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Thread: RPL labs positive

  1. #1
    Join Date
    Jan 2014

    Default RPL labs positive

    Dr Coulam,

    I am 38 years old, have never been pregnant and no history of miscarriage. TTC for 2 years with spouse, unsuccessful. I have a history of DOR with FSH 16-19 and AMH not detectable. Most recent FSH 12.8 after using DHEA and CO Q10 for a few months. I also have a hx of endometriosis dx by lap (6 months ago) and treatment of some of the endo during the lap. Septoplasty done for partial septum. Tubes patent on HSG. Based on my hx my RE recommends "max protocol" IVF tx (Follistim, menopur, lupron, HGH) which I will be starting this week.

    In addition to the standard w/u for infertility by my RE, my OB ordered RPL labs (which he does for all his patients who have infertility).

    Lab tests showed the following:
    TSH 2.2
    Thyroid antibodies positive/elevated
    PAI- 4g/4g homozygous
    NK assay CD 19% elevated

    All other labs were normal. He recommended baby aspirin daily and started me on low dose Synthroid (he likes the TSH < 2.0). I have initiated this treatment and feel comfortable continuing. Last TSH was 1.2.

    He also wants to start Arixtra injections daily and Intralipid infusions every 3 weeks---starting cycle day 6 of IVF.

    Again, I have never had a pregnancy or pregnancy loss. I have no family history of RPL. Fam Hx of hypothyroid during preg (mom and one sister). My RE is advising just to stick with the ASA and Synthroid only and see how it goes, but is okay with me being more aggressive (like my OB is advising) if that is what I want to do. My decision.

    But, of course I'm weighing the risk/benefit and am curious what your thoughts are.

    My questions:

    Are there studies that evaluate prevalence of these values (i.e. PAI-1 4g/4g, and NK assay) in a general population of woman who have had healthy pregnancies?

    Does having just CD 19% elevation (when other NK markers and total are all normal) put me at risk of miscarriage?

    Considering I have never been pregnant and no miscarriage would you advise the more aggressive tx still based on my test results?

    Thank you for your time and expertise,

  2. #2
    Join Date
    Sep 2008


    It is difficult to give advice regarding specific patient treatment without benefit of evaluation and consultation. In general, we have not been able to relate CD19 with pregnancy outcome. The prevalence of PAI-1 4g/4g in the general population is 39%. From the information you provided, it seems as though your major risk factor for infertility is los ovarian reserve which wont respond to immunotherapy. Dr. Coulam

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