How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • Go back-and-forth until satisfied
    Rate the answer you receive.
Ask Dr. Tim, MD Your Own Question
Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 1627
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
Type Your OB GYN Question Here...
Dr. Tim, MD is online now

I have recurrent early loss, Yes, I have had 4 early losses

This answer was rated:

I have recurrent early loss
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: Yes
JA: Is there anything else the Doctor should know before I connect you? Rest assured that they'll be able to help you.
Customer: I have had 4 early losses around 5 weeks and one trisomy 13
Customer: replied 1 year ago.
I keep miscarrying before 5 weeks during a thrombophilia panel raised lupus anticoagulant antibodies were discovered 3 times equivicol results last two pregnancies i have been on progesterone aspirin and enoxaparin sodium injections all from a positive pregnancy test still i have had 2 losses on this regimen as well as metformin for mild pcos

Hello and I would be happy to help. Here is what I know
1. You have a history of recurrent pregnancy loss
2. You have had greater than three unexplained first trimester losses
3. There is a question of antiphospholipid antibody syndrome
4. You have had very appropriate treatment but are still experiencing losses (two since being treated)

Is that about correct?
Dr. Tim

I am terribly sorry about your losses. There are a couple of things in the workup that you did not specifically mention. In couples undergoing what you have experienced, the typical workup would include:

1. Testing for anti-phospholipid antibody syndrome (lupus anticoagulant and ACA antibodies)
2. Thrombophilia testing: FVL, Protein C and S, antithrombin, Prothrombin gene mutation
3. Evaluation of the uterus with hysteroscopy or sonohysterogram
4. Genetic testing / karyotyping of you and your partner

In terms of what you are describing, the most important thing that you need to have done at this point is #4

Dr. Tim

Customer: replied 1 year ago.
Hi thank you for reply yes parental karyotyping had been done on me and my husband which has come back normal after trisomy loss, lupus anticoagulant antibodies were raised with 3 equivocal results to which Nhs doctors put down to possible aps
Pelvic internal and external ultrasound showed no problems apart from bulky right ovary which appears polycystic hence why i am on metformin daily and for aps from confirmed pregnancy i take utrogestan 400mg twice a day, 75mg aspirin 40mg enoxaparin injections and still hcg starts to fall before 5 weeks

Were the labs in #2 above done?
Dr. Tim

Customer: replied 1 year ago.
I believe so i am under tommys recurrent miscarriage clinic based in birmingham womens hospital a full thrombophillia and thyroid panel has been done therefore i believe #1 #2 #3 #4 has been covered

Based on what you are telling me, you have had an incredibly thorough workup. How else can I help you? Are there questions about all of this that you would like answered further?

Dr. Tim

Customer: replied 1 year ago.
doctor as i have experienced losses in the best protocol always occuring before 5 weeks i also experience severe cramping before the positive test and pain in calves suggesting possible trouble implanting properly would you suggest changing timing of aspirin or enoxaparin injections to after/before ovulation instead of after pregnancy to improve blood flow to help implantation as no other issue is coming forward? I pretty much conceive easily and ultrasound showed no fibroids or obvious abnormalities i also have had 1 child 4 years ago on clomid and metformin for whom i had problem conceiving due to anovulation which resolved.

In a patient such as you, I would have you on a daily baby aspirin and then start you on the lovenox injections with the first positive pregnancy test. You certainly could check with your OB Provider to see if they think that this is reasonable

Dr. Tim

Customer: replied 1 year ago.
Thats what i was hoping will help is 75mg per day enough (gastro-resistant or is it 150mg? Also should i be on the aspirin during my menstrual period? I asked the hospital who said they were not able to prescribe before positive test as in not licensed /insured to thats why i am need for your second opinion looking at my circumstances

Normally you can buy aspirin in the US over the counter. A baby aspirin here is 88 mg per day. Perhaps in the UK it is 75 mg That is what I would tell a patient to take. If this is what you decide, then you probably should check this with your doctor.

Dr. Tim

Dr. Tim, MD and other OB GYN Specialists are ready to help you
Customer: replied 1 year ago.
Thank you so much for your expertise i will try aspirin earlier in my cycle.

You are very welcome

Dr. Tim