A Successful Pregnancy Outcome After Continued Surveillance of Lupus Anticoagulant Antibodies in a Patient With Recurrent Pregnancy Loss: A Case Report and Literature Review.

Recurrent pregnancy loss (RPL) can be a devastating experience for individuals trying to have children. Various potential causes contribute to the multifactorial pathogenesis of RPL, including chromosomal anomalies, endocrine conditions, autoimmunity, thrombophilias, and infectious agents. Antinuclear antibodies (ANAs) offer an unspecific clue to the underlying autoimmune pathogenic etiology of RPL. This case details a 40-year-old female with a history of RPL, fibromyalgia, and ANA positivity, who spontaneously developed lupus anticoagulant antibodies during her second trimester of pregnancy. Although the recommended American Society of Reproductive Medicine (ASRM) diagnostic criteria for initiating a thrombophilia evaluation was not formally met, the patient's maintenance of low-molecular-weight heparin (LMWH) throughout her pregnancy may have contributed to the success of the pregnancy. When treating a patient with RPL, consideration of the comprehensive clinical picture should precede the need to strictly adhere to published criteria for using non-proven clinical interventions. A risk-benefit analysis ought to be considered when offering patients additional medications that may come with some risks but could significantly improve the chances of a successful clinical outcome, such as live birth. We aim to provide evidence to promote greater flexibility in guidelines so that a patient's unique autoimmune etiologies of RPL are not overlooked.

Transient Premature Ovarian Insufficiency Post-COVID-19 Infection.

Anti-ovarian antibodies (AOAs) have been linked to autoimmune premature ovarian insufficiency (POI). This report details a case in which a patient experienced transient POI after a COVID-19 infection and tested positive for AOA. After treatment with oral contraceptives and subsequent high-dose oral corticosteroids, the patient underwent fertility treatment with in vitro fertilization (IVF). A total of 23 oocytes were retrieved. Two euploid blastocysts and three untested blastocysts were successfully created. This report hypothesizes the connection between autoimmune POI, AOA, and COVID-19. Conflicting data have been reported linking COVID-19 and ovarian injury. However, it is suggested that COVID-19 transiently impacts the menstrual cycle and anti-Mullerian hormone (AMH) levels. Treatment to overcome poor ovarian response due to AOA has not been adequately determined; however, similar autoimmune conditions have been successfully treated with corticosteroids.