Coming Back... and Trying to Determine Next Steps

MrsG80inTN

Hello sweet friends... I really didn't want to be back here, but back here I am.  My first beta on Friday was 16 and my second beta on Monday fell to 3... CD1 came yesterday.  Bugger.  Thank you all for your love and support over the last few days.  It has helped tremendously to know that you are there for me and thinking of me.  I'm so grateful to have you all in my corner.  To say that a fourth loss is devastating is probably an understatement.  All of my losses have thrown me for a loop, but somehow with 4 I feel myself losing hope and I hate that.  There's no innocence in this process any more and it's hard to feel true excitement when getting a BFP, but rather I just feel like I'm on pins and needles... So, now I'm trying to determine what on earth I should do next.  

Here's what I know...

- I've had full RPL testing and karyotyping... nothing has come back truly abnormal though I am on baby aspirin for a PAI-1 mutation.

- I had my thyroid numbers tested on Monday because if the pregnancy stuck I needed to know where it was for my Hashimotos... My numbers were at 1.66 on Monday.  This in comparison to 0.89 in last August which was the lowest they've been.  I've been suffering from some slight depression and eating my way through it so I know I've put on some weight, but I feel like these numbers are concerning.  Of course my docs all feel like they are still in normal range so they aren't recommending a change in meds... Humph.

- My OB recommended that we see a different specialist at a Maternal Fetal Medicine place to give us a different perspective.  That appointment is next Wednesday.  

- DH and I aren't totally comfortable with our RE, but he's the only one in the area that does IVF so we aren't really sure where to go with him.  He wants us to move to IUI/IVF, but can't give us a reason for why those treatments are beneficial for someone with multiple early losses.  At a minimum he wants to try Femara to see if that helps, but why does Femara help us with early losses either?!?!

- A few folks on PGAL recommended that I see a RI (Reproductive Immunologist) which is hard since there aren't that many of them and it would be both travel and out of pocket.  

- DH has mentioned getting me accupuncture (not sure if it would be worth it), and also a monthly massage just to get my emotions more calm.  Any thoughts???

So, I say all of that to ask... what all should I be asking for or doing?  What else would you all throw in the consideration hat?!?!?!  I'm tired of not having answers and feel like I need to fight for something.  

Because you made it through all of that (bless you), I give you this reese's peanut butter cake dessert.  Enjoy a calorie free slice on me. (Don't forget to bring the wine!)

PinkCamino

I'm so sorry Mrs.G ((hugs))

Have you had a SIS or hysteroscopy?

mara005

So much love and ((hugs))

MrsKush1014

I'm so sorry sweetie.  I have no advice to offer in this arena, but want to offer you so many {{{HUGS}}} and snuggles.  I like your husband's idea of the monthly massages.  Keeping calm is always a good thing.

flyoffeve

Sorry, no advice here. Just came to offer (Hugs).

welly01

 No advice either, I'm sorry.  I just wanted to say again that I'm so sorry for your loss and I hope that you can find some answers.

lycih

I'm so sorry that you find yourself back here... ((hugs))

meredithcarole

I don't think there is any harm in the acupuncture or massage - and it is possible that it may do some good. Stress certainly does not play a role in RPL (in so much as a cause), but it is something that we all live with daily and much more so when facing pg loss and miscarriage.

I also see value in getting a second opinion. I'm not sure about the RI (I didn't even know that was a specialty until right now), but getting with another RE (even if they don't do IVF) might help. The worst they can say is you need IVF and then you're no worse off than with what your current doctor is saying.

All I can offer beyond that is my sincere wish that you are able to grieve and find a place where emotionally you can more forward. This journey is not the way any of us thought it would be; I am sure 4 losses is taking a huge emotional toll on you. So many (((((Hugs))))) Mrs. G.

MrsG80inTN

@pinkcamino – When my doc did my endo removal surgery in April 2013 he did do a hysteroscopy and all was fine.  My RE doesn’t feel the need to do any further exploration…

@cfearsy – I won’t turn down a monthly massage either!

@mlal78 – I’m on metformin too… though never fully diagnosed with PCOS.  Clomid has brough my O earlier, and given me multiple follies, but who knows.

alm288

I'm so sorry I think acupuncture and massages wouldn't hurt anything. If you feel like your stress levels have been quite high, it might help with that. Sorry I don't have any advice. I do hope you get some answers. (((Hugs)))

Frenchteachermama

((hugs)) love.  From my time on the infertility boards on TB I have met many women who have moved to IVF with PGD testing so your embryos can be tested before they are transferred.  I can't remember the exact numbers but my doctor said something like there is a 45% success rate with regular IVF and PGD testing bring that number up to 55%-60%.  

I have been seeing an acupuncturist who is a specialist in women's fertility and I love her.  

Please feel free to PM me if you want to talk more about any of this!!

tlc35

First I am sending hugs.

My understanding of the use of Femara or Clomid in these situation is the same as @jj32.  It can give a stronger ovulation and better egg quality.

AMH is useful to test ovarian reserve and can give you an idea of how many good eggs you have left.

I'm so sorry for what you are going though and that you don't have any answers.

MrsG80inTN

Thanks ladies - I have had AMH tested and all was supposedly fine.  Thanks for the insight @jj32 and @tlc35 - I've done 5 cycles of clomid (CPs with two of them) and so it's likely we'll try Femara... 

MrsPhD83

big ((hugs)) to you. I'm sorry you find yourself back here. I don't really have any advice, but I did want to give a little plug to acupuncture. I started going in January for stress and it has helped *immensely.* After a 30 min session I feel like a took a 2 hour nap, or like I was meditating. I highly recommend for stress management!

MrsG80inTN

@sarcaztic10 - I'll take the baked goods because it means perhaps I'd get to meet you F2F finally :-)  We should do that soon.

@furrypaws - good question.  He's had an SA, but not genetics testing.  @mlal78 recommended we do that as well.  Even though my women's intuition makes me believe it's me and not him causing the issues, it's at least something we are going to do.

TheAerialist

Oh man, so so so sorry!  I am new here, but all the good thoughts to you.

I don't have a lot to offer on the RE side of things, we are just in the beginning stages of that.

BUT! I will agree with PPs that I would never turn it down if my husband suggested monthly massages :-D I also have heard lots of good things about acupuncture (probably all the same things you have, from here on this board) but I don't see how it could hurt, even if it's just some 'me time'.

rmpar29

Hey honey!  I'm glad that you have the appointment with the MFM next week and maybe she will have some more insight.  As for your RE...you are well aware of what I think of him.    I don't know if the travel to see an RI is worth it, or what they would do since I have no knowledge about them, but I do strongly feel that a second RE consult is needed.  Did you hear back from your Endocronologist on your thyroid numbers?  I do not think that acupuncture or massage will help with your RPL, but it will certainly help you relieve some stress which you greatly need right now.  I wish I had more advice for you.  You know I'm here anytime you want to talk and you are in my T&Ps love! 

bunnybun4

I hate to see you back here...big ((hugs))

I was going to also mention getting your amh checked but it looks like you have done that already.

I did femara for several cycles to get a better egg (or a better ovulation...can't remember which one but it was for RPL not IF).

I've only been doing acupuncture a very short time because where I live it is 100 bucks a pop...but it has been very beneficial so far.  It not only makes you super relaxed it has physiological benefits too.  Mine is specialized in treating women with IF/RPL.  

If you aren't comfortable with your RE you may want to get a consult with another...I know how daunting the costs are but you do want to make sure you are with someone who is up to date and knowledgable.  You could always consult with one in town that doesn't do IVF and if you do have to go that route you could figure something else out.

wish I had more answers for you...rpl really sucks.

MrsG80inTN

@rmpar29 - my regular endocrinologist did call back and thinks I'm still in normal range so she just wants to see me back in 2 months... I do have my full check-up/physical with my GP in 2 weeks so I plan to ask her as well.

CheesyPeas

I think you should look into acupuncture.  It certainly can't hurt anything, and everyone I know that has done it has loved it.  It might not be THE ticket to your take home baby but it certainly can't hurt.

I've never looked into immunological stuff in depth for myself since my later losses don't fit the typical mold for those kinds of problems but if I were in your shoes, I would probably do a telephone consult with Dr Braverman or another RI that does phone consults or try to find an RE who is willing to work with a RI.  I'm guessing the direct phone consults will just result in a "yeah you need to come see us" kind or response but Dr. Braverman's consult is free so you don't really have anything to lose.

CheesyPeas

I can't edit my post for some reason but failed to add most importantly, I'm so incredibly sorry you're back here.  ((hugs))

rubysi

I am so sorry that you have had to come back to us.

EIsieMae

I have no advice. Just wanted to say that I am so sorry for your losses. ::hugs::

Nikolie93

As always others had much better advice than I do but I wanted to stop in and say that I am so very sorry to see you back here. *hug*

Km380

I don't have much new advice to add. @Frenchteachermama‌ already gave you the IVF w PGD stats, which is what I will be doing even though our tests were normal. Fwiw, my RE has always said he wants my thyroid below 2, but with such a swing I'm not sure what that means. A massage certainly would help you with stress. And if YH is pushing it, awesome! I'm just so so sorry you are back here. >:D<

gscoville

I'm so very sorry (((((hugs)))))

Elliecat17

((Hugs)) to you MrsG. The acupuncture might help, but I for sure would not turn down the massage! I get your feelings on the meds. Mine thyroid came down on meds, but I am still not happy with what they are at and the Dr. is not worried.

Rachaeleigh

So many (((hugs)))
This whole Damn process is frustrating and frustrating. Also having had 4 losses, I wonder if it will ever happen for us.
I actually haven't been able to get pregnant since our last loss, which is why I'm doing medicated cycles. BUT, 2 REs have told us that increasing egg quality with meds isn't a bad idea for RPL. Can they tell us if it'll work?of course not
I have researched RIs. I'm not sure what to think. Part of me wants to believe that immune issues just HAS to be the problem but then part of me really believes that maybe we've had shitty fucking luck.
My current RE doesn't seem to impressed with RIs. And I do think he would encourage me to see one if he thought out would help.
PM me if you want specifics about our discussion.

MrsG80inTN

HoldingOutHope said:

So many (((hugs))). I just answered your PM, BTW.

I've considered seeing Braverman and have consulted with him on the phone... But, it is a very large out of pocket expense. If they don't find anything wrong in your testing, they will credit some of the $ back though. If you have a phone consult with him, you'll speak to the financial rep who can explain everything to you.

As you know, I'm in a similar position and I wish I had answers for you. So far, I've got nothing. My RE is already starting to suggest IVF with PGD but I have a big problem with such an expensive gamble considering all our genetic testing - including chromosomal studies on my last loss - has been completely normal. Everyone has a different opinion - it could just be AWFUL luck (I find that one hard to believe), egg quality/genetic (though my AMH is good, so quantity apparently isn't an issue), or some sort of immunological response in my ute that only an RI can diagnose. Grrrr.

Ah! Light bulb just went off in my head. *-:) You may want to consider asking your RE for an endometrial biopsy, which I just had done the other week. The company/lab she used was e-tegrity. The biopsy can tell if you're missing beta-3 integrin, which is needed for successful implantation - and the lack thereof is linked to endo, which I know you've been Dx. It can also show if your lining is thick enough to support implantation.

More (((hugs))), lady.

Great thought in the endometrial biopsy... I will ask. Esp since they think my endo is back...

ellebelle2384

I'm sorry you are back here too.  I feel like our stories are similar with multiple losses and no real answers.  It is beyond frustrating so lots of hugs to you.  I read "It Starts with the Egg" and have tried some of the RPL suggestions in the book.  I take 300 mg ubiquinol (CoQ10), 25mg DHEA, and 81mg baby aspirin a day per suggestions based on research presented in the book.  I also do every other week acupuncture sessions.  I had my latest CP after 2 months of acupuncture treatments so I don't know if it helps for fertility but I will say I enjoy it and find it relaxing. 

I will say our RE (and a second opinion we got) both told us our only treatment options were IVF with PGD, which seems like such a big jump but makes sense because based on our D&E report our losses are most likely from poor egg quality.  PGD is the only way to ensure you pick a "good" egg.  I am interested if you have found any research studies or if anyone else has had their RE show them evidence/studies that Femara or Clomid help with a stronger ovulation and therefore better egg quality?  I would love to present that to my RE but I don't know if it's just theoretical or if there's actual research to back it up.  Anyway, if you ever need to chat feel free to PM me.  I totally understand about what you mean with having less hope after each loss.  I honestly have no hope left at this point.

schuebja

I don't have any advice, but just wanted to say that I'm very sorry that you are back here. I hope you are able to get the answers Soon.

nikiswimr

I'm so sorry to see you back here. All the ladies have already given great advice so I don't have anything to add. But I'm sorry you're going through this and am thinking of you. ((Hugs))

eliida

So many ((hugs)) to you...

jjbmstinco

I am so sorry girl.  ((hugs))

yellowcat10

I am so sorry you are back.  Others have already given the info on Femera.  The other thing you may want is a saline sono (there is another name for this I am forgetting).  I know some cps can be caused by polyps or other abnormalities that prevent implantation.  

Cheetara2

So sorry that you are back here. I strongly believe in second opinions. Maybe you can find another RE that's not too far away, esp one that can openly and clearly explain treatment plans.

stephy1221

I am so sorry. Hugs.

MrsG80inTN

GLB30 said:

I am so sorry! Do you know if you have normal progestrone levels throughout your cycle? That seemed to be the issue w my early losses, and (from what I can tell based on Google and the bump) not that common.

@GLB30‌ my re said it was normal 3dpo and was good on the day I got my bfp... Was yours tested throughout your cycle?