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Miscarriage, Multiple Miscarriage and/ or Immune Issues Moderated by Carolyn B. Coulam, MD
Carolyn Coulam MD, specializes in helping those experiencing recurrent pregnancy loss and implantation failure. Dr. Coulam is a pioneer in the field of reproductive immunology. She is board certified in reproductive endocrinology and infertility.

Dr. Coulam is a long-time advisor to INCIID and has been answering patient questions since INCIID's inception. Dr. Coulam's professional member profile is located here. Visit the Reproductive Medicine Institute (Chicago).

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Old 03-12-2010, 09:55 AM
PetRescue PetRescue is offline
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Default Recurrent Miscarriage and elevated ANA's

Hi, I have a six year old son and have suffered from two miscarriages in the last eighteen months. My last was in July 09 and since the D&C my body has not been the same. I was doing BBT charting and my baseline was 98F, now it's down to 97.4 and my cervical mucus is so different I thought I had a yeast infection (labs said I did not). I no longer get egg-white mucus, so I believe I may be suffering infertility now as well.
I was tested for everything, lupus anti-coagulant-neg, factor v leiden-neg, MTHFR-I am hetero, beta2 glycoprotein: igg, igm, iga-neg; all back after my D&C. I recently saw my PCP complaining of white fingers, she diagnosed Raynauds and did bloodwork. Well, now my ANA's came back positive-centromere pattern, titer 1:1280. She diagnosed CREST and sent me to a Rheumatologist.
Rheumy says I don't have CREST yet, but could develop it. She put me on Plaquenil to try and bring my ANA level down.

OK-now my questions! Should I do anything further to reduce my ANA level? I have read about IVIG-should that be considered now? I don't know if my ANA level was up in pregnancy, but I can only assume that was a factor in the miscarriages as no other cause can be found. Even if I don't have CREST, from a reproductive standpoint, do my ANA's have a role in recurrent miscarriage? I have read that elevated ANA's are treated with prednisone, but my rheumy said not to take pred. I don't disagree as pred is harsh on your body, but I'll do anything to have another baby!

Thank you so much for your help!
~Jennifer
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Old 03-12-2010, 11:43 AM
Carolyn Coulam MD Carolyn Coulam MD is offline
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At this point you should see your doctor to find out the reason you are having difficulty conceiving. At that time your doctor could also check to see if you have other immunologic factors that might contribute to you infertility and recurrent miscarriage. Dr. Coulam
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Old 03-12-2010, 05:50 PM
PetRescue PetRescue is offline
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Default follow-up

Thank you so much for the quick response. I guess the main thing I am asking is do elevated ANA's cause recurrent miscarriage?
I have seen my doctor for infertility and he wants me to wait and keep trying for a year and then see him again. I understand that one year of trying unsuccessfully constitutes infertility; however, I am contemplating treatment with IVIG and understand it should be used before conception. Is IVIG only used with IVF?
I believe I have had most if not all the the recurrent miscarriage testing done. The only thing that came back abnormal was the elevated ANA's.
Also, do you think you could help me? I am in the Chicagoland area and have an appointment with you in April. I'm afraid my OB/GYN may not be well-versed in treatment of miscarriages. I may not be either-which is why I'm here!

Thank you again,
~Jennifer
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Old 03-13-2010, 02:25 PM
Carolyn Coulam MD Carolyn Coulam MD is offline
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IVIg does not necessarily require IVF. I shall look forward to seeing you next month so we can determine the best course of action for you as an individual. Dr. Coulam
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