Infertility situation

Hello Sandi,

Hi, I am Gautam. My wife was diagonised with ITP in August 2008. Was in hospital for 4 days. So here is her history:

My age = 32
Wife age = 32

1) We are tyring to conceive since Jan-2008. My wife Started on infertility medicines since then and had endo operation in Apr-2008. In apr-2008 her platelets were 265000 taken before operation.
2) Got ITP in Aug-2008. Platelets went down to 3000.
3) In hospital for 4 days. Two IVIG bottles and on Pred (starting from 60mg down to 0 in Oct-2008). Since she was released from hospital her platelets are always in the 250K level. (Range 230K-260K) which is great.
4) Started homeopathy in Jan-2009 till Feb-2010 as we decided to go on IVF.
5) Started heavy infertility meds including IVIG for hyperactive immune system.
6) finally conceived in Apr-2010 in the first IVF cycle. But pregnancy ended into a chemical one. Doctors had asked to take Blood thinners (Arixtra,Lovenox) , but I straight away said no to it due to ITP issue.
7) Our Hematologist suspects that her ITP was one time occurence. But I am scared that it might come back again. Everyday I check my wife's mouth from inside to check any bruising is not there and also her legs and hands too. she is very angry now due to this. But I am too scared of ITP.
I observed that say 1 in 2-3 weeks she gets bruise in her cheek. But she has habbit of biting cheeks when she is working. Would that cause it?
9) We had done some tests for LAD(Lukocyte Antibody Detection) for my wife. For a body to carry pregnancy the number should be greater than 70. Hers was 40. On borderline.
So docs are suspecting this as one of the reasons for misscarriage. There is a treatment available for the same LIT. (Lymphocyte immunization therapy) where the WBC of husband are given to wife to up that number. We are planning to do the same.

So now some questions:

1) I hope LIT will not cause ITP. (Out immune specalists says no to this one).
2) Doctors said that due to ITP my wife's egg quality is poor. Does ITP one time occurrence can cause bad egg quality. I was very furious with doctor when he told the same.
3) Is Arixtra/Lovenox safe to take in my wife's case. Doctor's tell that my wife has clotting issues too (Another reason for Misscarriage).
4) Have you heard such cases before.
5) Is my wife's ITP just acute as after Aug-2008 she is in remission with very good counts. (More that me as my count is around 225K).

Will be great if you can answer them. I really respect you and feel good that you are there on this forum helping others. Thanks in advance Sandi.

Thanks,

Gautam

If your wife has had ITP and clotting issues she may have APS.. antiphospholipid syndrome. It is a cause of miscarriages. The treatment for APS is, as you say, anticoagulants.

autoimmunedisease.suite101.com/article.cfm/antiphospholipid_syndrome_aps

Wow...sounds like you guys have been through the ringer! I am not an ITP specialist, nor an infertility doctor. I am only 24 and have had ITP for a little over a year. From what I gathered from your post, your wife has been in a remission without treatment for 2 years now? That's really good. Most people on here have to treat constantly to keep counts stable. This makes me think that maybe it was a fluke and that it was acute. Did you look into ALL the possibilities that may have caused her short bout with ITP? Medications she was taking, etc.? With that said, ITP is a very tricky disease because it does whatever it wants to. Sometimes it will go into remission and sometimes it will linger for years and years. Sometimes it will go completely away for years, just resurface out of nowhere! Does your wife see a high risk doctor? Also, check out the link posted by Ann. It may be something you may want to ask your doctor about. I would go through all the tests before attempting again, just so you can make sure that there isn't an underlying problem that could hurt your wife or your future baby. Best of luck! I hope there is a baby in your near future :0)

Natalie

Hi Gautam:

I wouldn't say that ITP is the direct cause for the miscarriage, but it can be tied to APS (as Ann said), and that could cause miscarriage. Both ITP and miscarriage are symptoms of APS. If a woman has APS and has symptoms, the pregnancy should be most likely be managed with blood thinners.

Here is another link:

www.intelihealth.com/IH/ihtIH/c/9339/30957.html

Hi All,

Thank you so much for your help and support.

Answer to your questions:

1) My wife tested negative for APS and ANA.
2) Tested positive for Anti overian antibodies.
3) Also she has positive Antiplatelet Igm antiboides bur negative Igg antibodies.

Thanks,

Gautam.

What is the reason for the blood thinners? Did they identify the clotting risk? APS/ANA antibodies can come and go, so a re-test at some point isn't unreasonable.

ITP does not cause eggs to be inferior.

hi Sandi,

Yes per doctor clotting risk is there as her Protien S was lower than the normal limit.

Also her MTHFR was hetro.

Sandi-what is the difference between Igm Platelet antibody and Igg platelet antibody.

Also taking the LIT and also blood thinners - will my ITP come back?

Per Doctor having Igm antibody is not risky.

Thanks,

Gautam

I'm not really sure of the difference between the two antibodies; it isn't a question that comes up very often and does not seem to be important as far as affecting a person's ITP case. If it were, we would hear about it much more.

I did find this:

www.aruplab.com/guides/ug/tests/0095614.jsp

I can tell you though, that those antibodies come and go as well as other antibodies, so having a positive now does not mean it will stay that way, and vice versa.

I can't tell you if taking those medications will cause your wife's ITP to return. ANY medication has that risk, as well as any change to the body such as a cold or virus. My advice is to deal with what you have in front of you now, and try not to worry about the "what if's". Take one thing at a time, okay?

Hi Gautam,

I am neither a doctor nor any specialist, but my wife is diagnized with ITP, and as part of excluding infection as possible factor affecting platelets we had done blood tests to detect if any of the 4 viruses present and/or active (EBV, CMV, HBV, Toxiplasma) we got IgM positive for CMV but IgG negative, which as explained by Doctor (infections specialist)
* IgM are antibodies created by the system as soon as the infection occurs
* IgG are antibodies created by the system to fight the infection on regular basis as along as the infection is present]

in our case it meant that the infection happened sometime and IgG negative means that it is not active. But for confirmation they refer to DNA test, which if positive means the infection is on active phase.

Hope this helps,

Selva

I think that IgM and IgG also have slightly different functions, but I don't know any more than that.

Lily

He Selva,

Thanks for the information. So your wife's ITP is still there or now she does not have it now?

Thanks,

Gautam

Gautam, Hi!

Unfortunately, she is still having it. Most recent count 27k on 14th June. Last week she was tested positive for H.pylori, on Monday we started H pylori eradication therapy.
We are also continuing regular itp medicines Azathiprine (100mg) and Prednisolone (10 mg). Prednisolone tapered to 10mg on Monday from 15mg.
Hopefully H pylori eradication works for her.

She's on Azathioprine and Prednisolone from April after spending 3 days in Apollo hospitals Chennai.

Hope this info is useful to you,

Selva

Hi Selva,

There are multiple cases of ITP due to H Pylori.

Once you are able to get rid of the same then ITP should go away. Thats what my thoughts are. I have seen multiple cases like those.

So my prayers are with you and things will happen in the right direction.

Thanks,

Gautam