Recurrent Pregnancy Loss Update

It’s hard to believe that it’s nearly a year since my first loss and only 4-1/2 months since my last loss.  But I am starting to put the pieces together.  Here’s the list of causes my Reproductive Endocrinologist outlined for me at my early June visit as well as my status in each of these areas.  I hope this may help others who have experienced multiple losses advocate for the help they need.

INFECTION
Yeah, it really stinks to think that I could have lost babies due to low-grade infection, but it is possible.  The RE recommends that I do a round of antibiotics during early pregnancy.

IMMUNOLOGICAL PROBLEMS
This category refers to things like clotting disorders, immuno-deficiency illnesses, and the like that can and do contribute to primary and secondary infertility.  When clear immunological problems are not identified through extensive blood testing, doctors seem to recommend taking a baby aspirin (81 mg) a day as a possible protective measure.  My bloodwork came back just fine and dandy!

STRUCTURAL PROBLEMS
Structural problems can be congenital or acquired.  An example of a congenital structural problem is a bicornuate uterus.  Some women with this uterine shape have difficulty maintaining pregnancy to term and their babies may not descend optimally (vertex, anterior-ish) into the birth canal.  I had a HSG done in late April, and my OB believed that I had a congenital uterine defect.  However, my follow-up (and second opinion) with the RE has not confirmed this to be the case.  Rather, it appears that a relatively small (1-1/2 inch or so in diameter) fibroid is distorting the left side of my uterus.  Even though it is intramural (in the muscle, not in the uterine cavity), the RE thinks it is enough of a problem to justify a laparoscopic myomectomyI am not convinced and will hold off on this invasive procedure until all other avenues have been exhausted.

HORMONES
This is where we enter a major realm of disagreement in the medical world.  Some doctors believe in progesterone deficiency and luteal phase defect; others don’t.  Some of the doctors who don’t will still agree to supplement since conventional wisdom suggests that supplementing progesterone production isn’t dangerous.  As luck would have it and non-traditional practitioners have told me time and time again, I have a progesterone deficiency.  A fairly marked deficiency, actually.  I had my progesterone levels checked twice during my last cycle – the first level was 20 (good); the second level taken only 48 hours later was 3 (NOT good).

LUCK OF THE DRAW
The fact remains that not all pregnancies are viable.  All children are a blessing, but not all babies – in utero – are meant for this world.  I do take some comfort in knowing that if any of these babies were just not going to be healthy, that they were not put on this earth.  I’ve had friends and family members choose to terminate pregnancies in the 2nd trimester, and I am thankful that I have never been given that choice.  On the other hand, knowing that my body is not producing enough progesterone to sustain pregnancy makes me sad and incredibly angry.

I am sure that the sadness is quite apparent if you’ve read anything on my blog this past year.  The sadness and loss has been overwhelming at times.  I am quite certain that my baby boy has been trying so hard this past year to come home to me, so it’s been particularly trying and emotional.

Why am I angry?  First, it is extremely frustrating to have seen three practitioners who have disparate diagnoses and protocols for dealing with repeat pregnancy loss.  Secondly, being refused services is infuriating.  Thirdly, doctors who contradict themselves and/or make stuff up make me insane.

OB 1 doesn’t (WON’T) test hormone levels during early pregnancy.  I am angry because she refused to order a simple progesterone test, and now that I know I have trouble maintaining adequate progesterone levels during the luteal phase, I resent her even more than I did before.  She has contradicted herself; she has refused services; she told me I would have to schedule a repeat cesarean for future births moments after waking up from sedation following an unwanted (but needed) D&C; she didn’t ever give good justifications for her protocols; she wanted to put me on Clomid; etc.  Mostly I am angry with HER.

OB 2 doesn’t believe in luteal phase defect but is willing to treat with progesterone supplementation.  My beef with this doctor is that he made up a term on my HSG report – partially-didelphic uterus.  It doesn’t exist.  OB 2 is great in that he’s willing to collaborate with specialists and takes the time to explain the evidence underlying various protocols.  I also appreciate that he is cautious when it comes to reproductive surgery.  He told me that I shouldn’t consider a myomectomy at this time – isn’t one uterine scar enough?

RE 1 I appreciate because he has been very thorough.  Perhaps there has been some overkill, but at this point, more information is good.  I am glad that we can (for the most part) rule out acquired or inherited thrombophilia, for instance.  I wish he hadn’t been so quick to suggest surgery for my fibroid.  I wish he hadn’t invalidated my concern for what this myomectomy would mean for my reproductive future.  Sure it may improve my fertility (possibly), but it would certainly necessitate cesarean deliveries from here on out.  I got the feeling that since my uterus is already scarred, that he assumed additional scars were negligible concerns.  He wasn’t listening.  Additionally, my last conversation with the RE’s nurse was confusing – I almost wonder if he has me confused with another patient?  Or perhaps he consulted with other doctors in his group regarding my file and has revised his protocol.  It would be nice to know for certain.

I will likely seek another opinion from a RE since I am in a big city this summer.  Recommendations for surgery really need to be followed up on with additional unrelated practitioners.  You’d get a second opinion if a doctor recommended back surgery, right?

Next up – a sonohysterogram in about a week.

RESOURCES

http://www.rialab.com/miscarriages_prevented.php

http://repro-med.net/info/cat.php

http://www.instituteofalternativemedicine.com/bioidhormone.htm

http://www.ivf.com/recurrent.html

http://www.cushings-help.com/infertility.htm [luteal phase defect section]

http://infertilityblog.blogspot.com/2007/01/so-your-uterus-is-bicornuate-check.html

http://stirrup-queens.blogspot.com/2008/01/two-part-sonohystogram.html

http://www.coe.ucsf.edu/fibroids/bg_diagnosis.html

16 responses to “Recurrent Pregnancy Loss Update

  1. Sorry for your loss. You might be interested in a report on vitamins and what’s in some of them….Birth defects increase 400%. Did you know that the New England Journal of Medicine reported a study on 22,000 pregnant women who were given synthetic supplements, and birth defects increased 400%? They had to halt the study. It’s at http://askareyourvitaminssafe.com
    …on the left hand side.
    All the best,
    Monica

  2. Thank-you for sharing your frustrations about recurrent pregnancy loss. There seems to be so little know in the industry and we can feel like a pinball in a machine some days.

  3. Hillary, not only is there wide disagreement with why women lose babies and how to help them, but also women still don’t really talk about their losses. I’m thankful that the internet is a great venue for sharing information and support on this topic and others.

    Best wishes!

  4. as frustrating as all this is, you are at least gathering decent information. 81mg aspirin (I was talking with another MMC mom y’day about you), and possibly progesterone supplements. Like I told you, I will never know if the progesterone helped Delaney make it to me, but I don’t think it can hurt to go on it for the ttc & 1st trimester. Especially since you have a clear deficiency. I pray & hope this chapter ends soon for you & am here for you however you need. xoxo J9

  5. On call at the moment… for a friend who was given a similar run around from varied and sundry ‘professionals’.
    Third baby, hopefully the second hbac…
    There is hope. I believe in it.

  6. Thanks to everyone for the encouragement. I’ll be interested to see how insistent the RE will be about a myomectomy – not that I’m going to schedule that surgery any time soon.

    I’m starting to gain back some confidence that I can stay pregnant . . .

  7. Have you checked into alternative testing for allergies? I’ve just read a book called “No More Allergies” by Gary Null, and he says that a lot of diseases we normally wouldn’t associate with allergies may be caused by allergens or toxins in our environment — food we eat, chemicals in cleaners or other things, etc. He’s had a lot of success clearing up diseases like asthma, diabetes, ADD/ADHD just through changing diet and reducing the “chemical load” of affected people. It might be worth a shot. You can check out Dr. Denise Punger’s personal (continuing) story of her food allergies/sensitivities at permissiontomother.wordpress.com, and you may even ask her opinion about this “crazy idea” I’m suggesting. She’s an M.D. who is also a board certified lactation consultant, and had at least one of her children at home (the youngest, breech), so she’s pretty broad-minded in a lot of ways.

  8. Kathy, thank you so much for the suggestion. Actually, someone has mentioned allergy to me before, but I was avoiding it. I’ll start looking at Denise’s blog; I’ve come across that link before and remembered liking her information.
    Best wishes,
    Kimberly

  9. {{{Hugs}}}

    One more to add to your list: toxicity. Totally anecdotal, but once in a while a woman will go through a good cleansing and that can help either infertility or repeated losses. Sorry I don’t have any on-line resources handy. I’m old, and some of this came to me pre-internet.

    BEST OF LUCK TO YOU!

  10. Pingback: Bookmarks about Testing

  11. Pingback: Pregnancy Loss and Chromosome Testing for Miscarriages | WEBSITEPOINT.NET

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