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Did I suffer a miscarriage due to recurrent vaginal infection?

Q: I am 28 years old. I suffered two miscarriages within one month of pregnancy, the first two years ago and another one a year later. The test reports details after first miscarriage are: Glucose - (F): 112; (PP): 146; TORCH - Toxoplasma IgM: 0.39 AI; Rubella IgM: 2.16; Cytomegalovirus: 3.33; Herps Simplex Virus - 0.54 VRDL - Non-reactive; Haematology - B+; Hb - 10.7 gm%; Report of tests conducted after second miscarriage: SEMEN ANALYSIS - Volume: 1.0 ml; pH: Alkaline; Number: 70 million; Motility - Active: 70%; Non-motile: 30%; Glucose - Fasting: 90; PP: 110; Thyroid - FT3: 1.46 pg/ml; FT4: 1.21; TSH: 2.04; Prolactin: 1.2 ng/ml; TORCH - Rubella IgM (German measles): 0.33; Cytomegalovirus IgM: 0.20; Rubella IgG: 0.20. My doctor has advised me to undergo PCT tests. We are afraid of recurrence of mishaps and willing to do everything before trying again. What should I do for recurrent vaginal infection? At the age of 30, how much can I wait before making another attempt? People say that its too late now. What is ACA-IgG-Igm test, will it clarify the reasons of miscarriage and possibility for future pregnancy? Are vaginal and viral infections different things? What has caused miscarriage in my case?

A:At the outset I would like to state that every laboratory has its own cut off values for various tests, before deciding whether or not the test result is abnormal. TORCH tests and thyroid function tests are performed in many ways. So it is best your treating doctor reads the test reports in detail to tell you whether or not any one is abnormal. For recurrent vaginal infection both you and your husband need to be examined thoroughly. You should have a pap smear done and if you have a cervical erosion, which may be the cause of recurrent vaginal infection, that can be treated by cryotherapy. However, this will treat the cervical infections and not the vaginal infections like recurrent fungal infection. You must have a 100 gm oral GTT done to rule out tendency for glucose intolerance. The blood sugar reports after 1st abortion were borderline. Thirty years is not too old. If you are worried about having a Down baby, that can be ruled out by doing the triple test and ultrasound when you are pregnant. ACA means anticardiolipin antibody. It is one of the 2 antibodies that are positive in women with antiphospholipid antibody syndrome. The other one is lupus anticoagulant. You need to be tested for both. These antibodies, if positive, are associated with pregnancy loss in the form of recurrent abortions (with dead fetus), intrauterine fetal death, intrauterine growth restriction (IUGR) and pregnancy induced hypertension (PIH). If positive, you need to be treated with low dose aspirin or I/V immunoglobulins during pregnancy. Vaginal infections can be due to fungus, bacteria, parasites and virus. Usually it is due to first 3 causes. Unless I have more details of your vaginal infection it is impossible to state whether or not the vaginal and viral infection is related to your abortion. Lastly, I would advice you and your husband to have a karyotyping done (chromosomal analysis). As I do not have details of the 2 abortions, I cannot advice more. However, let me inform you, that depending upon the details of your abortion, you may need to have HSG/hysteroscopy, and luteal function tests (generally serum progesterone assay on Day 21 of a 28 day cycle). Other tests done for immunological causes of recurrent abortion include: antipaternal lymphocytotoxic testing, and Natural Killer Cell Cytotoxic Asssay; however, treatment for these is controversial.

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