Diagnosis: Luteal Phase Defect
by Melissa

What a Luteal Phase Defect (LPD) Means and Its Impact on Fertility

In order to talk about the important things like progesterone levels, you need to know something about your cycle. Simply put, your cycle is broken down into two parts. Pre-ovulation, it’s called the follicular phase. As it sounds, this is the part of the cycle where the follicle is growing and preparing to release an egg. After ovulation, the second part of your cycle is called the luteal phase. This is the time where the embryo implants and (hopefully) gets cozy for the next nine months. If the embryo fails to implant–or going even more basic, the egg fails to fertilize–the cycle ends and begins anew with your period.

Follicular phases can vary in length. Sometimes, they fit the average 28 day cycle and the person has a 14 day follicular phase and a 14 day luteal phase. But the length of time is determined by the follicle’s rate of growth because the follicular phase will continue until the egg is released. That could happen earlier than 14 days or much later than 14 days.

The luteal phase isn’t really supposed to vary in length like the follicular phase. The length of the luteal phase is determined by the corpus luteum (the “yellow body” that is left after the egg is released from the follicle). The breaking down of the corpus luteum and the end of the cycle usually happens around 12–14 days after ovulation (unless the embryo implants).

But in some women, it happens much sooner. Or the corpus luteum doesn’t secrete enough progesterone. Or the progesterone it does secrete doesn’t build up the endometrial lining for implantation. Which means that the person either cannot become pregnant or maintain a pregnancy.

Diagnostic Process

There are several tests that are used to determine a luteal phase defect. The least invasive is what is called a “day 21 progesterone test.” It actually needs to be drawn around 7 days post ovulation (7 dpo). Therefore, it would only occur on the 21st day of your cycle if your cycle was 28 days long and you ovulated on the 14th day. Most doctors want to see at least 10 ng/mLs of progesterone and some give a diagnosis of low progesterone for anything under 20 ng/mLs.

Some doctors will treat a LPD with progesterone supplements and follicular-stimulating hormones without conducting more tests. But those who have normal progesterone levels and adequate follicles may have an endometrial biopsy performed if a day-21 sonogram (again, 7 dpo) reveals endometrial lining that is too thin. Whether or not your doctor progresses to performing an endometrial biopsy will be determined by his comfort with diagnosing from blood work and sonograms.

Treatment Options

The corpus luteum is only as good as the follicle that creates it. Therefore, many doctors begin by attempting to nurture great follicles which will in turn become strong corpus luteums. Doctors will prescribe Clomid (oral) or an follitropin like Follistim or Gonal-F (sub-cue injectible) to stimulate follicle growth. After ovulation, vaginal suppositories of Prometrium are prescribed (there are also IM injections of progesterone).

Personal Experience

We began suspecting there was a problem once I began charting my temperature. Most months, my luteal phase was only 10 days long (or less). But on other months, my luteal phase would stretch as long as 21 days without tipping a positive home pregnancy test (though blood work showed low hcG levels). Blood work 7 dpo confirmed low progesterone. My first blood draw had a result of less than 5 ng/mL. Every subsequent test showed under 3 ng/mL.

We took Clomid (days 3–7) and then Follistim (over the course of many days based on sonograms and hormone levels). After few days after an hcG shot to trigger ovulation, I took Prometrium twice a day until I received a negative beta (or in the case of the month I got pregnant, I continued taking Prometrium until my 15th week of pregnancy).

Uterine Anomalies
by TeamWinks and Serenity

What a Uterine Anomaly Means and Its Impact on Fertility

A uterine anomaly is a form of congenital birth defect – in that the uterus forms when the fetus is inside her mother’s womb.

About ten weeks after conception, the uterus is comprised of a pair of structures called mullerianducts. The top of the ducts (i.e. the ones closest to the embryo’s head) will become the fallopian tubes – they remain separated throughout development.The bottom of the mullerian ducts, however, begin to fuse together to become one structure that will become the uterus. At stage one of this fusion, they have formed a central wall, or “median septum” in the middle of the fused tube. This structure, when first formed, is a cylindrical structure of equal diameter.

Between ten and thirteen weeks, the central wall of this tube begins to expand at the top to form the uterus fundus. At the bottom of the uterus, this central wall, or median septum also begins to dissolve; leaving a continuous chamber that will become the uterine cavity.Between weeks thirteen and twenty, the median septum should dissolve completely from the bottom to the top of the uterus, resulting in a single, continuous uterine cavity.

Uterine anomalies result from the following:

• failure of one of the two mullerian ducts to form (unicornuate),
• failure of the two ducts to fuse completely (bicornuate), or
• failure of the two fused mullerian ducts to dissolve the median septum (septate).

Diagnostic Process

Some uterine abnormalities can be diagnosed with a simple ultrasound – a bicornuate uterus, for example, sometimes clearly shows two uterine cavities (or “horns.”) However, once a uterine abnormality is identified, it does take some work to fully diagnose it. The best method of diagnosis is generally a hysteroscopy and/or laparoscopy, but that requires the use of generalanesthesia and is generally more expensive.

A HSG & Saline Infusion Ultrasound, where they fill your uterine cavity with fluid/dye can give your RE a good idea of what type of abnormality exists. Your RE may want to perform a MRI, CT scan, and/or 3D ultrasound as well.

Treatment Options and Prognosis

Treatment of a uterine abnormality is entirely dependent on which type of diagnosis you receive and your RE. Generally, however, a septate uterus will present fertility issues in that the septum has no blood flow and will sometimes interfere with the implantation process. In that case, a hysteroscopy and laparoscopy will be recommended, where your RE will surgically remove the septum. Depending on its size, you may need multiple procedures. Unicornuate and bicornuate uterus diagnoses will often not be treated at all, since with both types there tends to be a normal blood flow to the uterus. However, there is an increased chance of preterm labor – since the uterus doesn’t stretch like a “normal” uterus would. Thus, when a woman with this type of anomaly becomes pregnant, some doctors classify them as high risk.

Personal Experience

TeamWinks’s perspective

Once you learn that you have a uterine anomaly, you can expect a whole lot of confusion. It is often very difficult to pin down exactly what your uterus looks like. Reproductive outcomes for women with these anomalies aren’t all that reassuring, and it certainly doesn’t help that there is a lack of literature out there to educate yourself. Be prepared to primarily read literature that was prepared for other doctors and not the average woman. They are often dense articles, and take time to work through. There is a wonderful support group on yahoo that does help (http://health.groups.yahoo.com/group/MullerianAnomalies/)

I am not sure whether I have a bicornuate uterus or a unicornuate uterus. My RE has been unable to pin this one down. Soon we should know for sure. I would say on a good day that having this birth defect can be difficult. Often women with a uterine anomaly have only one kidney. Thankfully I have two. They also have high incidences of PCOS, endometriosis, insulin resistance, high miscarriage rates, and pre-term labor. That’s a strong cocktail thrown at you at once. I truly believe you need a support system from the moment the diagnosis is handed to you. It’s important to remember that it isn’t a death sentence. However, it is important to ask as many questions as you can.

Serenity’s perspective

My RE thinks that I have a true bicornuate uterus, which was diagnosed last year after my hysteroscopy. But given our recent IVF failures and that we believe it might be implantation related, we are revisiting this at the end of the month, however, with a 3D ultrasound to ensure that he didn’t miss a septum earlier. The biggest thing to remember: the statistics and risks they throw at you when you’re diagnosed are often skewed. There are a lot of women who a have bicornuate/unicornuate uterus who have never been diagnosed; they have gone on to get pregnant and have perfectly normal pregnancies and healthy babies. My OB and my RE told me that having a bicornuate uterus was probably the “best” one to have, practically speaking, since I have good endometrial lining in both horns. They have also told me that the bulk of women who have this to go on and bear very healthy, normal children. So my advice would be to take the risks you’ll read about with a grain of salt.

Links for uterine anomaly research:

http://www.emedicine.com/med/topic3521.htm

http://www.sidelines.org/

Images of Uterine Anomalies

In addition, Preventing Miscarriage by Jonathan Scher has some information about uterine anomalies and their role in miscarriage.

Ovulation Predictor Kits (OPKs)
By Cassandra

Why would you use an Ovulation Predictor Kit?

An Ovulation Predictor Kit is a home test that can be used to help you determine if and when you are ovulating by detecting the level ofluteinizing hormone (LH) in your urine. In most women, the level of luteinizing hormone rises slightly right before ovulation. Using ovulation predictor kits during specific times of the month allows a woman to pinpoint when that surge occurs and estimate fairly accurately when ovulation will happen.If you are trying to get pregnant, you might use this test to figure out approximately when you will be ovulating and thus, the best times to have intercourse. If you have been trying to get pregnant with no success, this test will also help you–and possibly your doctor–determine if your body is indeed releasing an egg during your monthly cycle. Finally, some women utilize the OPK tests to prevent pregnancy by using them to determine when they are most fertile and avoid intercourse during those time periods.

What to expect

You can purchase Ovulation Predictor Kits in a variety of places, including K-mart or Target. Some online retailers will offer a discount for bulk purchase which is helpful if you have an irregular cycle and tend to use alot of OPK’s each month. OPKs are almost always located near the home pregnancy tests in the typical retail store.

Most Ovulation Predictor Kits usually contain 7 individual tests that appear almost identical to a home pregnancy test in shape and size. They typically consist of a “pee stick” wrapped in a foil or plastic covering. One end usually has a thumb grip and the other is an absorbent tip that is passed through the urine. In the middle you will usually find one or two windows where the control and result lines will appear. Some brands will provide a cover for the absorbent end so that you can lay the stick down while waiting for results without worrying about having the urine covered tip exposed on your counter.

Since you are attempting to find the LH surge and ovulation during your cycle, you will want to start testing prior to when your best estimate ofthat date would be and continue testing until the OPK indicates that you have reached your surge. This means that if your cycles vary from month to month or you have an extremely long cycle, you may use more tests in a month than a woman with a short or regular cycle. The most widely used method of calculating when to start testing is to take the number of days in your shortest cycle and count backwards by 14-16 days. The result will be the cycle day on which you should begin using the OPKs. (Note: Cycle days are counted from the date your period begins until the day before the next period begins). For example, if your shortest cycle in the last six months was 27 days, you would begin testing on day 11 or 13. In addition to this “rule of thumb”, the OPK box usually contains which days you should use the test based on various cycle lengths.

The best time to use the OPK tests is early afternoon or evening. This is due to the fact that occasionally your body will experience an LH surge inthe morning but it will not show up in your urine until several hours later. By testing mid-day you are more likely to catch a surge if it happens that day. It is a good idea to test the same time each day. Use the test by placing the absorbent tip into your urine stream for several seconds and then reading the results in the test window after waiting for the time specified on the kit’s instruction leaflet. If you want to, you can also place the urine into a sterile cup and dip the absorbent tip of the OPK into the cup for several seconds.

Every time you use an OPK test, one line will appear in the window. This is the control line and is there for use as a comparison to the result line and to let you know that the test is working properly. At some point during your cycle a second line (result line) should appear. It may be faint at first – this is not a positive test result. When this result line becomes as dark or darker than the control line, you have gotten a positive OPK test and will most likely ovulate within the next 12-48 hours. (Note: Some brands of OPKs consider it a positive result only if the test line is darker. Other brands consider it a positive result as soon as the result line is equal in darkness to the control line). If you are trying to get pregnant, at a minimum you should have intercourse on the day your test is first positive and for at least two to three days after.

Problems that may arise and ways to troubleshoot

It is important to note that the use of Clomid may produce false positives in an OPK test. Many manufacturs suggest waiting several days after taking Clomid to use an OPK. I have also read that Pergonal, Humegon and Repronexcan also cause false results.

If you do not get a positive result there may be several different reasons. First, you may have missed your surge. Some people need to test earlier in their cycle and some need to test more than once per day in order to catch their LH surge. If you try more frequent testing and more than one brand of test and still find that you are not detecting an LH surge, you may want to discuss this with your doctor. You may have a line in the results window for several days that gets darker each day until finally becoming a positive result. This is not unusual. If you are trying to get pregnant it is not a bad idea to begin having intercourse when the line gets close to being an actual positive result rather than waiting until it is truly positive.You may experience a positive test one day and then another positive a day or two later. This, too, is not unusual as you may catch the LH surge on both the way up and down. If you do not have a line in the control window, the test may be defective and you may want to consider trying again.

Lastly, it is possible to have more than one LH surge in a cycle. Often times, the body will gear up for ovulation several times, giving several false LH surges before producing the true surge that releases the egg.

Personal tips

I strongly suggest starting testing very early in your cycle when you first begin using OPKs. You are more likely to find your LH surge this way. I went by the “rule of thumb” and charts on the pamphlet for months with no success before testing earlier than they said and finally getting a positive test. It turned out that I usually ovulate way before the days they were telling me to begin testing. When you first start using OPKs, it might seem like an impossible task trying to decipher the “dark” or “darker” color coding system (I can’t tell you how many pee sticks I’ve held up to the light trying to figure out the subtle color shades). Don’t stress. It will probably be pretty obvious when the actual surge occurs.

I mentioned above that OPK tests look a lot like a home pregnancy test (HPT). Since I use a lot of both, I always have both on hand. I also switch brands of both a lot depending on what is available at the store and what is priced reasonably. Needless to say, I have a variety of brands of each in my cabinet. One month I accidentally used an OPK thinking I was taking a pregnancy test and was quite surprised by the results. I would definitely suggest keeping your various pee sticks in separate places to avoid this confusion. Many women also use basal body temperature charting (BBT) to track ovulation. I use this in conjunction with the OPK tests since the OPK test tells you that you are ovulating prior to it happening but the BBT charting shows more after you have already ovulated.

Finally, as a side note, there are also saliva test kits, ovulation monitors (expensive), and mucus test kits that can be used to help detect ovulation.

D&C (Dilation and Curettage) or D&E (Dilation and Evacuation) After a Pregnancy Loss
by Tina

I just wanted to say, before getting into the details of D&C or D&E, I am sorry for your loss and that you even need to be reading this area. I have miscarried three different ways (detailed further in the text), so I hope my experiences can help you to make a decision on how you handle yours.

There is no right or wrong way to manage your miscarriage, as long as it is not life-threatening to you. Sometimes you do not have an option in how you manage your miscarriage–it just begins without warning and you miscarry naturally. Other times, you have choices and time to make those decisions, and your choices should be made based on your own personal wants and needs to honor the baby to whom you are saying goodbye.

Why You Would Opt For a D&C or a D&E?

As background, D&C (which stands for Dilation and Curettage) is a procedure done in the uterus by scraping of the lining of the uterus (the endometrium). Another, less invasive, version of a D&C is the D&E (which stands for Dilation and Evacuation). In a D&E, instead of scraping, the lining of the uterus is suctioned out.

The following are the main health reasons a woman may have a D&C or a D&E done:

• for a woman who knows she is going to miscarry and opts not to have a natural miscarriage at home;
• for a woman who a recently miscarried naturally, or who previously had a D&C/D&E done and retained tissue remains in the womb;
• for a woman who is experiencing heavy or irregular periods, or vaginal bleeding after the menopause.

Opting for a D&C/D&E when a miscarriage is detected and has not begun is a personal choice, which has its own set of pros and cons – and there is no right or wrong choice in opting for a D&C/D&E, as long as it is the right choice for you.

Choosing to have a D&C/D&E depends upon several personal factors you need to consider:

• how far along the pregnancy might have been or what bleeding has already occurred;
• how long you have known about the impending miscarriage and the emotional toll already taken on you because of it;
• strong emotional feelings over the impending pregnancy loss;
• emotional preferences on how one feels the pregnancy should be allowed to end;
• family issues, such as care of other children in the home;
• preference for medical testing on the fetal tissue from the miscarriage, especially in recurrent miscarriage;
• work issues, such as project management and duties, and time off for the miscarriage.
  

What to Expect

A D&C/D&E is considered minor surgery, therefore, it is performed in a hospital or ambulatory surgery center or clinic.

In most cases, you would be given general anesthesia, which would require someone to drive you to/from the location of the procedure. You should not eat/drink anything 12 hours prior to the procedure. Sometimes, women will request local anesthesia instead – that is something that would have to be discussed with the gynecologist performing the procedure.

In the actual procedure, a speculum is inserted into the vagina to open the walls to view the cervix. A clamp-like instrument holds the cervix in place as the cervix is dilated with a series of tapered rods of increasing widths, which are inserted into the cervical opening.

If a D&C is performed, the ob/gyn will insert a specialized scraping scalpel (called a curette) to scrap the retained tissue from the uterus;

If a D&E is performed, the ob/gyn insert a hollow tube through the cervix and suction is applied to remove the retained tissue.

The procedure usually takes anywhere from five to twenty minutes to finish, depending upon how far along the pregnancy was or if the procedure is specifically to clear out retained tissue from a natural miscarriage or previous D&C/D&E.

It is normal to experience light, irregular bleeding in the days following the D&C/D&E, along with mild cramping. Naproxen or ibuprofen is usually given for relief from cramping. You may also be given a prescription for a medication to stop a hemorrhage (just as a precaution should you begin to hemorrhage after the procedure).

Most women are told to take the day of the procedure and the following day off from work (if you work), and to rest as much as possible for those two days. But, generally, physical recovery is fairly quick.

After a D&C/D&E, you should get a list of instructions with the following instructions:

• Avoid intercourse for 2 weeks. Bacteria can easily get into your uterus and cause infection until your cervix returns to normal after the dilation;
• Use only sanitary pads for bleeding. Avoid tampons for at least 2 weeks. Do not use douches;
• Be sure to return for your follow-up visit, usually 2 weeks after the procedure. Your ob/gyn should discuss all lab reports on your tissue sa
  mples, if testing of the fetal tissue is ordered. Your ob/gyn will also examine you for any signs of infection and to make sure your cervix/uterus have returned to normal size.

Problems That May Arise and Ways to Troubleshoot

Although I personally have not had any problems after either my D&E nor my D&C, there are several problems that can arise from the procedures:

• If your ob/gyn is too cautious in the procedure (especially with a D&C, since it involved a real scraping scalpel), retained tissue can remain. This tissue is usually passed without complication afterwards, although in some instances, the possible need for another procedure may arise. Sometimes, like a natural miscarriage, tissue is missed;
• Rarely, an ob/gyn can accidentally puncture the uterine wall while performing either a D&C/D&E;
• Hemorrhage is rare, but it can occur if an instrument injures the walls of your uterus. It also can occur if an undetected fibroid is cut during procedure;
• You can end up with an infection because your natural uterine environment is being invaded to do the procedure. Some ob/gyns’ prescribe antibiotics up-front to prevent it from happening – some, like my ob/gyn, do not;
• Asherman’s Syndrome, although rare, can develop later on. This syndrome involves the formation of scar tissue in the uterus, caused by aggressive scraping, repeat D&C/D&E’s, or abnormal reaction to the scraping. Thick scars can result, which can fill up the uterus completely. Abnormal bleeding/loss of periods and heavy cramping are signs of the syndrome. A sonohystogram can detect this scarring, which can be corrected surgically if diagnosed correctly.

Call your doctor immediately if you develop any of the following symptoms:

• Fever/chills;
• Severe persistent pain or cramps not relieved by ibuprofen or naproxen;
• Prolonged or heavy bleeding (more than 6 hours, or requiring a change of sanitary pads several times in 1 hour);
• A foul-smelling discharge from your vagina.

Personal Tips

I have personally experienced three miscarriages: One natural miscarriage at 4 wks 1 day (9/04), a blighted ovum which required a D&E since the miscarriage would not start on its own (11/05) and a missed miscarriage when the baby stopped growing at 6 wks 4 days, which I opted to have a D&C immediately (3/06).

Through these experiences, I have several tips that I hope can help anyone that has to go through this experience:

1. Do not let an ob/gyn pressure you into an immediate choice of a D&C/D&E. You need to take into account how you feel you need to manage this decision, and make sure the diagnosis of miscarriage is confirmed.

2. Make sure your miscarriage is confirmed by blood work AND ultrasound before you consider a D&C/D&E. My ob/gyn is very experienced, but he told me that even he has made mistakes in diagnosing a miscarriage – on rare occasions, blood work and repeat ultrasound can detect an incorrect diagnosis and the pregnancy is viable. So, having repeat betas and ultrasounds to confirm the miscarriage is crucial. With my 11/05 miscarriage, I had three beta draws and three ultrasounds to confirm the miscarriage.

3. Discuss the procedure thoroughly with your ob/gyn so you understand how the procedure is done and any questions you have are answered. Be clear on what kind of anesthesia you want – and what is allowed in the surgery center where you are having the procedure. This can be a very emotional procedure, and you need to have your concerns and questions answered before hand.

4. If you experience nausea/vomiting as a morning sickness sign like I did with my 3/06 miscarriage, even though you are miscarrying, you can ask for meds to be injected into your IV line so that, when you wake up from the procedure, the nausea subsides for you.

5. When you wake up from the procedure, be prepared for the reality that the pregnancy is now completely over. When I woke up from my D&E in 11/05, I was crying as I realized the procedure was done. Luckily for me, the nurse was very sweet and gave me tissues and allowed me to cry while she stood there holding my hand.

6. Make sure your ob/gyn leaves instructions on what you should do when you go home and if you see any problems arise after the procedure. Better yet, ask that your ob/gyn stops in to see you after the procedure is done. My ob/gyn stopped in to see me after both my D&C and D&E to make sure I was physically okay.

7. If you have children at home, ask someone to care for them for a little while as you sleep off the anesthesia and you are sure your bleeding after the procedure is within the normal range. To recover well, you need to rest.

8. Remember: After a D&C/D&E, you have now had a complete miscarriage. Your hormones usually “dump” quickly, which can potentially make you an emotional basketcase. I cried through Thanksgiving dinner in 11/05 since my D&E was done two days prior and my hormone levels were going down quickly. So, if you are having a hard time with the loss right after the procedure, it is completely normal and to be expected.

9. If you are not prepared to go back to work (if you work) after the two days home, don’t. My D&E in 11/05 was done two days before Thanksgiving, so despite the holiday, I had several days to begin to sort through the emotions. But, after my D&C was done in 3/06, I returned to work after the two days – and it was just not enough time to begin to the grief process.

10. Insist on that follow-up visit in two weeks. Some ob/gyns try to skate around it – you really need the follow up to make sure you are physically recovered and to ask questions you may have.

11. Ask for repeat betas afterwards to make sure your HCG levels are going back down to zero. For some women, it takes a few days – for others, it can take a few weeks. If you want to TTC right away, you need to make sure your HCG levels are down to zero again.

12. You are usually very fertile after a D&C/D&E – the lining is almost always cleaned out and fresh. So, if you do chose to TTC after the procedure, your odds are usually a little better for conception.

13. And, lastly, be comfortable with the decision in how to handle your miscarriage. Waiting to miscarry sometimes is not an option and you miscarry quickly. Other times, like for my 11/05 miscarriage, you are waiting for weeks for it to begin. A part of the emotional healing process is to be comfortable with how you chose to manage your miscarriage…there is no right or wrong way to do that. It just has to be right for you.

Testing for Recurrent Pregnancy Loss
by Amy

A starting list of tests for your doctor to run if you are experiencing recurrent pregnancy loss (RPL). This post is simply a starting point to help you start the conversation, though your care should be guided by your doctor.

Anti Phospholipid Antibodies (APA)- cardiolipins are proteins found in your body that work against your body. Cardiolipins help regulate blood flow throughout the body. However, when your body looks at the cardiolipins as an invader, it will attack them. The three main groups are: IgG, IgM, IgA.

• Normal Results: IgG is below 23 ug/mL, while normal IgM and IgA is below 11 ug/mL. This indicates typical levels of cardiolipin antibodies in your blood.

• Abnormal Results: levels between 25ug/mL and 70 ug/mL. However, these levels may interfere with your ability to become pregnant or carry a pregnancy to term.

Other anticoagulant tests that fall under APA are the following:

Anti Cardiolipin Antibodies (ACA)- cells that attack the nuclei of other cells in your body. This is a mistake made by the body, thinking the good guys are the bad guys. Low levels should cause no problems.

• Normal results: levels are typically under 1:20, though 1:40 is also acceptable.

• Abnormal Results: levels above 1:40 indicate a high presence of anti nuclear antibodies in your blood.

Anti Nuclear Antibodies (ANA)- Again this is your body mistaking the good for the bad. Only this time it attacks the nuclei of the cell(s).

• Normal and abnormal levels are the same here as they were for the APA.

• Typical treatment for abnormal results is the use of the medication prednisone.

Lupus Anti Coagluant (LAC)- this is a protein in your blood that causes it to clot in your bloodstream and veins differently than it normally would. To test for this there are actually several tests compiled and then looked at as a whole. These tests are the Activated Partial Thromboplastin Time (aPTT), the Modified Russel Viper Venom Time (VPTT), the Platelet Neutralization Procedure (PNP), and the Kaolin Clotting Time (KCT).

The typical treatment for this is baby aspirin, prednisone, and heparin/lovenox.

Anti Thyroglobulin Antibodies (ATA)- Thyroglobulin is the protein that connects with the thyroid, which produces different types of hormones. Antithyroglobulin is usually found with antimicrosomal antibody in the bloodstream. These two antibodies together, a.k.a antithyroid antibodies, attack the thyroid gland.

• Normal/ Negative Results: levels less than 1:72

• Borderline Results: levels between 1:72 and 1:300.

• Abnormal/ Positive Results: levels higher than 1:300

Further testing is usually required to rule out other issues and is then treated with prednisone and dexamethasone.

Parental Chromosome/ Karyotype- when blood samples are taken from both partners and tested for extra chromosomes, missing chromosomes, deletions or additions to the data within each chromosome, and translocations of chromosomes (in which all chromosomes are present but rearranged.

Embryo Toxic Factory (ETF) Panel- this when your immune system looks at your new embryo and says, “invader!” So it attacks the embryo because your body is producing too many white blood cells. This test occurs in two steps

First, your blood is taken and the cells (lymphocytes) are isolated and placed ina special solution

Second, is the embryo culture. This is when the lyphocytes are combined with a two-cell embryo from a mouse. After several days, the mouse embryos are looked at again to see if toxic substance is being produced. If the mouse embryo has stopped developing or died, it is and indication of ETF. If it’s still developing then there is no toxic substance being produced.

Anti-Mullerian Hormone (AMH)- this appears to a relatively new test. However, it is expensive and still not covered by insurance companies. It is projected that it is accurate 70% of the time.

This test measures the hormone, Anti-Mullerian, which is produced by the ovaries. This hormone does not fluctuate through out the month and is considered to be an indicator of a women’s ovarian function. The manufacture believes this test to be a more reliable test than testing a women’s oestrogen. If it turns out that this is true it could be a predictor in how successful a women will be when undergoing IVF and a diagnostic test to help indicate if a women has PCOS. Women with PCOS have higher levels of AMH than their peers.

NK Cell Test/ Natural Killer Cell Activity Levels- this test measures the bodies immune system and it’s natural production of natural killer cells. Natural killer cells are made by the body to attack cancer cells. Once the NK cell binds with the cancer cell it emits a toxic chemical to kill the cell. However, during pregnancy the natural killer cell mistakes the embryo for a cancer cell and begins attacking. This is why women with multiple miscarriages, or Recurrent Pregnancy Loss, have a tendency to have high levels of NK Cells.

In the lab after mixing the NK cells and embryonic cancer cells and dying ech with a different solution they are cultured. After two hours, another solution is added that absorbs only the dead cells. Finally, the remaining cells are placed under a laser and counted by a computer. The number of cells left indicate a positive or negative result.

The treatment for a positive NK is IVIg. This is where blood products are gathered and used in an infusion. This infusion helps suppress the immune system and success rates are as high as 80%. Treatment lengths vary and can start as early as 2-3 weeks before conception and as late as 35 weeks. Also, an individual treatment of IVIg can cost anywhere from $3,000- $5,000.

However, it should be noted that many in the field of reproductive medicine consider this treatment and test controversial as there has been difficulty duplicating studies. If you are interested though, to get started you can check out SIRM (Sher Institute of Reproductive Medicine) at haveababy.com. There are several clinics throughout the country and if travel is not an option for you perhaps you can look at their chat rooms/ message boards and get some ideas of where to begin in your area.

Leukocyte Antibodies Detection (LAD)- Leukocytes are white blood cells. During a pregnancy your body can recognize your baby as an invader and attack it. In response to this your body produces leukocyte antibodies. These antibodies are found in pregnant women, those receiving blood transfusions, and donated organs.

• Lower- than normal levels of these antibodies have been liked to those with miscarriage, still births, and recurrent pregnancy loss.

• Normal Levels/ Negative Results: above 50%

• Borderline Level Results: between 30% and 50%

• Abnormal Levels/ Positive Result
  s: less than 30%

Treatment is Leukocyte Immunization Therapy (LIT) and consists of an injection of white blood cells either given by your partner or donated.

**** It is important that you have the traditional IF work up done in conjunction with these tests as well if you are suffering from Recurrent Pregnancy Loss*****