Immunologic recurrent pregnancy loss

Hello Doctor,
My husband and I have suffered three first trimester losses in a year. The first two ended at week 5, and the third one ended at week 7 after noting a heart beat of 119. Our karyotypes are normal, and the baby was 46xx normal by chromosome microarray analysis without maternal contamination. I have hashimoto's thyroiditis with positive TPO antibodies (500+). My TSH was being managed but at the time of the third pregnancy spiked to 7.1. Using progesterone vaginal suppository 200mg twice daily. Thrombophilia panel was negative. Rh+. No infectious diseases. No uterine issues voiced by our RE. My husband and I are 37 years old with no prior live births. My most recent day 3 FSH was 10.9, AMH was 1.2, Estradiol was 40, and AFC was 7 (trans abdominal day 8.) Semen analysis is normal. Ethnically, I am Caucasian, and my husband is Asian Indian. My RE at Mayo Clinic recommended IVF/PGS. He said he is not concerned about the immunological or endometrial receptivity aspect. I was wondering if you may be able to shed some light on it, and give us your opinion if we need an immunological work up, and if IVF is a sound choice to make given the diminished ovarian reserve?
Thank you.

Our Expert's Answer

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With such a low AMH and high FSH, it seems likely the egg quality issue is important with regards to the three miscarriages. T agree that immunological work is not necessary nor endometrial assessment. IVF has very low success rates with such a low AMH, but with Preimplantation Genetic Screening (PGS), you would be able to identify chromosomally normal embryos so this could be considered.