Holly and Mike first came to see us after Holly had her fourth miscarriage. The recurrent miscarriage problem had all of her OB/GYNs and other consult doctors scratching their heads as to the cause. The doctors had done tests for immunological and other causes, but did not have a solution. She even consulted with another reproductive immunology program, but like the other consults, they had come up empty.
Holly and Mike’s Consultation at Reproductive Immunology Associates
Holly was really hurt by her inability to carry to term. I remember her sitting in my office crying her heart out, convinced that she was on a fool’s errand, that no one would be able to help her. She was afraid to keep trying, because she couldn’t bear the agony of another devastating loss. She even argued with me when I told her that perhaps, with our help, she could have a baby. Her husband Mike finally forcefully told her to stop being belligerent and listen. Holly mustered the courage to try one more time.
Testing and Diagnosis of Immunologic Causes for Holly’s Recurrent Miscarriages
We tested Holly and Mike for any immunologic causes for the recurrent miscarriages, and found that Holly tested positive for anti-phospholipid and antinuclear antibodies.
Antiphospholipid antibodies can cause blood vessels to constrict, causing decreased blood flow throughout the circulatory system. The combination of blood clots and constricted blood vessels may impair blood supply to the fetus and placenta resulting in complete fetal demise or growth retardation.
Some phospholipid molecules have adhesion properties i.e. glue like, and allow cells to fuse. The formation of the normal placenta involves the fusion of small cells called cytotrophoblasts into giant cells known as syncytiotrophoblasts. The syncytiotrophoblasts play a key role in the regulation of nutrients going to the baby. Antibodies to phospholipid molecules can, therefore, interfere with the development of the placenta.
With each pregnancy loss, there is a 10% chance that the mother will develop an antibody to a phospholipid molecule. Most women with antiphospholipid antibodies are not sick. However, some have underlying autoimmune tendencies and should be appropriately evaluated. Women with underlying autoimmune diseases may have antiphospholipid antibodies even before they ever become pregnant.
Some people have antibodies to different nuclear components. What causes these antinuclear antibodies to be made is currently under investigation but there appears to be a genetic susceptibility which may be reflected by the HLA tissue type. Most women who suffer recurrent miscarriages may exhibit autoimmune phenomena which is similar to that seen in Systemic Lupus Erythematosus (SLE) patients. The placentas in these women are inflamed and weakened. Most people have no antinuclear antibodies all the time (A,B). Many women who miscarry have borderline (C,D,E) or abnormal levels of antinuclear antibodies (F,G).
Treatment for Antiphospholipid Antibodies and Antinuclear Antibodies
Once we properly diagnosed the problem, we began giving her treatment in preparation for her and Mike trying again to conceive. Holly was one of those individuals that require a combination of IVIg and heparin therapy because of anti-phospholipid and antinuclear antibodies. Holly also had to take prednisone because of antinuclear antibodies.
Antiphospholipid antibodies are treated with low dose (baby) aspirin and a blood thinner called Heparin. Heparin is a very large molecule and is unable to cross the placenta. Aspirin is able to cross the placenta but the dose used is so small that the fetus is unaffected. The effectiveness of treatment is much greater when the medication, if indicated, is started prior to conception and continued throughout the pregnancy. All medication, if indicated should be discussed with one’s physician.
Women with ANA are treated with prednisone, a corticosteroid, which suppresses the inflammatory process and stabilizes the cell. Prednisone does not pass through the placenta easily and is also broken down by enzymes in the placenta so that the fetus is exposed to only trace amounts. Additionally, the body produces the equivalent of 8 mg per day of this corticosteroid. When indicated, Prednisone should be started prior to conception.
Getting Pregnant – Another Challenge for Holly and Mike
Then, after beginning treatment, Holly found that she could not seem to get pregnant. This was not caused by the treatment for anti-phospholipid and antinuclear antibodies. We gave Holly and Mike a referral to a fertility specialist who was able to help. Soon, she and Mike were expecting.
Staying Pregnant – The Final Challenge in Reproductive Immunology Treatment
This was no easy course of therapy. Still, Holly hung in and the pregnancy progressed. After the twelfth week, Holly had carried longer than she ever had before. This caused her great joy and at the same time even more anxiety. She had real hope, but that also meant that if things did not work out, her loss would be even more painful.
Holly’s Last Appointment at Reproductive Immunology Associates
To make a long story short, the last appointment I had with her was when Holly came to see me complaining of pain in her right arm. We examined her and were stumped. Then, it hit us: Of course! Holly’s arm hurt because she was carrying her baby around all the time! Our prescription: change arms!
Reproductive Immunology Case Study Conclusion
Since the birth of their baby, Holly and Mike have kept in touch, sending us pictures and letting us know how things are going with their family. Our entire staff loves to watch them grow older and see the pictures of the baby growing into a young child. We laugh when they tell us how much work it is, raising a child, and how much they appreciate being able to sleep in on weekends. What a miracle, since that child that might never have made it into this world. Their happiness is contagious. We share it too.
Reproductive Immunology Associates has been diagnosing and treating immune-related miscarriages since 1990, Our physicians, medical techs and staff have worked with couples and their physicians, some of them since we began. At RIA we are commited to provide an environment where people who have suffered recurrent miscarriage can come for evaluation and results. For more information or to schedule a consultation, please visit our website at http://rialab.com/consultations.php or call us at 1-805-578-7000.
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