Trying to Get Pregnant

Dear Dr,

Thank you for your input and compassion.

I am 40 yo, with 1 x 2 1/4 yo daughter.  Have been trying to get pregnant again for about 18 months now, 12 months with fertility treatment.

I have hypothyroid (12 years) & diabetes (about 3 years), well managed. Mild asthma.

My partner has low sperm count.  He is 48.

I have now had 3 iuis: 2 with clomid and I got pregnant on the second, but early m/c (5 wks).  

3rd with femara: Ended up with a D&C at 12 weeks when I didn't miscarry after baby stopped growing at 6 wks.  

I got pregnant naturally (last January, 2nd cycle after m/c), where we saw heartbeat at 7 weeks, but next ultrasound showed no heartbeat. We used misoprostol to trigger m/c.  

I have frequent UTI, with the 2 most recent bouts only 1 month apart and requiring antibiotics each time, but testing clear after the antibiotics finished.

My Dr. asked me to wait 2 cycles before trying again (and we will try again with another IUI on a femara cycle next week).

Just did Day 3 tests for:-
Estradiol - 45 pg/ml  (Follicular 39 - 189)
FSH - 8.64 mIU/ml (Follicular 4 - 13)
LH - 7.5 mIU/ml (Follicular 1 - 18)

We've done immunological tests as follows, all of which are normal:-
Anti-Beta 2 Glycoprotein IgG 7.9 (negative 0 - 20)
Anti-Beta 2 Glycoprotein IgM 5.2 (negative 0 - 20)
KCT 77 (50-90 secs)
APTT 30 (25 - 40 secs)
DRVVT 37 (31-44 secs)
ANA (IF) Negative
ACA IgG - 0.70 (negative < 10)
ACA IgM -  0 (negative < 10)

The immunologist asked me to take baby asprin daily, and to repeat APL tests in 12 weeks.

I take a prenatal multi & 5000 IUI vitamin D3 (levels are mid range).

My identical twin sister is pregnant with her 4th.  Two of my other sisters each have 4 & my 4th sister has 2.

I seem to get pregnant easily, so I am assuming that IUI with femara is still a reasonable approach, given my partner's low sperm count.

Is there anything else we should reasonably consider doing?

I am hoping that it is just a matter of time and finding the right egg.

[Elaine Brown, MD]

Hi!
Unfortunately, your age is probably the culprit, and there is just nothing you can do about that.  By the time you are 40 and your eggs are also 40, they have undergone considerable wear and tear.  If they don't divide properly, the embryo will miscarry.

The one option you have is IVF.  With an IVF cycle lots of eggs are produced and lots of embryos which increases the chances that a normal one is in the crowd.  Some doctors then advocate waiting to transfer the embryos back until day 5, at which point most of the abnormal ones will no longer survive or appear normal.

The obvious down side is the cost.  Because you are able to conceive so easily, you may just get lucky without resorting to IVF.  You may want to discuss a time limit with your doctor, and if you haven't been successful within that amount of time, proceed to IVF.

Hope this helps!
Dr B