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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.
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Please note that all the answers we give are on a generic basis only, as we cannot provide more in-depth answers without access to your medical history. If you need a more detailed response, tailored to you, we would recommend a consultation with one of our Fertility Specialists for more comprehensive medical advice.
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.
If you still feel you need more guidance and support, you can book a FREE 1-2-1 discovery meeting to talk through the options available to you.