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Infertility/Fertility/borderline high ACA and miscarriage


I have been trying to conceive for approximately a year now. I learned I was pregnant in March 2012 and at 10 weeks learned the fetus had stopped growing at 8 weeks 5 days. We resumed trying shortly after a D&C and found we were pregnant again in August 2012. We learned at 8 weeks that there was no heartbeat and that I was pregnant with twins in a single sac. They had both stopped growing somewhere around 5-6 weeks.

Both times took 3 cycles to conceive. I chart, temp and use OPK's for timing. My cycles are generally 24-28 days with ovulation around day 14 - 17 and a 9-10 luteal phase.

My OB agreed to 3 blood tests - lupus, thyroid and ACA's. Everything was normal except for an ACA level of IGM of 16.
My doctor prescribed baby aspirin and said we could TTC at any point. What else can I do to prevent a 3rd miscarriage? I have been reading about Lovenox. Are there any other tests that I should undergo to determine other causes?

Thank you so much.

Hello Kimberly from the U.S. (Wisconsin),

The ACA may or may not be the reason for the miscarriages because of how far the pregnancies got before the miscarriages occurred.  Most immunologically caused miscarriages occur well before 8 weeks gestational age.  The most common reason for late first trimester losses is a genetic abnormality or anatomic abnormality.  If fact, genetic abnormalities is the most common reason for miscarriages, accounting for 85%.  You don't mention your age, but this can be directly age related as well.

The treatment for antiphospholipid antibody syndrome is low dose aspirin, heparin or lovenox and medrol.  Progesterone supplementation is also given to reduce the chances of a luteal phase defect causing the miscarriage.  The only option for treating genetically caused miscarriage is IVF with or without genetic testing prior to transfer.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate  


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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