4 miscarriages, advice Prednislone, Clexane, progesterone and under Dr Atalla

[RePrry]

Hi,
I’ve had 4 miscarriages in 18 months.
Two at 6 weeks, one at 8 weeks and one at 11weeks 5 days.
ive been seen at Lister and Hertford.
Ive just seen the specialist called Dr Atalla.
Hes stated that all my blood work and ultrasounds are all normal and clear.
Hes said I could try and get pregnant again and be under his specialist care having scans every 2 weeks. He said that I could try again with no meds, with Prednislone, with Clexane or both.
I don’t know why I have a choice of one or the other or both.
On the second miscarriage I took baby aspirin, he said not to do this.
Ive asked about progesterone, but he said I didn’t need this.
Im so confused about going forward.
Has anyone heard of taking both together? Or been under Dr Atallas care?
I see him again in a month to discuss what we would like to do, he said to do some research by the next appointment.
hope I can have some clarity and make the right decisions.
xx

Hi
I'm not under the dr mentioned but under another dr with care fertility.
I'm so sorry to read about your losses it's absolutely heartbreaking. I have also had 4 losses in 18 months. All at varying weeks, only one we saw a heartbeat at 8 weeks which stopped growing just after the scan.
After many many tests nothing significant came back but some borderline results for anti nuclear antibodies and a 'clotting disorder' only an issue during pregnancy.
For my next pregnancy my Dr prescribed lovenox injections, prednisone 20mg daily till 12 weeks, baby aspirin from 8 weeks and progesterone pessaries.
She did tell me the evidence was weak for the above medication but have nothing to lose.

I'm currently 10 weeks pregnant we had an ultrasound a couple of days ago, so this will be the furthest we have got but appreciate I've still got a long way to go.
But so far the above protocol has offered us some hope.

Wishing you all the best

See extract from medical/research journal I recently read...

Aspirin has both anti-platelet and anti-inflammatory effects, and glucocorticoids exhibit a beneficial clinical effect in most autoimmune diseases. Therefore, they are considered potential therapies in ANA-positive women with RPL, which has a suspected immune etiology. In a placebo-controlled trial, prednisolone and low-dose aspirin were used to treat women with RPL and positivity for antiphospholipid, antinuclear, anti-DNA, or anti-lymphocyte antibodies (57). Although the live birth rate was higher in the treatment group, it was not significantly different from controls (OR 1.5; 95% CI 0.8–2.6). However, the treated patients had a significantly higher risk of preterm birth (62% versus 12%, p <0.001) and higher risks for diabetes and hypertension, which are well known to be associated with high and prolonged administration of prednisolone. However, another case–control study, including more than 200 women who were diagnosed with unexplained RPL and tested positive for ANAs at a titer of 1:80 or more, showed that live birth rates were comparable in women receiving prednisone plus aspirin and women prescribed aspirin only. Additionally, no previous preterm delivery, fetal growth restriction, or placental abruption occurred in any subject (58).