Torch test

My wife got aborted 2 times... and 2nd time it was a dnc on 20.12.15. After having 6 month break we planned 2 time but it was not successful so we consulted a doctor, doctor suggested to test for torch. The test results showed a everything normal but only hsv igg to be 4.54 which was positive but hsv igm was in the range and was negative. And also cmv igg was 2.5 and was postie but cmv igm was doctor prescribed us a tablet acyclovir and rovamycin for 3 months to take morning and night...please suggest me to do next and explain me what was it about?
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Dr. Aditi Kishore Shinde
Gynecologist 9 yrs exp Kolkata
Dear Sir, Thank you for your query regarding TORCH titre and recurrent miscarriage. I would at the outset reiterate that this test is done usually for establishing a viral etiology for  consecutive recurrent spontaneous miscarriages. An IGM antibody significant titre suggests a recent infection and an IGG titre suggests a past infection. After reviewing the reports I would gather that your wife has has a HSV and CMV infection in the past for which her body has produced a natural immune response. It is your treating physicians perspective and decision weather to give empirical anti-virals or not. If your wife has any active lesions on the vulva or perineum,  suggesting an active HSV 2 infection a swab followed by acyclovir would definately be necessary,  this has to be noted during her next pregnancy especially in 3rd trimester as it would influence the mode of delivery. Recent evidence does not suggest very definative causality of recurrent miscarriage and the TORCH titre if patient is clinically asymptomatic. Her chances of future successful conception just on the basis of this report cannot be commented upon, it would also require other tests like APLA,  HbA1C, vDRL, Karyotypic analysis etc. Most gynaecologists wait for 3 spontaneous miscarriages to initiate testing. Rest assured that more than 70-80 percent of women with 2 spontaneous miscarriages conceive normally and have good obstetric outcome. I would suggest an additional folic acid tablet 3 months preconceptionally, which has good data on improving conception and reducing early pregnancy complications. Any testing for subfertility should start 1 year after unsuccessful attempt at conceiving. Having a healthy lifestyle, smoking cessation helps. Regards, Aditi
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