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  1. #1
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    Default Immunology testing

    Hi Dr Jessup, Thank you for assisting me with this question.

    I have fallen pregnant naturally 3 times since 2007, 1st with my healthy daughter and then m/c at 15 weeks and then at 5 weeks. It has now been 12 months of TTC since then.

    We had an autopsy done on 15 wk m/c which showed fine but no chromosome test was done (and I dont know why). A m/c this late concerns me.

    We have had 3 natural IUIs and an IVF this year all resulting in negative. We got 10 blasts and our first natural FET is in a few weeks. A Laparoscopy showed clear in Nov 09.

    As FS's like to see several m/cs before testing, I would like to be proactive in this area and get necessary autoimmune and neccessary testing now before money and time slips through our fingers. I would like to cover recurrent m/c and implantation failures.

    I asked FS if I could have some tests and he gave me the following: Lupus Anticoaglent, ANF (what is this?), thrombophilia and one other. I really want to be thorough so do you think I should ask for the following tests to cover all areas?
    • AntiNuclear Antibodies
      Anticardiolipin Antibodies
      Antiphospholid Antibodies
      PAI-1 levels and activity
      Antithrombin III
      Prothrombin II mutation
      Protein C activity
      Protein S activity
      Factor V Leiden
      Serum Immunoglobulins (IgG, IgM and IgA)
      Thyroid levels (TSH, T3, T4)
      MTHRR Gene Mutation
      Elevated Homocysteine
      Urea Plasma DNA
      Karotyping
      NK Cells
      TNF-a (TH1/TH2 Cytokines)
      LAD
      DQ Alpha
    Which ones should my husband be tested in?
    My FS gave me a blood test for NK Cells, but I see a biopsy on day 26-28 is the normal process. Can you please advise?
    Cannot thank you enough for your help with this.
    Take care,

  2. #2
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    Default Immunology testing

    Hi Mya,

    The list of tests you have outlined is certainly the comprehensive list of tests for RMC. Given that you have had two miscarriages, one at a relatively late gestation, and both at a relatively young maternal age, I do not think it would be unreasonable to investigate fully. My thoughts are that karyotyping for you and your husband is worthwhile, as well as a full thrombophilia screen, TSH, Antiphospholipid antibodies, ANA and LA. If you are Sydney based, a blood test looking at your NK cells is just as good as a mid-late luteal endometrial biopsy. The other tests you have indicated are slightly less commonly checked, but certainly would complete the workup. I assume your laparoscopy and ultrasound scans have excluded any uterine abnormalities.
    Even after two miscarriages, the most likely outcome in your next pregnancy will be a healthy baby. You may wish to consider trying Prednsolone 20mg daily in your next cycle. This is what would be suggested if your NK cells were elevated. Keep trying . It sounds as though you have a good grasp of the issues, and I am sure given you have already had a baby, that is is just a matter of time before it all works for you again. Good luck. Sonya

  3. #3
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    Thanks Sonja. That is wonderful feedback. May I ask 2 more questions?

    1. I am Perth based. Can a blood test be done here / sent to Sydney? Or would I have to have a biopsy?

    2. What tests would be needed for a full thombophilia screen?

    Many many thanks again.


 

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