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Miscarriage, Multiple Miscarriage and/ or Immune Issues Moderated by Carolyn B. Coulam, MD
Carolyn Coulam MD, specializes in helping those experiencing recurrent pregnancy loss and implantation failure. Dr. Coulam is a pioneer in the field of reproductive immunology. She is board certified in reproductive endocrinology and infertility.

Dr. Coulam is a long-time advisor to INCIID and has been answering patient questions since INCIID's inception. Dr. Coulam's professional member profile is located here. Visit the Reproductive Medicine Institute (Chicago).

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Old 02-15-2009, 01:47 PM
poohbear poohbear is offline
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Default Guidance (Pg./Loss Ment)

Dr. Coulam,
About a year ago I had some testing done at Millenova labs in order to gain some perspective after my loss in 7/2007. I have had two pg. to term 2x. After my second injectible cycle in 2007, I got pg. although never developed h/bs. I never had the testing done at the time of the d&e because the doctor said it's most likely chromosonal given my age which was 40 at the time. I totally understand the stats on women over 40 conceiving and the likelihood of abnormal eggs and the increased m/c rate and that even low fsh isn't an indicator of success. However, I can't even get there again since the loss.

The results of the immune testing showed big red flags on the RIP with CD16+CD56+ at 21.9%. Every other value was well within normal range. The thyroid panels were also totally normally and no ab. ANA was negative. The nka result was 22.4% and with both suppression of IVIG and Intralipid was 12.5. The Ebryotoxicity Assay was absent. The APA Millenova panel also showed borderline for the ACA and I think phosphatidine. There were some red flags with SSA and SSB so of course I had all the tests re-ran by a rhematologist that my internist insisted I see. It was determined I don't have shogrens or lupus. You might ask me why haven't I addressed the nk issue. Where I am from the immune theory isn't looked as an "answer" to IF. I have seen two local RE's that discounted it so it's been hard to seek proper tx. and get someone on board.

I also tested + to C677T and PAI-1 with one copy of each and no one really seems to think it's a big deal (hematologist) and was told baby aspirin and extra folate should handle that. In addition I had these genetic factors prior and never had events during my prior pg. The one thing that concerned the rhematologist was moderately elevated ACA at 27 on the IgM and 5 on the IgG. Again no one really thinks it's a huge impediment but to be safe with a BFP I could go on lovenox. There is some theory that the hematologist told me they are finding some connection with Hep C and ACA and I had Hep C in 1984. I didn't have ACA in 1998 when I was initially tested. At present, I don't have chronic Hep C nor have I ever and have consistently tested negative with the PCR test several times as well as had normal liver function tests.

This was basically my last covered cycle and I did the lovenox post ovulation just to see if it made a difference. Of course it didn't and it's another bust. Every single cycle I do whether injectibles or natural I always get this cramping between 6-11 dpo and no one can tell me if it is normal. Sometimes it's actually quite painful. I know the nk activity can cause implantation failure. Would that be something I would feel or know is happening?

There is another RE that I briefly consulted with 2 months ago re: IVIG but they aren't offering intralipids which is by far more reasonble. I am going to have a consult with him as they now have a local sattelite ofice but that doesn't solve my problem of intralipid accessibility.

I guess my questions are what do you suggest based on the testing I already had that could be done differently that might increase chances? Should I repeat the nka and the RIP to see if it is worse or better? I'm coming to the end of the road and before I totally quit I want to make sure I have done all that I could to address the immune issues.

I appreciate your response. Thank you.
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Old 02-17-2009, 09:47 AM
Carolyn Coulam MD Carolyn Coulam MD is offline
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Yes, the best thing to do at this time is to repeat the RIP and NKa to make sure these elevations are persistent rather than transient. Dr. Coulam
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Old 02-17-2009, 02:12 PM
poohbear poohbear is offline
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Thank you Dr. Coulam.
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Old 02-18-2009, 10:21 AM
Carolyn Coulam MD Carolyn Coulam MD is offline
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You are welcome. Dr. Coulam
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