Hi Dr Sher, I am 40 years old and have suffered with a number of early pregnancy losses in the past year, all conceived naturally. I have a 3 year old son who was conceived easily with no issues during pregnancy or birth. I have read your info on IID and I’m hoping you can help me. I have had some bloodwork done in the UK and am borderline APA, with anticardiolipin results of 17.8 and 19.2. My plasma antithromb activity was 73. My clinic advised progesterone 3 days post LH surge, with aspirin and clexane after a positive pregnancy test. I did this with my last pregnancy but unfortunately a scan at what should have been 6 weeks gestation showed nothing in the uterus, but my lining was thick. I experienced a bleed soon after and have conceived again this next cycle and am now around 4 weeks 5 days.

I have only taken the progesterone and don’t plan to take aspirin as it was tough on my digestion and I have read your advice regarding aspirin for IID. I am unsure whether to begin the clexane as it didn’t help with my last pregnancy, would you recommend starting it now, or waiting until hcg levels have been tested to show the levels are rising as they should? I also have an ulstrasound scan planned for next week when I will be 5 weeks and 5 days, should I wait until after the scan to begin clexane? Getting past 5 weeks has been the biggest problem.

Is there any further tests I can do, either now during this pregnancy, or if it is not viable, should I have any other tests done before conceiving again? My clinic has suggested an endometrial receptivity test, with samples being sent to Chicago, would this be helpful?

I’m also curious on your thoughts about anti HY antibodies and RPL? As I have had a boy previously, could this be a factor?

Many thanks!