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Dr. Smith,
Thank you in advance for your help on this...
I would appreciate your sharing some information on Trisomy 3 and an opinion regarding whether PGD sounds warranted in our case.
We have had 2 miscarriages out of 4 IUI's. First was too early to biopsy, but second indicated Trisomy 3. Is this a common sporadic trisomy (bad luck) or a sign of something potentially recurrent and more serious?
RE recommends IVF with PGD, but we're concerned that may be overkill and not worth the risk that the biopsy itself could prevent the embryo(s) from making it to blast, as you indicated in a previous post. We were also told that trisomy 3 isn't even screened for in the PGD.
Regarding our background: wife is 34, I'm 37, only diagnosis is borderline male factor after varicocelectomy. Chromosome blood work on each of us was normal. Sperm DNA fragmentation test labeled my fertility as "good."
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Trisomy 3 is rare and would not be detected by routine PGD. I think IVF/PGD at this point may be premature. We don't know the cause of the first miscarriage and cannot assume it was also caused by a genetic problem. Women miscarry for a variety of reasons. Since your wife's problem is not getting pregnant, but rather staying pregnant, I suggest you guys try IUI again a few times. If your wife becomes pregnant and miscarries again AND the cause is genetic (i.e. another trisomy), then I would suggest you move on to IVF/PGD. If your wife miscarries again and its NOT caused by a genetic problem in the developing embryo, I would suggest looking into other causes of recurrent miscarriage such as immunological and clotting factors. You may even want to look into that before you proceed with another IUI cycle.
Unfortunately, first trimester miscarriage is fairly common in women in their mid to late thirities, so I wouldn't give up on IUI just yet. It may be just a matter of getting the right sperm-egg combo for a term pregnancy. If the SCSA was O.K., then it seems unlikely that the sperm is the problem.
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