Monday, December 3, 2012

Why I Miscarried & Our Next Steps

We were able to get an apt. with the RE today to discuss his thoughts on my recurring miscarriages. As always, Dr. Vaughn did not disappoint. Did I mention I love this man?  He keeps it simple, while also being very thorough and caring. I already knew he wouldn't be able to give a diagnosis of the situation with 100% certainty. Miscarriage has many gray areas.

Basically, he says that with miscarriage lost so early in a pregnancy, it is most times due to a genetic abnormality from either the egg or the sperm. Progesterone deficiency also happens to be a cause of early miscarriage, but since I was taking Prometrium during my luteal phase and during the pregnancy and levels measured fine, this is ruled out as a cause for the miscarriage. So chances are it was a genetic abnormality. Finding out which person the abnormality came from is somewhat impossible at this point, because the sperm and egg have already come and gone. The only real way someone can make sure they are getting pregnant (before even getting pregnant) with a sperm and egg that have NO genetic defects whatsoever, is to do IVF along with something called PGD or Preimplantation Genetic Diagnosing. This is where they test the genetic make-up of the embryo before inserting it back into the woman's uterus.

For most people who have gotten pregnant and miscarried even more than once, IVF with PGD still isn't the next step, because it's just so crazy expensive and invasive, and the chances are favorable that miscarriage won't happen again. Yeah, tell that to people who have miscarried 3 or more times! Nevertheless, we are definitely not considering IVF with PGD yet, especially considering it costs $18,000 to go that route.  Dr. Vaughn certainly wasn't suggesting we do that, but was just explaining how genetic abnormalities happen and the ways in which they can be avoided.

So, what are the odds that this happened 2 out of 2 pregnancies with me? Well it isn't shocking due to the fact that my age is creeping up, my eggs are getting older, and the amount of eggs I have left is falling as well. I mean, I'm still just under the 35 year old mark for Advanced Maternal Age, but I'm not a 24 year old either. AMH or Anti-Mullerian Hormone is the hormone used to test for ovarian reserve, and although I knew mine was low (0.88) I never knew that I actually had the diagnosis of DOR or Diminished Ovarian Reserve. However, apparently I am considered DOR. You've got to be kidding me! Hmmm, that's a pretty important piece of information for my previous RE to leave out ya think?!

I'm not a huge expert on DOR. It is a fairly complex diagnosis, but from what I do know, it basically means that I have a lower than normal number of eggs left in my basket. Lowered egg quantity sometimes (not always) lends to a lowered egg quality, and thus another reason why it's more likely for older women with less ovarian reserve to produce eggs with genetic abnormalities. You following me here? Bear with me!  The only real way to assess the quality of each individual egg is by retrieving the eggs from your body, as is done in IVF.  And again, we are not there yet.

There are plenty of other reasons for miscarriage including chromosomal abnormalities in the parents themselves, autoimmune issues, clotting disorders, etc. Even still, my RE thinks it is unlikely that these would cause such early miscarriage, and still thinks that mine are due to genetic issues. However, just to be on the safe side, both hubby and I are having a complete chromosomal blood panel done. I will do an extra "recurring miscarriage panel" which will test for the autoimmune issues and clotting disorders. Should be interesting to see if our insurance covers this, as it is VERY expensive. I made sure it was coded for "recurring miscarriage" and nothing fertility related, but insurance companies like to fight people on getting these tests done, so we shall see! No matter what, it is worth it to us to have a definitive answer whether any of these things could be causing our issues, and we are happy to have it done.

As long as the blood tests come back normal and I'm able to have this miscarriage naturally with my hCG dropping to zero sometime soon, we should be on track to TTC again. We will be testing down my hCG to make sure it goes to zero, making sure there is no chance it was an ectopic pregnancy before proceeding with any further treatments. We will be able to begin again with Femara/IUI once the miscarriage actually happens, hCG returns to zero, and a new cycle starts...hopefully in January. The chromosomal testing and recurrent miscarriage workup takes about 3 weeks to get results anyways, so I feel we have a really good timeline in place to follow.

All in all we are happy that we are having further testing done to check for possible causes, but also happy to know that we still have a shot continuing with Femara and IUI. I do think it could just be a matter of a better egg and sperm hooking up. If at first you don't succeed try and try again! If only I could host a little party with free cocktails to coerce all the studly sperms and miss priss eggs to finally unite with their perfect healthy mates!

13 comments:

  1. I hope that your next IUI works. My DH and I are doing IVF next month. IUIs never worked for us. Our doctor recommends PGD because I am 35. It is pricy but when you're already spending $15k, what's an extra $4k more. My RE said it gives you a better shot at selecting the best egg and sperm to avoid miscarriage due to chromosomal abnormalities. But I hope you never have to go to the next step. IUI has proven successful twice so it's only a matter of time before it sticks. Fingers crossed for you!

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    1. I don't blame you one bit for adding the PGD. I think if I were in your shoes I'd do the same thing. I mean, why would you spend $15K just to put in a bad egg or sperm ya know? You are definitely covering your bases, and I think you are going to end up with the most perfect little baby because of it! Excited for you Jessah!

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  2. I am really sorry on the DOR. As you know, I am dealing with that too. I am glad that your number isn't too far below 0.88. Not sure how long ago it was retested since you mentioned the other RE, but you might want to see if there's a new number. Mine was .67 last Dec and then this Oct it was .36. Most of the supp's I take are to help improve quality since I can't improve quantity. Maybe ask Dr Vaughn about Royal Jelly and CoQ10? Those are found at Walmart and stuff, so no speciality anything.

    I am so glad Dr. Vaughn is so awesome and glad he has a plan. I am so incredibly sorry this happened to you, but I've seen women with DOR have a few MC's and then a very healthy, sticky BFP! I love that your Re is so proactive and with the program, so really hoping that this next one is perfect! *hugs* Emily. I'm so sorry for everything, but one day you will conceive, carry, and deliver a beautiful, healthy, baby!

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    1. The AMH was tested in mid August, so about 3 1/2 months ago. I highly doubt Dr. Vaughn would suggest royal jelly or CoQ10...let's just say he's not a big fan of supplements. I understand his misgivings about them, being that there is no regulation for sups, but he basically just laughs off the supplements I'm already taking. He's definitely a Western medicine kind of guy. It's actually kinda shocking I like him so much, being that I am such a believer in holistic approaches as well and he just doesn't give any credence to them whatsoever.

      Hoping this next cycle is the one too. Thanks Amber!

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  3. If you go the extra mile with PGD- ask about adding predisone and or intralipids empirically- I have know many women who have had a few m/c's go through IVF with PGD and transfer a perfect embie and still not stick due to a immune issue, just something to look into before you spend the big bucks...xxxx's
    so sorry again...

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    1. We are nowhere close to the quite yet, especially since we have zero infertility coverage, but I will definitely make sure we consider that as a factor before just going for IVF with PGD. Thank you for the reminder!

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  4. Emily,
    I hope you are able to get all the necessary blood tests done without too much of a hassle from your insurance company. I just went through that =/ After my 16 week miscarriage my doctor wanted a full panel of blood test done on me. The baby and placenta had been sent in for chromosomal testing, but that came back inconclusive so we will never no if there was or was not something wrong with our baby. Our insurance company did not want to cover the blood tests (and they would have ran us thousands of dollars) because it was my first miscarriage. Their policy is that a woman has to lose two or more babies before they will cover the testing. How ridiculous is that!?! However, with the help of my wonderful doctor the insurance company agreed to cover all but a couple of the tests. I just had them done last Monday so I'm still waiting for the results.... I pray that your insurance company doesn't put you through the ringer like mine did! Thinking of you and sending hugs!
    Miranda

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    1. I am so sorry you had to fight so hard for proper testing. From what I'm told insurance companies used to require THREE miscarriages before they would cover testing. Can you believe that? That makes no sense to me.

      We are definitely aware they may not cover it, but to us, we didn't want to chance not knowing about something that could make it a problem again. If it comes back normal, we'll have peace of mind. If they find something, well then we can hopefully fix it! So glad you had an awesome doctor advocating for you to resolve the situation!

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  5. I just found your blog and wanted to say that I'm really sorry to hear about your loss. I'm 36 and also have DOR (my AMH is 0.17!) but have yet to ever get pregnant. I can't imagine what you're going through but just wanted to let you know you're definitely not alone. My doctor also isn't a huge fan of supplements, but the one thing she did recommend was CoQ10, 800 mg per day. I would definitely ask about that one at least, if your doctor is open to it, since there have been some pretty positive studies about it as opposed to other supplements which are more part of eastern medicine.

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    1. Thanks Aramis. Getting the DOR diagnosis was depressing, but not surprising to me really. I asked my nutritionist about CoQ10, but she said I'm already taking a boatload of other antioxidants (I'm taking a bunch of Standard Process supplements and vitamins) that she said adding another powerful antioxidant probably won't make a huge difference since I'm to the max as it is. She said it wouldn't hurt, but I am already on the verge of getting sick of popping so many pills, so I may hold off for now. I do hear many recommendations for DOR on it though and will still be doing some research on my own. Tnx for the reco!

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  6. Emily, so glad that you were able to get in to see Dr. Vaughn so early. I'm sure it made you feel somewhat better to have a pro-active plan in place for the next step. I think a RPL blood panel is an excellent idea and will give you lots of peace of mind if everything comes back normal. Then it's just a matter of uniting the right sperm and the right egg to create your perfect little baby.

    As for the DOR diagnosis, I can't believe your old RE never talked to you about that. It is pretty well known in the RE world that anything under "1" is considered DOR. He should have discussed this with you. I have an AMH of 1.18, so barely over 1. My RE didn't label me DOR because I made his "cut-off" but that paired with my high FSH (7.8-13) makes me think that I suffer from DOR as well. Especially seeing how my IVF cycle is going so far. It fits the mold.

    Hope you and DH are hanging in there. I think about you so often throughout the day and say a quick prayer for you each time you pop into my thoughts.

    Hugs,
    Kara
    www.waitingonbabyb.wordpress.com

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    1. Yeah, I my old RE told me it was low/normal but no mention of DOR. I don't know if she just didn't want to alarm me, but I think that's something you should flat out disclose. I'm not an idiot. I know what different fertility diagnoses are, and I would have wanted to know that! Anyways, I'm just so glad I switched RE's.

      I hope your IVF cycle pans out ok too lovely lady and that you two are also hanging tight. Will definitely keep you in my prayers!

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  7. Thinking of you Emily and hoping for an update soon!

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