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What is the reason for repeated failed pregnancies?

Q: My 33-year-old wife has had one still birth and two miscarriages in the three years of our married life. The first pregnancy lasted for eight months. The second and third pregnancies lasted 6.5 weeks and DNC was performed on both occasions. After the stillbirth, her SGOT, SGPT and alkaline phosphatase levels were very high which were brought to normal by medication. The TORCH test showed elevated levels of CMV; rubella, both IgG and IgM values, were normal; anti-cardiolipin, anti-phospholipid and antibody levels were also normal; and so were the thyroid function test, RA, lupus, anti-coagulant, VDRL and HIV 1 and 2. After the first miscarriage, the chromosomal analysis of POC was normal. During her third pregnancy, she was given Ovigyn injections (one per week) and folvite. What could be the reason for all these failed pregnancies? Is it possible to have a successful pregnancy this time? Are there any tests to detect the causes that can be prevented?

A:Your wife will need to undergo TORCH test, anti-phospholipid and anti-cardiolipin tests again and also a GTT for diabetes. Serum progesterone on the 16th day of the menstruation cycle and karyotype of both partners can also be done; however, one should keep in mind that all these tests could be normal, as in several cases we cannot be sure of repeated mishaps. An ultrasound and urine for culture to rule out any infection should also be done. The next pregnancy should be planned only after a gap of at least six months. In the time being, preconceptional Folic acid 5 mg/day can be started, and a healthy balanced diet, rich in all vitamins, should be taken. If any abnormality is detected, it should be treated before planning pregnancy.

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