Cause of recurrent biochemical pregnancies & pelvic pain

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kelstopia
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Joined: Wed Apr 05, 2017 11:01 am

Cause of recurrent biochemical pregnancies & pelvic pain

Post by kelstopia »

I am 31 and since Sept. 2016 I have experienced 4 biochemical pregnancies. Additionally, I began experiencing some recurrent sharp pelvic pain on the left side in Nov. 2016. I asked my OB/GYN about this during my annual exam and also mentioned the pelvic pain. An ultrasound was performed by the PA in early January 2017 and no unusual findings were noted. I already have 2 healthy children, the first was conceived on our first cycle trying in May 2011 and the second was conceived on our second cycle trying in September 2013 (after a biochemical pregnancy in August 2013). My OB/GYN attributed my biochemical pregnancies to bad luck and offered me an RX for clomid, which I declined. Last month (March 2017), I went to an RE for a second opinion. During the appointment, she performed transvaginal ultrasound to evaluate my pelvic pain and cramping and noted a small accumulation of fluid in my uterus (I was on cycle day 8 if that matters); my ovaries looked fine, although she did mention that I had a higher than normal number of follicles for my age, and my fallopian tubes could not be visualized. She ordered several blood tests (results posted below) and a saline ultrasound to be performed around cycle day 7 of my next cycle. The reference ranges weren't posted with my blood work results, but from my own research it looks like my AMH and Anticardiolipin IgG results are a little high and my Vitamin D is a little low. I continue to experience pelvic cramping and nausea and since I won't see my RE again for several weeks, I was hoping to get another opinion on my blood work results, as well as the presence of fluid in my uterus.

Ultrasound results:
Right Ovary - Follicles: 11.1mm
Uterus Length (mm): 6.0
Uterus Height (mm): 3.1
Uterus Width (mm): 4.9
Uterus Volume (cc): 47.7
Endo Thickness: 4.8
Endo Type: None
Cul de Sac Fluid: None

Blood work results:
Anti-Beta2Glyco,IgG: 8 GUNIT
Anti-Beta2Glyco,IgA: 10 AUNIT
Anti-Beta2Glyco,IgM: 6 MUNIT

Anti-Mullerian Hormone (AMH): 5.65 ng/mL

Antibody Screen: Negative

Anticardiolipin Ab, IgG,QN: 22 GPL
Anticardiolipin Ab, IgA: 5 APL
Anticardiolipin Ab, IgM: <1 MPL

Platelet count: 301 x10(3)/uL
RBC: 4.12 x10(6)/uL
WBC: 5.81 x10(3)/uL
HEMATOCRIT: 39.3 %
MCV: 95.4 fL
MCH: 33.5 pg
MCHC: 35.1 gm/dL
MPV: 10.2 fL
EOSINOPHILS: 2.8 %
BASOPHILS: 1.4 %
HGB: 13.8 gm/dL
Lymphs: 47.7 %
RDW: 11.7 %
Immature Granulocytes: 0.2 %
POLYS: 42.7 %
MONONUCLEAR CELLS: 5.2 %

Rubella Ab,IgG: 78.0 IU/mL

Varicella Zoster IgG: 3.51

FREE T4: 1.20

TSH: 1.210

Vitamin D Total: 27.4
Dr. Wisot
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Joined: Fri Oct 14, 2005 11:16 am

Re: Cause of recurrent biochemical pregnancies & pelvic pain

Post by Dr. Wisot »

Hi:

I cannot give opinions or diagnose symptoms here; just answer questions.

Your question is "what to do." You have two problems that seem unrelated but need to be addressed. The four biochemical pregnancies deserve a thorough workup for recurrent pregnancy loss, although with two normal pregnancies it's unlikely that you have some sort of chromosomal abnormality in you or your partner. If nothing abnormal is found, to avoid another biochemical you may want to consider IVF with preimplantation genetic screening for chromosomes. BTW, your high AMH is a probably good thing if you have regular cycles.

For the pain and the fluid in the uterus I would probably be considering a hysteroscopy and laparoscopy and if something like polyps are found that could help explain the recurrent miscarriages.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group, Inc.
Redondo Beach, California
kelstopia
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Joined: Wed Apr 05, 2017 11:01 am

Re: Cause of recurrent biochemical pregnancies & pelvic pain

Post by kelstopia »

Thank you for getting back to me! I'm relieved to know that my high AMH is probably a good thing, but am still wondering about my elevated Anticardiolipin IgG. I appreciate your suggestions and will definitely mention the hysteroscopy and laparoscopy to my RE. We are hoping to avoid IVF and will be at peace with our two children if that's all we can conceive naturally!
Dr. Wisot
Site Admin
Posts: 1208
Joined: Fri Oct 14, 2005 11:16 am

Re: Cause of recurrent biochemical pregnancies & pelvic pain

Post by Dr. Wisot »

The elevated anti-cardiolipin is probably not terribly significant in your miscarriages and could be dealt with by taking a baby aspirin a day.

Arthur L. Wisot, M. D.
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