What worked for you? RPL

[Anonymous]

Hi all,

I have a somewhat complicated history, but I’m hoping to get some ideas and thoughts for things to explore or add. I’m 33 with two previous losses conceived through IVF. The first one was an untested embryo at 6 weeks. The second one was a MMC of a euploid embryo discover at 12w2d, but measuring 11w1d. No obvious cause for the second loss and all the recurrent pregnancy loss testing on me and my husband came back normal. I do have two autoimmune diseases that are very well managed (T1D and hashimotos with an A1C of 5.0 and TSH of around 1.0 and relatively low antibodies). Karotyping of fetus showed a complete normal male. So the loss was “just one of those things” or potentially a result of some underlying autoimmune issue associated with my autoimmune problems.

My doctor proposes essentially the same protocol, which included baby aspirin and tapering of progesterone starting at 8 weeks, but adding 5mg of prednisone. I’m not sure when she plans to have me stop prednisone, but as far as I’m concerned if I don’t take it the whole first trimester, I’m not sure what the point would be. I’d also like to stay on progesterone through 13 weeks and plan to ask about supplementing with NAC, and avoiding gluten or dairy (although not sure how sustainable that would be once pregnant because those are about the only foods I was able to tolerate for my entire last pregnancy until it ended).

Any other suggestions of things to add or tests to run? Thanks!

[Anonymous]

I miscarried my euploid embryo at 9w despite prednisone + aspirin, and despite not having any of the clotting issues my next protocol involved lovenox, and I am currently 22w.

[Anonymous]

Anonymous wrote:I miscarried my euploid embryo at 9w despite prednisone + aspirin, and despite not having any of the clotting issues my next protocol involved lovenox, and I am currently 22w.

Thanks. Are you still on the lovenox? If not, when did you stop? I’m being tested again for antiphosolipid syndrome bc my doctor has “a strong clinic suspicion” even though my first test was negative. Part of me is just like why not try the lovenox.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I miscarried my euploid embryo at 9w despite prednisone + aspirin, and despite not having any of the clotting issues my next protocol involved lovenox, and I am currently 22w.

Thanks. Are you still on the lovenox? If not, when did you stop? I’m being tested again for antiphosolipid syndrome bc my doctor has “a strong clinic suspicion” even though my first test was negative. Part of me is just like why not try the lovenox.

I'm still on. My OB is indulging me, the RE had suggested stopping at 12 weeks. my intention is to stop the week I expect to give birth-- basically, if you've taken lovenox within 24 hours of labor, you wouldn't be able to have an epidural, and an emergency C would mean being put under a general. While it might be just random luck/superstition, the lovenox is the only difference in protocol for me, and so I have no desire to stop and have the placenta clot or degrade before term. This is my last (donor) embryo. I _am_ hetero for MTHFR, so while the RE and OB don't consider MTHFR to require lovenox... well, I'm still going. Also there may be some untested genes/sperm issues that can affect placental development, most of this is still very much a black box.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I miscarried my euploid embryo at 9w despite prednisone + aspirin, and despite not having any of the clotting issues my next protocol involved lovenox, and I am currently 22w.

Thanks. Are you still on the lovenox? If not, when did you stop? I’m being tested again for antiphosolipid syndrome bc my doctor has “a strong clinic suspicion” even though my first test was negative. Part of me is just like why not try the lovenox.

I'm still on. My OB is indulging me, the RE had suggested stopping at 12 weeks. my intention is to stop the week I expect to give birth-- basically, if you've taken lovenox within 24 hours of labor, you wouldn't be able to have an epidural, and an emergency C would mean being put under a general. While it might be just random luck/superstition, the lovenox is the only difference in protocol for me, and so I have no desire to stop and have the placenta clot or degrade before term. This is my last (donor) embryo. I _am_ hetero for MTHFR, so while the RE and OB don't consider MTHFR to require lovenox... well, I'm still going. Also there may be some untested genes/sperm issues that can affect placental development, most of this is still very much a black box.

Thank you! I also forgot to say congratulations before, so congrats ! That all makes sense. I’ll see what happens with antiphosolipid syndrome testing and if it’s still negative ask about taking lovenox anyways. I am having similar thoughts/fears and just need to do something different this time or else I don’t think I’ll be able to feel mentally prepared to try again.

[Anonymous]

DP. Lovenox. After 2 back to back losses, went for a 2nd opinion (first doc basically said better luck next time) and clinically my history indicated anti phospholipid syndrome but I tested negative. The 2nd opinion doc said something to me that changed everything: “There is definitely something wrong with you. We may not have a test that says so but you shouldn’t be going through what your going through.” After going through what I went through, hearing him say that was like a huge weight suddenly lifted off my chest.

A blighted ovum came next, but the pregnancy after that they started me on Lovenox after confirming the heartbeat. It made all the difference in the world. I’ve had 2 Lovenox babies and no further losses.

[Anonymous]

Anonymous wrote:DP. Lovenox. After 2 back to back losses, went for a 2nd opinion (first doc basically said better luck next time) and clinically my history indicated anti phospholipid syndrome but I tested negative. The 2nd opinion doc said something to me that changed everything: “There is definitely something wrong with you. We may not have a test that says so but you shouldn’t be going through what your going through.” After going through what I went through, hearing him say that was like a huge weight suddenly lifted off my chest.

A blighted ovum came next, but the pregnancy after that they started me on Lovenox after confirming the heartbeat. It made all the difference in the world. I’ve had 2 Lovenox babies and no further losses.

Thanks for your response. I’ve asked my RE to put me on lovenox regardless of the outcome of my bloodwork so we will see what she says.

[Anonymous]

Lovenox and intralipid transfer worked for me, as did prednisone

also tried to do progesterone shot exactly 120 hours before my transfer so I wonder if that was the contributory factor