Intro and looking for advice - RPL - UPDATE after RE

[pinkpeony08]

Hello all. I have lurked on this board on and off over the past year and posted on other boards, but I'm new here. Looking for advice on next steps as well as what to ask at our next appointments. Sorry for the long post below.

I had two healthy, term pregnancies - now an almost 6 year old and a 3 year old- no issues getting or staying pregnant.   After my second was born, we really felt like we wanted a third to complete our family. We got pregnant easily spring 2017, but MMC at 11 weeks.  I had a d&c and again got pregnant quickly, with everything looking great, until it wasn't.  I went in for my routine visit at 15 weeks in the fall, and again no heartbeat.  I had a d&e.  The fetal genetics came back normal, and I was still measuring ahead of dates when I found out about the MMC.  I had RPL panel and everything was normal.  My TSH wasn't checked until a month after the loss, but it was normal at 1.4.

 I had been working with a fertility acupuncturist from my pregnancy with my now 3 year old as well as the previous two.  We felt like we wanted to give a third one last shot.  She recommended adding Coq10, adding prenatal DHA (had previously only taken while pregnant), and changing my prenatal to one with folate.  She also recommended waiting a few months to give the supplements a change to impact my egg quality.  She also recommended diet changes, including no gluten, low sugar, low alcohol and caffeine.  I also went to Mayan abdominal massage at her recommendation.  Again, I got pregnant easily in January.  Again, everything looked great, until I went in for my 12 week US to find again no heartbeat.  I had another d&c and again normal fetal genetics including microarray.  A few days after the loss, I had another RPL panel (normal) and TSH, which went from 1.4 in the fall to 3.6 though technically still normal.  This last loss, I had terrible cramping 2 weeks after the d&c and was found to have retained placenta requiring another d&c.

I was referred to RE.  I had my initial consult a few weeks ago with a lot of labs ordered and hysterosonogram ordered.  My cycle finally returned last week, and I went in for labs.  I was shocked and crushed my FSH came back at 13 and my AMH at 0.235 given no trouble getting pregnant in the past.  I'm 36 with several family members who had kids in the late 30s and at 40 without difficulty.  I go in to see the RE for hysterosonogram later this week and then for a full follow up with RE in 2 weeks. 

Does it make sense that diminished ovarian reserve would be causing RPL given normal fetal genetics??  My worry has been scar tissue given 4 d&cs, which might also be going on and further complicate everything. 

What else should I be asking about?  I'm not feeling we would want to do IVF given I'm losing genetically normal fetuses, so I presume even IVG with PGS wouldn't have changed that. 

I'm unsure I even have the courage to try again, but hearing about my labs, I'm quite discouraged.  Any words of wisdom?


UPDATE:
 I had my hysterosonogram a few weeks ago- totally normal.  The RE who did the test tried to tell me that my low AMH and elevated FSH likely were the cause of the loss, but when I pressured that my understanding it would be due to egg quality/chromosomal issues and I had normal genetic testing plus microarray, she said it seemed less likely.  She had no real ideas, but admitted she hadn't spent the time scouring my chart like she would have if it were a full follow up appointment.

I went in to see the other RE in the office for official follow up from all the testing today, who I liked much better.  She ordered more testing to rule out any less common hypercoagulable states.  She didn't think the regular "pregnancy after loss" statistics applied to me and didn't have any sense of the odds of further losses.  She said she wouldn't normally start lovenox and baby aspirin without a diagnosis, but would really consider it in my case as the likely cause of sudden loss of a healthy fetus is likely a clot.  She also started me on a baby dose of levothyroxine even though my TSH was 2.5 at last check, and she would monitor it more closely if I were pregnant.  

In line with every other time I have some sort of complex blood work ordered (seriously it's expected at this point), one test was missed, and I have to go to be poked again on Monday.  

I'm hoping for some kind of answer with the rest of the blood work, but given the extensive work up with no answers, I'm not holding by breath.  I'm at least feeling like trying again with the possibility of changing something (thyroid meds/monitoring + lovenox/baby aspirin) is slightly less terrifying than changing nothing and expecting a different result. 

[Mushe]

I am so sorry you find yourself here. I’ve had a four year journey in trying for #2. When I had day 3 bloodwork, my FSH was 16, and AMH 0.24, so similar to yours. I had 6 miscarriages, so also repeat pregancies, but we also had male factor. I know one loss was normal genetics, but two were not; others weren’t tested.

I assume they tested for MTHFR mutations? I wonder why they’d recommend the prenatal with folate if you don’t have that?

I had mentioned on an earlier post, but I’ve been taking baby aspirin since BFP this time, and also recommended it to a friend who had two losses around 16w, with no reason detected, and she was able to carry to term.

I know how scary it is to even open yourself up to trying after so much loss and heartbreak. You’re in the right place here, and I hope you find success!

[pinkpeony08]

Mushe thank you. They did not test me for MTHFR mutation, but my acupuncturist recommends the folate prenatal to everyone as the folate doesn't hurt and may not be helpful if you happen to have the mutation.

I can inquire about the baby aspirin, thank you.

It's scary to think of trying again, and while we really want a third, it's hard that the gap just keeps getting bigger between our hypothetical third and our other kids. Ugh, all of it is hard.

[ivy]

What a difficult journey. I'm so sorry for everything you've been through. I'd be really interested to hear what the RE has to say in a few weeks. I don't know much about RPL but wanted to chime in with my support. I hope you get some answers soon.

[Mushe]

Give yourself some grace on the age gap thing too! My son is 6.5, and while it’s certainly not the age gap we’d hoped for, he is SO EXCITED to be a big brother, and I think having him so independent will be a big help for us.

[pooh8402]

I'm so sorry for your losses.

I agree with asking about MTHFR and blood thinners like aspirin. A former coworker of mine had 5 losses, all before 10 weeks. She had RPL testing, and found out she has Factor V Leiden and MTHFR. I got her to go to my RE in Houston. She had to take folate and baby aspirin, and when she got a BFP at home, she called for a lovenox prescription that very day. She was on lovenox until 36 weeks, and switched to twice daily heparin until she was induced at 38 weeks. That was the only pregnancy she carried past first trimester and we attribute the blood thinners. I hear a rumor she's pregnant again, so she is probably on the same regimen.

I'm also worried about age gap. We started trying again when E wasn't quite 2, and as it stands, the shortest gap we're looking at is 3y8m. It's a bigger gap than we'd like but it is what it is. I am encouraged by the fact that E will be more independent than if we had gotten pregnant a year ago.

[loira]

Have they ever tested your TSH while you were pregnant? It can change significantly in pregnancy, and was totally normal for me until my 5th pregnancy. I had to take Synthroid when pregnant with my DD. Ditto the baby aspirin. I took it from before getting pregnant with her until 36 weeks.

RPL is awful, and I'm sorry you find yourself here.

[pinkpeony08]

May 29, 2018 12:35:21 GMT -5 loira said:

Have they ever tested your TSH while you were pregnant? It can change significantly in pregnancy, and was totally normal for me until my 5th pregnancy. I had to take Synthroid when pregnant with my DD. Ditto the baby aspirin. I took it from before getting pregnant with her until 36 weeks.

RPL is awful, and I'm sorry you find yourself here.

If I am pregnant again, I definitely would want my TSH monitored closely. My worry is that it goes way up while pregnant given it was 1.4 a month after the loss and 3.6 a week after... so what was it while I was pregnant?  Even higher?  I wanted to talk with RE more about this as well. 

The plan this last pregnancy was actually to test TSH at 12 weeks just to be safe- adding it to my OB panel, which I was holding off on doing because I was nervous about everything and it had been done the year prior. But the day of the 12 week appointment is when we found out about the MMC.

[claireasmud]

I"m so sorry and sad to hear your story. You're not alone here and the women on this board have given such wonderful support to anyone who needs it!
I've heard such positive results from baby aspirin in similar cases so it's great to hear that you will investigate that!

As for the age gap...if our latest IVF attempt works, mine will be almost 13 years apart! I'm less concerned about the age gap than I thought I'd be, I'll just be happy to actually have a baby!

[pinkpeony08]

bump for update

[Mushe]

I am so glad you got to speak with another RE, and they validated that there must be SOME reason, even if they’re not sure yet. I had the same thought of blood clot. Wishing you the best in deciding whether to move forward and try again. ❤️

[luv2rn4fun]

Lurker here (I was on this board back in 2013/14).

I had two losses prior to DS1. Both had heartbeats and then no heartbeat. My OB referred me to a RE where she did RPL panel and bubble ultrasound. My results came back unexplained, which was beyond frustrating.

She suggested doing baby aspirin daily, starting at the follow up appointment, and PIO shots once I got pregnant. The protocol worked (for both DS1 and DS2)!! Just wanted to share my story as I know I was in a place where I was very cautiously optimistic. Also, I do feel it was likely the baby aspirin that was the major game changer. My RE doesn’t believe in testing/treating for MTHFR but my gut tells me baby #1 loss was due to a clotting issue while #2 was likely a 1 in 4 statistic (the betas were all over the place, baby measured behind, progesterone was lower, etc.

Good luck! I really hope the changes result in your rainbow baby!

[gerder3]

I have no advice but I'm sorry you've found yourself here. I hope you find answers soon!