Testing after 2 MC?

ahackett1990

I've been lurking the boards on here for a few days now and haven't found an answer to this question, so I thought I'd throw it out there. Little bit of background info first:

I suffered my 1st MC back in December and then got a BFP back in February. Went for a 6 wk US and everything looked "fine" according to my OBGYN. Went for my nurses visit at 8 weeks for family history and blood draw. They didn't test my HCG levels or Progesterone but apparently everything they tested for was ok. Went for 10 week appt with OBGYN on Friday. Had a doppler done and couldn't find a heartbeat. She said that wasn't unusual at only 10 weeks and I also have a tilted uterus, making it difficult. Decided to do a US instead. After fiddling with the machine for 5 minutes she questioned me about how far along I actually was. She said that the gestational sac looked normal but the yolk and fetal pole didn't look much different than it did on my 6 wk US. She sent me away and told me to come back in 1 week for a follow-up US but things didn't look good. I haven't had any spotting or cramping like I did with my first MC. I'm not in denial or really too optimistic. However, I have decided to get a second opinion because I felt like she really didn't care and she rushed me through my appointments. What is the point of designating women with a high risk pregnancy if you aren't going to do anything different than you would for a normal pregnancy?

Anyway, I know the "rule" is usually that they won't start doing testing until after 3 MC, but that's ridiculous. I am not going through this blindly 1 more time just so that I can qualify for additional testing. I am just wondering what sort of tests they can do to find a culprit for reoccurring MC? I definitely want to have my Progesterone levels checked because I have thought for a long time that I suffer from most of the symptoms of low levels.

Any advice or experience is much appreciated!!!

lilp2015

So sorry for your losses. I had a miscarriage a month ago it was my first pregnancy. My dr tested my progesterone and said it was low. 4.5 and needs to be 15 to support a healthy pregnancy. I would check into a different DR. Explain to them you want your levels tested right away. Even if it was something other than the progesterone that caused my miscarriage I am happy she tested it so the next time I can start taking it right away. Once again so sorry for your losses!

ahackett1990

@lilp2015 thank you for your feedback!  I'm very sorry about your loss also- glad to hear that your doctor testing your levels for you.  I've since changed to a different doctor and he seems a lot more motivated to find out why this has happened twice.  He seems a bit more hung up on chromosomal abnormalities (since the tissue is the most obvious thing to be able to test first).  If he seems to push back about testing my progesterone then I will find another doctor that is willing!  Thank you again!

MrsGargoyle

I am glad that you found a doctor willing to look more closely at your repeat loss case. Unfortunately, this hang up about the third loss largely stems from insurance companies, who won't pay for repeat loss testing until the 3rd loss. Some companies have stopped that practice, but most continue with the restriction. There are certain ways around it, such as being over 35, but most of the time you will find that it's the general practice. However, a good doctor should be willing to run other tests for common causes for loss. The 7dpo progesterone test measures the progesterone level when it reaches it's peak at 7 days past ovulation. Be wary of an order written for 'cycle day 21' because most women do not actually ovulate on day 14 of their cycle, that is just an average. OPKs can help predict when ovulation might happen, but going to fertilityfriend.com and beginning to track your daily basal body temperature can help you verify when you did actually ovulate, in time to arrange for the 7dpo test. Other things that docs can check that can contribute to loss, but do not have to be coded 'repeat loss' for insurance is your thyroid and prolactin levels, as well as your estrogen/estrodial levels on CD3.

If you are unfortunate enough to suffer from a 3rd loss, then insurance companies tend to cover more expensive testing, including your endocrine system, tests such as HSG and/or SIS to check the physical structure of your uterus, and checking for genetic things like blood clotting disorders. If you reach this point, before any further testing is done, I strongly recommend you move on to an RE (reproductive endocrinologist) to complete the testing and recommend any treatments. This is an actual fertility specialist with the tools and training to help get you pregnant with a healthy baby. They tend to follow your case closely when you do get pregnant, with repeat HCG levels until switching to early ultrasounds to verify development, until handing you over to a regular OB at around 9 weeks.

Hopefully though, you will not face this challenge, and will have better luck.

lilp2015

I'm glad you were able to find a different dr! I love my OB! Most friends I've talked to are surprised she checked my levels after 1 miscarriage. They all were checked after 2. I have a question for you now. How long did it take to get back to your normal cycle? It's been since March 6th and I only had very light spotting from March 31st- April 4th. I called my OB yesterday cause I spotted one more time and they said it can take a couple months. So frustrating when we are ready to ttc again!

ahackett1990

@MrsGargoyle Thank you so much for your extensive reply- I am saving it to my computer for future reference.  Fortunately, my new OB came right out and said that he doesn't believe in the old "3 time" rule and he will start testing immediately.  You have given me great advice and I appreciate it!

@lilp2015 When I had my miscarriage back in December and I passed everything naturally with no medical intervention, I had a period within about 5 weeks.  However, my next cycle after that one was only 25 days long.  I have a fairly irregular cycle to begin with though, so that might have influenced it.  I'm having a D&C tomorrow morning for this one though, so this could completely change my cycle again.  Good luck to you and your SO ttc!!  

lilp2015

Thank you. Thoughts and prayers for you today!