What questions should I ask/what should I be pushing for?

[tacoflavoredkisses]

I’m sorry to just barge in here, but I was hoping to see if I could get some advice.

I’m currently in the midst of my third loss since July. I had an ectopic (likely caused by my IUD still being in place, I didn’t even know I was pregnant) and my right tube removed at the beginning of July 2019, a miscarriage at 5 weeks in November, and am now having a second miscarriage, again at 5 weeks. I was fortunate to have no trouble with my first pregnancy, so these issues TTC #2 have been new territory for us.

I asked after MC#1 if my progesterone could be an issue and one of the doctors at my OB’s office sort of blew me off. She told me how I’m “clearly super fertile!” and that it must just have been an abnormal embryo. This time, they did measure my progesterone and at 4w6d, it was 2.4, which the lab marked as low.

My OB hasn’t called me (I only even know my blood results because I logged into Quest’s website), but I expect a call tomorrow. Am I right in wanting to ask for a progesterone supplement when we are clear to try again? Or should I be asking for additional testing of some kind? I just don’t know where to go from here, and I suspect I’m going to have to be a more firm advocate for myself if I want to make progress here.

[seeyalater52]

I’m sorry for your losses.

I would do two things:

1. Request a recurrent pregnancy loss blood panel. Also get a genetic karyotype (and your husband too.) If your OB will do one, get an endometrial biopsy to test for endometritis.
2. Request a referral to an RE. Most OGYNs are pretty useless when it comes to difficulty getting or staying pregnant. With 3 losses you’re in a pretty statistically small category that warrants being seen by a specialist who can do more in depth testing.

[msmerymac]

I'm so sorry. I've been there myself so I understand.

I agree about the progesterone. I see a reproductive endocrinologist and I'm going through IVF. They tested mine 3 days after transfer and it was 9. They wanted it higher, so they upped my dosage. The day of my pregnancy test it was 22, which they were quite happy with.

Progesterone suppositories or vaginal gel are messy, but easy, but harder to track in your blood. The shots are suspended in oil, so they are also messy and will bruise, but it's easily detected by blood test.(my doctor has me on both). Each are maybe a few hundred for a 4-6 week supply? They may be covered by insurance too.

[joenali]

First, I’m so sorry you are going through this. I would second an appointment with an RE. I think sticking with a dr who is not a specialist might be wasting valuable time.

[pinkpeony08]

I'm so sorry. I would also recommend requesting a repeat loss panel. And I would third a request to see an RE. I would also say that if you don't feel your OB is super supportive throughout all this, you should get recommendations and find a new one. It's already hard enough to go through losses, and you deserve a doctor who is very kind, responsive and supportive through all of this.

[tacoflavoredkisses]

Feb 2, 2020 21:06:29 GMT -5 pinkpeony08 said:

I'm so sorry. I would also recommend requesting a repeat loss panel. And I would third a request to see an RE. I would also say that if you don't feel your OB is super supportive throughout all this, you should get recommendations and find a new one. It's already hard enough to go through losses, and you deserve a doctor who is very kind, responsive and supportive through all of this.

It’s frustrating because she was the doctor who performed my ectopic surgery and was so compassionate towards me during that time, but she just kept focusing on my ability to get pregnant (which I admit I’m exceptionally fortunate both losses have originated from my tubeless side) rather than that I can’t seem to stay pregnant. I saw a different physician this week at the same practice, and I’m hoping she will be more proactive.

If anyone has an RE recommendation in the DC metro area (preferably on the Virginia side), I’d gladly take it.

[lovelyshoes]

I would consult an RE, but low progesterone alone could just mean that the pregnancy wasn’t viable and your body was miscarrying, not that something is necessarily is wrong. After my mc my new dr blew me off about testing my progesterone and I switched doctors right away. Pregnancy after loss is complicated enough and you need a doctor who will explain their reasoning, not blow you off. Best of luck to you. I would move on to an re. I feel like I wasted a lot of time dealing with obs.

[tacoflavoredkisses]

So to update, I finally got an OB from the practice on the phone. She happens to be the one who focuses on early/recurrent miscarriage.

She told me my progesterone level wasn’t a concern, that there’s no proven benefit to prescribing progesterone supplements to prevent early miscarriage, and that she generally only refers patients to the RE if they want to pursue IUI or IVF. She wants to run the baseline bloodwork the RE would run this week.

I’m so frustrated. I said several times to her that my issue is staying pregnant, so how do we fix that, and I got “this was just bad luck, your ectopic just implanted wrong and it seems as though you just had 2 eggs that fertilized with genetic issues early on, your best bet is to keep trying” in response.

[loira]

I'm sorry. I definitely get the frustration at being unlucky multiple times, especially for 2 or more unrelated types of loss. I had an ectopic, then TFMR, then 2 early miscarriages. Like you, the getting pregnant part wasn't the problem. I was referred to the repeat loss clinic after the 4th loss but mostly because at that point I was a such a headcase that my GP waived the 3 miscarriage rule. My specialist ran a hormone panel and everything was fine with my eggs, and I didn't have any known clotting or thyroid issues. Basically I really was just extremely unlucky. One thing the specialist recommended though was baby aspirin. She said it will sometimes help and they don't really know why, but it also doesn't hurt to try it. I took 1 a day in the month leading up to and all during my pregnancy with A and that was successful. No idea if it was the aspirin or just better luck.

[msmerymac]

tacoflavoredkisses, can I ask how old you are? She might be right that it's bad luck, especially if you're over 35 when genetic issues tend to be higher, but there can absolutely be more to it than that.


*trigger warning - loss*

I've had 3 miscarriages. Unfortunately, I can never get pregnant on my own, so all were a result of IVF. I tested all the embryos. The first one, my beta was only an 18 when we tested, and they like it to be at 50. We DID end up seeing a heartbeat, but it was always a week or so behind developmentally, and stopped developing around the 6.5 week mark (when it was 7/8 weeks gestation age). We chalked that up to it not implanting correctly, or having something mosaic about the embryo that wasn't picked up on the genetic testing.

The second time, we transferred 2 "non-concurrent" embryos, which means they were tested, but they weren't able to definitively say if they were genetically normal or abnormal based on the cells sent to the lab. One of them implanted. After developing totally normally I had a miscarriage at exactly 6 weeks. Okay, we chalked that one up to there being something genetically wrong too, because we didn't have that information.

I switched doctors, went through a very successful egg retrieval, and got pregnant with a frozen transfer of a high-quality, genetically normal embryo. Awesome. Everything was developing normally. At 6w4d, I had a miscarriage. Okay. Now we knew something was definitely wrong. My new RE was like, "okay, wait a minute, we have to do more testing to figure this out." Long story short, I went through a ton of immune testing, and still nothing came up, but I am now on an immune protocol, which adds in a few more medications to try to balance out my immune system, with positive #4.

All of that to say, when I started this process, I would have never known we would be in this deep or that there were these types of issues. And it can certainly occur in secondary infertility as well. I'd keep an open mind and research if your insurance needs a referral or if you can just set up an RE appointment.

[tacoflavoredkisses]

msmerymac I’ll be 34 this summer. I’m sorry for all you have gone through. I believe our insurance requires a referral, but I’ll call to verify.

[pinkpeony08]

So frustrating. If your insurance allows, I would consider just scheduling with an re. You could also ask your ob for re referral specifically for saline ultrasound to be sure there is nothing with your uterus causing the issue. Mine was fine, but a friend with recurrent miscarriage after no problems having her first child was found to have a bicordicate (heart shaped) uterus. I’m so sorry. I would also consider a new ob bc you shouldn’t have to advocate so hard to get what you need.

[tacoflavoredkisses]

I called my insurance and I guess their policy has changed in the last 18 months. I no longer need to get a referral! They sent me a list of in-network docs so hopefully one of them will work.

My OBs office called me as I was finishing that insurance call to tell me the doctor “mistakenly” told me I should come in Friday for a follow up beta and instead said I need to wait 2 weeks and then go to Quest for labs. I absolutely think I’m done with them.