Why did I have recurrent missed abortions?
Q: I am a 38 years old woman who had two missed abortions. First missed abortion happed 1.4 years back during eighth week of pregnancy when no heart beat was found. And, the second occurred 8 months back when I had slight bleeding in the sixth week of pregnancy and heart-beat stopped in next week. My blood group is B+ and my husband's is O+. The tests reports stated - lupus anticoagulant screen - negative, glucose tolerance test – normal, rubella – negative, toxoplasma – negative, free T4/TSH – normal, glycosylated haemoglobin (HbA1c) – normal, complete blood count (CBC) – normal, ACA – negative, VDRL test - non reactive, analysis of protein C and S – normal, G20210 A mutation – negative. Apart from these, 3D ultrasound of my pelvic area – normal, karyotype of self, husband, product of conception - all are normal. Semen report of husband showed - normospermia with prolonged liquefaction and mild infection. My periods are regular and blood pressure is also normal. As all the reports were normal after second missed abortion so the doctor advised me Folvite and Loprin 75 and to plan pregnancy. I conceived again after 3 months of second abortion. I had my last menstrual period 4 months back. The doctor started Inj Susten 200 mg twice a week and Duphaston 10 thrice a day apart from Loprin 75 and Folvite immediately after I tested positive for pregnancy. I was advised to take complete rest. The ultrasound at 7 weeks 4 days showed gestational sac of 5 weeks and 3 days, yolk sac but no fetal pole. So a repeat ultrasound after 10 days was performed and showed no growth. The doctor concluded it as missed abortion again. In spite of susten, why there was no growth after 5 weeks? What could be the possible reason for my 3 missed abortions? Is there any test to access the quality of egg and sperm? What should I do? Please advise.
A:I am very sorry to read about the unfortunate missed abortion a third time. You have received all possible medicines this time. All relevant tests are also normal.
- It is difficult for me to pinpoint cause of 3 missed abortions. Last time, karyotype of the aborted material was normal; that does not guarantee that is so this time as well. However, that is just a theoretical point. One needs to analyse what needs to be done next.
- One can choose good quality egg and sperm by assisted reproductive techniques (ART). You have not mentioned percentage of abnormal sperms in your husband's semen analysis, and the motility - guess these parameters are also normal. In any case, going through ART is very stressful, time consuming, physically stressful, and expensive.
- I suggest you wait for at least 6 months before you plan the next pregnancy - your uterus needs to recover. Also, take folvite for 3 months prior to next pregnancy. There are reports that antioxidants help in cases like yours. I have personally not conducted a trial, but I feel it is worthwhile for you and your husband to take these starting 3 months before the next pregnancy, and you need to continue it through pregnancy. One such tablet is LycoRed 1 tablet to be taken twice daily. Other similar preparation is tablet Gardian 1 tablet to be taken once daily.
Best wishes. Cheer up - because this may be nature's way of preventing a bigger problem -taking place later.
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