Recurrent Miscarriage: My happy endings

I am somewhat pleased and sad to know that my post about Pregnancy Hormones and Miscarriage is consistently one of my top posts.  I wish I could hold everyone who comes by looking for answers.  I remember being there.  It’s still a healing wound that opens up from time to time.  I still grieve that I’ll never know those souls I lost.  Or do/will I?

Nutshell background:

After an uneventful first pregnancy that produced my 6 year-old daughter in 2004, I suffered three consecutive first term losses.  Getting pregnant has never been my issue; staying pregnant was becoming a real problem for my body and my psyche.  The last straw, the one that nearly killed me, was the 10-week loss, and the OB standing over me as I woke from the curetage telling me my uterus was too thin to ever consider a vagina birth, and this same OB wanting to put me on Clomid to treat my losses.  This OB had also refused to test my progesterone levels, saying that even if they were low she’d not treat for low progesterone.

Here’s what I had to do:

  • Change providers – I’m in a small town, so no one is super specialized in this area, but I at least found a doc willing to work with me; he had also dealt with infertility personally
  • This OB did ultrasound to check for PCOS (which he thought he found in me) and HSG to check for uterine abnormalities
    • PCOS markers may include u/s, but that’s not the only determining factor, so I ruled that out myself
    • The HSG showed an abnormality, alright; the OB thought it was a double uterus
    • I decided it was time to find a specialist
  • I found a yahoo group that supports women with Mullerian Anomalies (double uterus is a type of MA)
    • This group has an anonymous consulting doc who looked at my HSG film and believed the anomaly to be either a septum or bicornuate uterus shape
    • This group had a fantastic resource – a database of recommended reproductive endocrinologists and repro surgeons
  • Because I have family in Denver and was planning on being in Denver the Summer of 2008 for a voice science research program, I chose a RE in Denver.  Tough stuff when you’re essentially ‘out of network,’ but thank God we ponied up and did it.
    • The RE looked at my film and didn’t think it was a MA; he was sure it was a fibroid
    • SHG confirmed his suspicions
    • Extensive blood work revealed . . . LOW FRIGGIN’ PROGESTERONE . . . actually, really really crappy luteal phase progesterone (I am still so angry with the OB who refused to test my progesterone; I still blame her for that loss.)
  • The RE also recommended a myomectomy to remove the fibroid
    • He wanted to do it laparascopically which means cutting through connective tissue and the fundus to reach the fibroid
    • I didn’t want the integrity of my uterus further compromised and requested a hysteroscopic myomectomy instead; he agreed
    • Folks, do your research so you can advocate for your needs!!  I can’t stress this point enough!!!!
  • Thank goodness we did the hyst myo because instead of a regular fibroid, he found adenomyosis which he attributed to the PREVIOUS CESAREAN!
    • Hyst myo turned out to be the best way to remove as much of the adenomyosis as possible
    • Otherwise my uterus looked normal, no thin LUS, cesarean scar wasn’t even visible
  • This RE had a drug protocol that worked to address my progesterone deficiency
  • 3 months later my local OB examined my uterus via ultrasound and said that I was healed and ready to TTC!
  • I also made sure that the RE confirmed that the integrity of my uterus was not compromised from the surgery; my OB was nervous about ‘letting me’ VBAC

My happy endings:

I naturally conceived twins in 2008.  Luckily, I was in Denver over Christmas, and the RE was involved with my early pregnancy care.  My HCG levels were abnormally high, and an early early ultrasound revealed twins.  I enjoyed an easy term pregnancy (39 weeks!) with di-di twins!  My twins are such a blessing – can’t believe they’re almost TWO!

I became pregnant again in October 2010.  God has a sense of humor for sure.  I followed (more or less) the same treatment plan for low progesterone.  The first week of my pregnancy was stressful because I was having a hard time getting ahold of my OB and who had different ideas of how to treat low progesterone that conflicted with the RE’s protocol.  Can you believe this RE’s nurse was still supporting me through this stressful time . . . 2 years later?!  I was able to e-mail her and call her and they were willing to oversee my meds for the 1st trimester if I couldn’t get it worked out with my OB.  I had to ‘correct’ my OBs script a couple of times, and thankfully he was compliant.

Again, you have to advocate for what you need.  Right this minute.  Trust your intuition.  Know that infertility and pregnancy loss is more ‘art’ than ‘science’ at this point.  Know that there are widely disparate ‘camps’ when it comes to treating infertility and loss.

Currently, I am 37 weeks pregnant with my Happily Ever After baby.  May you find a way to yours!

Nearly a Year Ago

My babies will be ONE tomorrow.  I can’t hardly believe it.  I never thought I’d be the type of woman who would say that the year just flew by or grieve the passing of such a special year, but I guess I am.  I take my babies for granted every day . . . and yet, every day they are a miracle to me.  I can hardly believe that after several years of heartache and pain, that I have two one year old girls and one five year old daughter.  I am blessed.

So why do I feel so crappy?  My mother in law is worried because I look pregnant.  No, I don’t think she’s rude for saying that . . . she said what I had been thinking, so I have to take it that much more seriously.  Why does my lower abdomen still hurt to be touched?  Why do I not EVER want to have sex?  And the constant spotting and cramping – I’m so tired of it.

Tonight I began researching the side effects of the Mirena IUD.  I tried to schedule an appointment with my OB/GYN, but he referred me to a GI person.  I’m going to cancel that appointment.  Perhaps I’m having GI trouble, but I really think it has something to do with the way Baby E was positioned, or the fact that my bladder was nicked during the cesarean, or a fibroid, or the reappearance of adenomyosis, or something.  I also suspect the Mirena.  It seems like there is an adjustment phase, an ok phase, and then a shit phase that continues to worsen.  I’m in the worsening shit phase, I’m sure.  So, I called and scheduled an appointment with my GP.  I’ll have her take it out and hopefully change my depression meds.  If that doesn’t work, Lord help me.

I have so much to be thankful for . . . why am I in so much mental and physical pain?

Think of Me: Post-Op Ultrasound

I’m a bit of a wreck today.  I seem to get pretty antsy and stressed out before OB visits anymore.  Hmm, wonder why.  Anyway, I have an ultrasound scheduled tomorrow to check on my healing from the hysteroscopic myomectomy that was performed in August.  The myomectomy was supposed to remove a fibroid from the uterus and uterine muscle.  However, the surgeon found NOT a fibroid but an adenomyoma, endometrium growing in the muscle layer.  He’s not sure how much he was able to remove.

I must admit that I’m not feeling terribly confident.  I think I’m feeling less discomfort during ovulation from before, but that’s the only noticeable positive change.  I had one ok period followed by a horrific one in September where I was bleeding and clotting so heavily, and of course, I was busy at a conference at that time.  This last cycle only lasted 22-24 days.  I started spotting on the 22nd day and started heavy flow on the 24th day.  Bummer.  My progesterone must really suck.

I suppose the two possible outcomes for tomorrow are: (1) things look healed, so go for it, or (2) things don’t look so great.  I wonder how distorted my uterus still is?  I wonder if the myoma really had anything to do with my losses?  If things don’t look great, will that mean another surgery?  Or will it just mean more agonizing waiting?

And then what?  I can’t hardly remember any more.  I think I’m supposed to start on antibiotics and low-dose aspirin the cycle before conception.  Then I’ll have HCG shots during my luteal phase and progesterone shots once I get a ++.  My husband and I are both itching for another baby.  It’s crazy, really.  However, we don’t feel like our family is “done.”

What would I do if I lost another baby . . . God forbid.

Please keep me in your thoughts over the next 24 hours.  Thank you!

RPL Update Number I Lose Count

I started writing up a big post about the more recent developments in my journey through recurrent pregnancy loss.  I still need to finish it up, but in the meantime, he’s a quick update:

  1. In August I had a hysteroscopic myomectomy done in Denver.  The idea was to hopefully remove a fibroid that was bulging into my uterus.  Instead of a fibroid, the surgeon found an adenomyoma located directly above my cesarean scar.  I have to review my records from my 1 successful pregnancy to determine whether or not the fibroid that was present during that pregnancy changed into this adenomyoma.  Otherwise, it is likely a lovely by-product of the 2004 cesarean section that was performed on me and my daughter.
  2. I have a substantial progesterone deficiency.  Progesterone levels should not drop below 8-10 in 2nd luteal phase draw, and mine dropped to 3.  I will have to have HCG shots during the luteal phase and progesterone shots during the first trimester to support the corpus luteum and developing baby.  It makes me INSANE that the last OB I asked to test my progesterone outright refused.  I lost that baby, obviously.
  3. I have to wait until November to have an ultrasound performed to let me know if my uterus and endometrium have repaired from the surgery.  Then we can talk about ttc.

That’s my nutshell.