and thus are non-repetitive, having had a single miscarriage the likelihood of a second one occurring is no greater than for the first.
However, once having had 2 losses the chance of a third one occurring is double (35-40%).
After having had three (3) losses the chance of a 4th miscarriage increases to about 60%.
The reason for this is that the more miscarriages a woman has, the greater is the likelihood of this being due to a non-chromosomal repetive cause such as Immunologic Implantation Dysfunction. In such cases, there is a strong likelihood that miscarriage will recur in subsequent pregnancies.
It therefore makes sense to take action to remedy the cause rather than to wait for the disaster to recur.
Diagnosing the Cause of RPL
Establishing the correct diagnosis is the first step in determining effective treatment for couples with recurrent pregnancy loss. RPL results from a problem within the pregnancy itself or within the uterine environment where the pregnancy implants and grows. Diagnostic tests useful in identifying individuals at greater risk for a problem within the pregnancy itself include:
- Chromosome analysis done on both prospective parents (COMPLETE and NORMAL)
- Chromosome analysis results from previous pregnancy losses and from both parents (COMPLETE and NORMAL)
- Ultrasound examination of the uterine cavity after sterile water is injected or hysterosonography (saline ultrasound, sonohysterogram, fluid ultrasound, ultrasound) (COMPLETE and NORMAL)
- Dye X-ray test of the uterus and fallopian tubes or hysterosalpingography (COMPLETE and NORMAL)
- Hysteroscopic evaluation of the uterine cavity (COMPLETE and NORMAL)
- Evaluation of hormonal response of the uterine lining (COMPLETE and NORMAL)
- Immunologic testing useful in the diagnosis and management of recurrent pregnancy loss in affected couples. Such tests include: a)Antiphospholipid antibody (APA) panel (SCHEDULED FOR SEPT 12) b) antinuclear antibody (ANA) panel (COMPLETE and NORMAL); c)Antithyroid antibody panel (i.e. antithyroglobulin and antimicrosomal antibodies) (COMPLETE and NORMAL) d) Reproductive immunophenotype; (INCOMPLETE-so far NOT ordered) e) Natural killer cell activity (NKa) using the the K562 target cell test (SCHEDULED FOR SEPT 12)
- Alloimmune testing of both the male and female partners (DQ alpha and HLA) (COMPLETE and NORMAL)
- Thrombophila Panel (COMPLETE and NORMAL)
Treatment for Recurrent Pregnancy Loss that is NON-chromosomal in nature but instead immunologic:
Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid
Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.
I am currently playing phone tag with the IVF coordinator at SIRM-but you can bet your sweet ass that I am done pussy footing around with my current douche canoe of an RE and will be cycling with SIRM-4 states away- as soon as mother fucking possible. I don’t care if I have to charge treatment to multiple credit cards and sell all of my worldly possessions to make this happen-I REFUSE, flat out REFUSE to waste another day of my life with any RE from Boston and want some fucking answers, OR BETTER YET TO BE KNOCKED UP WITH A NORMAL HEALTHY PREGNANCY, before I have to ring another New Year in.
Please, please for the love of all things good and pure in this world, please don’t let me be in this same spot in 129 days. There is no thought that makes me want to throw up in my mouth more than that. Amen.