Patient's Query
Hi doctor,
I am a 29 year old female. I am trying to conceive for almost a year. In this time, I have had three miscarriages at 4 weeks, 6 weeks and 5 weeks respectively. With my last pregnancy, I was also on Baby Aspirin 75 mg and Progesterone 400 mg. But, it did not make any difference. I have been recently diagnosed with Grave's disease. During the last pregnancy, I had overt hyperthyroidism. Thyroid antibodies were ATPO 115 (elevated), anti-Tg 33 (mildly elevated) and TRAb 5.8 (elevated). I had a thrombophilia panel done which was clear, with only being heterozygous for MTHFR A1298C which I was told is not an issue. I was advised to have an APS panel and ANA. Shall I take Prednisone 10-15 mg to help with immune issues? In the meantime, I discovered that I have an arcuate uterus from an older MRI. I have read online that an arcuate uterus can be a cause of recurrent miscarriages, as it is a variant of a subseptate uterus. I will attach a photo of that MRI. My question is, if the APS panel is clear and I continue to lose pregnancies two to three times despite having my thyroid under control, is it reasonable to look into the arcuate uterus issue? If so, shall I go for hysteroscopic metroplasty to repair it? Is it a safe procedure? Will it help with my fertility?
Kindly help.
Hi,
Welcome to icliniq.com.
From the MRI picture attached (attachment removed to protect patient identity), it does not appear to be an arcuate uterus. Arcuate uterus generally has fundal depression from outside.
It neither appears to be a septum. Just ostia are deep seated giving appearance of septum/arcuate uterus.
Even if it is arcuate uterus, such things normally does not lead to recurrent pregnancy losses. So, correction is not warranted.
Once TSH (thyroid stimulating hormone) levels come to normal, you can try to get pregnant. Take support of Baby Aspirin and Progesterone. We normally do not prescribe steroid unless patient does not respond to Aspirin and injectable Enoxaparin in case of antiphospholipid syndrome.
With all these corrections, your pregnancy should continue (unless there is a genetic abnormality) and you should not at all need correction of arcuate uterus even if it is present.
For further information consult an infertility specialist online.
Thank you.
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