Hey folks. I've got some questions about repeat loss workup.
2 weeks ago I had a D&C for my 4th non-viable pregnancy this year.
• The first was anembryonic/blighted ovum
• The 2nd was kind of mysterious. hCG levels got high enough that something should have been visible on ultrasound...but it never was. It presented a lot like an ectopic; fortunately, pregnancy tissue was seen when I had a D&C and hCG values fell afterward.
• The 3rd was ectopic, treated with methotrexate
• The last one had cardiac motion at 5 and 6 weeks, but when I went back at 9 weeks, development had stopped sometime between 6 and 7 weeks.
I was supposed to do repeat loss workup after the ectopic, but, I got pregnant again before it could happen. This time, I'm preventing until that workup can happen because the uncertainty and all the time spent dealing with appointments for miscarriage/ectopic management is getting really taxing.
Did anyone's workup actually turn anything up?
If there's something fixable, I would feel good about trying again. If there's something like a translocation where the odds are just abysmal, I could feel good about having an only.
I'm not sure what to do if the workup turns up nothing (which I know is most likely).
hostess / wonderful grape / 20803 posts
I had a recurrent loss workup after my third early miscarriage in a row (could have been four but only 3 were confirmed). And I'd had a prior loss before my first child. I thought that my consecutive losses were possibly due to nursing (I was still nursing my 1 year old) but my doctor didn't agree and thought it was just bad luck or chromosomal (since I was 35). The work up showed that all of my numbers were normal except shockingly low AMH. Low AMH tied with high FSH is indicative of low ovarian reserve, but there's very little research about low AMH in and of itself. Some believe that it has to do with egg quality. My mother did have early menopause (age 40) and at the time of my weird results, I was 35. Based on these results we made an appt. with an RE; but then I got and stayed pregnant -- unfortunately that baby was sick with an open neural tube defect but we did not find out until 18 weeks and he was born sleeping shortly thereafter.
One thing that I did NOT ever get tested for was the MTHFR mutation (which is believed to impact the body's ability to absorb folic acid). It is really debated in the medical community whether MTHFR mutation impacts fertility or birth defects -- my OB's feeling (and same with my geneticist and high risk OB) was that it's hogwash since so many people have the mutation. Also that because I'd had two healthy children, even if I did have it, it wasn't a factor in my fertility. Ultimately I went on a super high dose of prescription folic acid and also took methylfolate (direct folate) and then got and stayed pregnant again and ended up with a healthy pregnancy and baby.
This is something you may want to look into. There are other women here who probably have more info on MTHFR than me, but I can say the internet is a bit of a rabbit hole on this issue.
So sorry for your losses
nectarine / 2433 posts
@lilyofthewest: I’m sorry for all the losses you have experienced. After either of your D&C’s did they do any sort of testing on the tissue?
I had a natural miscarriage a few weeks ago at 7 weeks and the RE had me collect anything that I could and it was sent off for testing even though it is my first loss. If it hadn’t passed she wanted to do a D&C so that she could test the tissue.
In your case I would push pretty hard for testing, 4 losses are too many for anyone to have to bear
ETA: the reason she wanted to do this is because the pregnancy was the result of a frozen embryo transfer and we only have one embryo left now so we want to know if there is anything else at play in case we need to do another retrieval
pear / 1697 posts
@mrswin: Testing is pending on the last one. I'm definitely going ahead with the work-up, but I am a bit worried I'll feel even worse if there's no answer.
nectarine / 2813 posts
After I had two miscarriages and an ectopic my RE did the recurrent loss panel and found nothing. He told me I was "perfect on paper" and that I had bad luck. I haven't been able to get "clinically" pregnant since my MC a year ago though so I think I have some underlying issues they aren't able to test for yet, which sucks. Having no explanation for the losses and now not being able to get pregnant with no reason does not make it any easier.
I'm sorry you're going through this
cantaloupe / 6085 posts
I did it and got no answers, although I guess it was helpful to rule some things out like chromosome issues or clotting etc. I only had one d&c we could test and that was a trisomy (22 maybe? One of the ones that always ends early). So we know that one was random bad luck. My RE’s perspective at the time of the testing was that for whatever reason we made more than normal amounts of genetically flawed embryos (this was after my first 3 earlier losses) - probably something they could not test for - but we also knew we’d had one healthy baby. I guess in a way it was helpful because we knew it was likely an odds game, but we might have to play a long time. He suggested IVF so we could do PGD and pick the “best” but never got there because we moved and ended up with a viable pregnancy on our own.
I’m so sorry you have to deal with this. It’s heartbreaking but I think it’s worth ruling things out in case there is a straightforward answer - even knowing there probably won’t be.
pomegranate / 3764 posts
I had it after my third loss, and nothing showed up. I had chromosomal testing on my first miscarriage as it was a later one, and that baby had T21. We all then had genetic testing, and none of us carry any concerning genetic results, so the little boy we lost with Down Syndrome was just a random issue. For my last successful pregnancy, I went on baby aspirin as a precaution & high dose progesterone too. Big hugs to you xx
nectarine / 2433 posts
@lilyofthewest: I totally know what you mean about feeling worse if there is no answer. I am trying to hold onto the hope that there will be something they can tell us (i.e. it was just a bad embryo) rather than finding out there is a very specific reason..
honeydew / 7463 posts
@lilyofthewest: I did and it turned out I have a balanced translocation that requires IVF with PGD. I have a 3.5yo and due with DS2 in a few weeks, both from ivf. Feel free to ask me any questions!
pomelo / 5228 posts
I’m on my phone so I can’t type too much now, but get your progesterone tested, and clotting factors. Once I started Lovenox I got pregnant right away (and it stuck).
pear / 1697 posts
@Mrs.Someone: Yup on the menu. I thinking that if anything shows up in the testing it may be progesterone. I have a shorter luteal phase, don't have a dramatic temp shift, and urine pgd is never positive for me. It wouldn't explain loss #1, but, could explain or contribute to 2-4.
pomegranate / 3230 posts
I did not have a "recurrent loss workup" -- not sure what that is -- but I started working with an RE at age 39.
My history prior to the RE was (1) mc at age 35 (2) my son who was born when I was 36 and (3) mc #2 at age 38. I was diagnosed with "unexplained infertility" and told that it was likely just that my egg quality was lower due to my age.
I got pregnant two more times with the RE. The first turned into mc #3 (which was in progress on my 40th birthday! fun!). Now I am 14w pregnant with twins, and I will be 41 when they are born.
They ran an analysis on mc #3 and determined that it was a trisomy 6 which is a random event (ie not hereditary/genetic) and incompatible with life.
If you have an issue such as a translocation then you can look into IVF + PGS to screen the embryo before implanting. That is expensive though!
pomelo / 5228 posts
@lilyofthewest: That definitely sounds like progesterone could be a factor. It looks like the link I have of the autoimmune stuff I had tested no longer works, but I think it's a pretty standard recurrent loss panel. I hope you find some answers!
cantaloupe / 6131 posts
I did the panel work up. They didn't find anything significantly off about me, but they also tested my husband at the same time and they actually found male factor issues that were concerning.
BUT I DID actually end up having a major problem, which the panel wouldn't have shown anyway. I had golf-ball sized brain tumor that was impeding my pituitary gland, so it wasn't supporting my pregnancies because I wasn't making the right amount of hormones. I had to have brain surgery to remove it and it took a year of recovery (my hormones were out of whack the entire time) and then we miraculously got pregnant twice (they told us with DH's factors alone we would need IVF).
pear / 1697 posts
I got back the karyotyping from the last loss - it was a trisomy.
I also ran my 23andMe through Promethease and found that I do have two of the MTHFR mutations. I was already taking a prenatal with methyfolate, but, I guess it is good to know.
Still waiting to get back in for f/u and further testing...which means missing two cycles. urgh.