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Trying For IUI. Had Miscarriages. All Blood Report Came Normal. Is It Possible?

Posted on Tue, 29 Jan 2013

Question: case history of my wife age: 29
PO+2 miscarriage-8 week-2011, Miscarriage- 7 week-2012,both IUI pregnancyHistory of endometriosis,laproscopy & histeroscopy done in october'12,cystic mass at right ovary removed,fimbrial dilation done for partial chocking at right tube .left tube ok.some of test done before laproscopy of my wife,reports are as follows
TSH: NORMAL
LIPID PROFILE: ok
Lipoprotein A : 7.6 mg/dl
Prolactin: 24.94 ng/ml
Prolactin after peg preparation: 22.83ng/ml
Homocystene: 7.32 micromol/l
LA1 screening: screening test does not reveal lupas anticoagulant
Toxo plasma IgG: 0 iu/ml IgM: .08 index
RUBELLA IgG: 88 iu/ml IgM: 0.15 index
CMV: IgG: 25 au/ml IgM: 0.21index
PROTEIN C: 138.9%
PROTEIN S : 115%
Antithrombin: 104.5%
APA: IgG: 0.9 u/ml IgM: 0.99 u/ml
ACA: IgG: 0.99 gpl/ml IgM: 0.98 mpl/ml
CULTURE OF HIGH VAGINAL SWAB: no pathogenic micro organism grown
FSH :on 4th day of last mens period:19mIU/ml
LH:2.7mIU/ml
E2: on 2nd day of last cycle:61.86 pg/ml
History of mine(husband)age : 34
Semen analysis(08.04.2011):
Sperm count: 9.1 million
Active Motility: 30%
Semen analysis(17.08.2012 after taking PRODUCTIVE M): 40 million
Active Motility: 50%

we are trying for IUI in this cycle. for that she has taken 4 nos foligraph inj 75IU from 3rd day.after 6 th day only one follicle has seen of size 9x7. now what to do?? can we continue with IUI in this cycle.
if that so then what will be next detailed steps. also please suggest whether hormonal result,blood test result are normal or not.

Answered by Dr. Mahesh Koregol (5 hours later)

Hi,

Thanks for your query.

I read your query with diligence and understand your concerns. Following is my reply to your query:

1) The early miscarriage that your wife suffered is probably due to chromosomal abnormality. It was unfortunate events and I am sorry for that.

2) Your semen analysis appears to be fine. You need not worry.

3) Your wife has FSH of 19 which is very high for her age. I suggest you repeat it along with another new test called AMH (AntiMullerian Hormone). These tests suggest eggs remaining in ovary.

4) You go ahead with IUI as per schedule this cycle.

5) Try another 3 cycles of IUI and if no pregnancy, go for IVF.

6) If there is pregnancy, she can be started on low molecular weight. This prevents miscarriage in some women by thinning blood. Discuss with your treating gynecologist.

I hope I answered your query. Let me know if you need clarifications.

Regards,
Dr. Mahesh Koregol
IVF & Infertility Specialist

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Mahesh Koregol (6 hours later)

sir,
we have done chromosomal test for both partners.that founds normal.
also we have done AMH test earlier before 2nd miscarriage, the value was 0.83.
you have suggested for low molecular weight.what is this? can you elaborate it?
& also suggest what to do?

Answered by Dr. Mahesh Koregol (1 hour later)

Hi,

Thanks for the follow up.

1) Chromosomal profile of you both gives idea about certain set of chromosomes. There lot of other defects and mutations which cannot be identified. Hence that is a possibility.
2) AMH & FSH levels are indicative of low ovarian reserve. Means lower number of eggs. So when eggs are low in number, they are unhealthy.
3) With these investigations, I suggest you to go ahead with IVF without wasting time. If the miscarriage repeats, you may have to go with IVF using donor eggs.
4) Low molecular weight Heparin thins blood and helps to minimize clotting factors associated with miscarriage. Anyway it is an option only after achieving pregnancy. Don’t worry about it now.

Hope I have cleared your doubts.

Regards
Dr. Mahesh Koregol
IVF & Infertility Specialist

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Mahesh Koregol (2 days later)

sir
we are trying for IUI in this cycle. for that she has taken 4 nos foligraph inj 75IU from 3rd day.today is her 10th day. today follicle size is 16x17. is there any need of taking HCG injection tomorrow or no need of injection so that follicle will rupture naturally.
also if follicle ruptured,when iui shall be done?

Answered by Dr. Mahesh Koregol (1 hour later)

Hi, You have to take Inj. hCG tomorrow. IUI to be performed 36 hours after taking hCG. So time your hCG injection in consultation with availability of your doctors timing. Because follicles rupture after 36 hours of taking hCG.

All the best.
Regards,
Dr. Mahesh Koregol

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar