The story of Julia and Antonio

On this occasion, I would like to tell you about a recent case I had.

They are Julia and Antonio, a couple aged 39 and 41. They came to our clinic reporting a desire to have children for more than 5 years. They explained to me that Julia had suffered 4 consecutive miscarriages during the first trimester of pregnancy and that she had needed psychological help because the last two, which were 8 weeks ago, had required uterine curettage and therefore had been more traumatic.

I asked the couple for a series of tests.

I prescribed specific thrombophilia tests to Julia to determine if she had a bleeding disorder. We also performed a diagnostic hysteroscopy to evaluate her uterine cavity and vaginal and endocervical cultures for mycoplasma, ureaplasma, and chlamydia.

All findings were normal except for protein S deficiency.

On the other hand, I asked Antonio for a spermogram with FISH, which was completely normal.

I explained to Julia that protein S deficiency can have medical consequences that can increase the risk of excessive blood clotting and even the risk of thrombosis. The risk of spontaneous abortion or implantation failure is higher in these cases. Therefore, in the case of a new pregnancy, the best option would be to treat with heparin during pregnancy.

On the other hand, I explained to them that due to Julia's age, there is also a higher risk of miscarriage due to associated chromosomal abnormalities. In fact, I told them that this is the leading cause of miscarriage during the first trimester. For this reason, a good option for them would be to undergo IVF with PGD, that is, perform a biopsy of the embryos to select those that are chromosomally normal before transferring them. This seemed justified to me because Julia did not want to experience another spontaneous abortion or, at least, wanted to reduce the risk of spontaneous abortion due to her traumatic past experiences.

Julia had a normal ovarian reserve despite her age since she had an AMH of 1.6 and an ovarian reserve of 5+7.

As part of the IVF, Julia was stimulated to produce mature eggs. A total of 13 eggs were collected, of which 11 were mature and could be inseminated with Antonio's sperm sample. Eight were fertilized, and four reached the blastocyst stage (fifth day of culture). The 4 embryos obtained underwent biopsy, and two weeks later we had the result: 1 euploid (meaning chromosomally normal) and the others were abnormal.

In the following cycle, we transferred the euploid blastocyst to Julia in a natural cycle with heparin starting from the day she started taking progesterone vaginally. The result was a success as 10 days later the B-HCG was positive, and she is now 24 weeks pregnant.

Congratulations to the couple!

Dr. Claudia Forteza