Why don't they do RLP blood work before you start to get pregnant?

heatherlynn321

Just a thought, why don't they do Recurrent Loss Panel blood work at your first preconception visit before you even try to get pregnant? It just seems like if they can discover you need some baby aspirin each day before you lose 2 babies, that could be easily discovered before you even try to have a baby. Why do you have to wait until 2 or 3 miscarriages before they try to discover issues when they could just as easily try to figure it out beforehand? Just a thought I had today while they were doing my RLP blood work. Hopefully I will hear back soon on the outcome.

RiverSong15

I'm sorry for your losses. I'm not sure if you started this post just to vent (which I get), but here are my thoughts on why testing everyone isn't feasible, as much as it sucks to go through RPL. I've had 2 losses, and I've just been through RPL testing. The reason they don't do this for everyone is because most people won't need it and it's expensive. Before insurance, my bloodwork alone was $6-7K, and that doesn't include the saline sonogram. That was another couple thousand. Although I was lucky that my insurance covered most of it, if they tested every woman thinking of TTC, that would drive insurance rates up like crazy. When you look at numbers, about 5% of women will have back to back losses. 1-3% of women will have 3 consecutive losses. That's a lot of unnecessary bloodwork and exams for 95%-99% of the population. And even among women with RPL, 50-75% of the time, they find nothing wrong at all during testing. Logically, it doesn't make sense financially or medically to test every woman when maybe 1-2% of the women will find something wrong.

All this to say, I totally get where you are coming from. RPL sucks - and I too have felt like "why did I have to go through this twice before testing?" It really sucks that most of the time, losses are caused by unpredictable chromosomal abnormalities.

heatherlynn321

It was mostly venting, and I figured it was due to costs. I wish there was a way to make it more financially feasible though, I feel like the amount of coworkers I know who've had repeat miscarriages, it seems more common than the statistics say. 

rainbowwishes5

So sorry for your losses. I have had 2 losses and they won't do RPL testing until I lose another one. (Im guessing it's a cost issue?) I'm now taking baby aspirin just in case! Best of luck with your testing. 

heatherlynn321

Thanks, good luck to you too.

chloe97

I completely agree with the cost issues, but some tests are not cost prohibitive. Diagnosing PCOS, DOR, and low progesterone are not expensive tests. I think those tests ran my insurance around $300-500 and you know that my insurance actually paid like $150 of that bill.

I do think that OB-Gyn community diminishes the effect that repeat musicarriages have on a woman's mental health and well-being. I can't believe the number of times that Drs have said "you can try again" when Ive told them about my MC. This has literally rocked my entire being to its core, it's not just a small medical problem that happens to many women. It's my life and it's my future and it affects how I feel about myself as a woman.

Many of us are suffering from depression and have a finished quality of life because of our multiple MCs. I'm sure my loss of work productivity, work medical leave, multiple D&Cs, and therapy appts offset the cost of RPL blood work. I know that RPL testing is no guarantee of not suffering another MC, but it just sucks that so many women have to blindly go back into the fight not having any idea what they are dealing with!

RiverSong15

It definitely sucks either way. It's not just a cost thing on its own. I forgot to add that when they've looked at studies of women who have RPL, there's a 60-80% chance that those women will go on to have a successful pregnancy without any testing or treatment. The odds only go up significantly for women who have something show up in testing that is fixable (uterine septum, for example). So, the medical community looks at the fact that 50-75% of women won't find anything wrong, and most RPL patients will go on to have a successful pregnancy regardless of what they do. So, it's a cost/benefit analysis. Ugh. That sounds so clinical... It still sucks.

@rainbowwishes5 In 2012, the ASRM revised their guidelines on RPL testing. If you have no history of prior successful births and have had two losses, they found that the risks of another loss were about the same among women who had 2 losses versus 3 losses. They recommended that women who lost two "clinical" pregnancies should be tested and that there was no need to wait for a 3rd loss. By clinical pregnancy, they mean you were far enough along that something could have been seen on an ultrasound (5.5+ weeks or so). If you want testing, you could advocate for yourself if your doctor isn't up to date on the revised guidelines.

@heatherwilson321 I hope your testing goes well and that you get the all clear to move forward.

ETA: @chloe97 posted while I was responding. You're right that many doctors don't consider mental health, and whether testing could help a patients mental well-being. Also, I hate hate hate the phrase "You can try again". I wanted those babies, not just any baby, thank you  very much. Give me time to grieve.

When I was waiting to MC a second time, my doctor strongly discouraged me from a D&C because it was "over treatment". She did say she'd do it if I felt I needed it for my mental health, but it made me feel like I was being risky and "weak" if I chose that path. So I didn't. I will say, I ended up having mixed feelings about my RPL testing. I was happy that everything was mostly normal, but I felt devastated that there was nothing to "fix". I wasn't prepared for that reaction. It's a complicated mix and I wish doctors did a better job helping their patients. My OB did not ever offer to refer me to a counselor. My wonderful PCP was the one asking about my mental health after my MCs and gave me a referral. I wish all doctors were as awesome as her.

heatherlynn321

@chloe97 I completely agree with you! The affect it has had on my mental health, I'm trying to see if I can afford some type of therapy to get through all of this. And all of the work I've missed this year! I'm a middle school teacher, and with all of the blood work appointments and days I missed grieving, I feel like I was gone for half of September. And I'm about to miss more days by switching my OBGYN and seeing an RE. I bring in doctors notes, but I hate to miss this much work, it's necessary, but makes me feel irresponsible which I don't like. It's also something I can't really explain to my students. I'm pretty sure they think I'm dying with all the time I've missed. Sorry this kind of turned into a rant towards the end. 

heatherlynn321

@RiverSong15 What is a PCP?

RiverSong15

@heatherwilson321 Primary Care Physician

TScalei

I decided to go for RPL testing after my second mc - my OB's office never suggested it - I just called on my own. Im starting the testing this week - I kind of have mixed feelings about it like @riversong15 - I feel like Im spinning my wheels knowing that more than likely they are not going to find anything. RE already said that based on my history, normal cycles etc. that their is nothing to indicate that my next pg wouldn't be successful.

I wish that there was something more that could be done to possibly prevent mc  like doing some basic bloodwork before ttc. And more that could be done to treat the mental health affects of mc. I suffered a deep depression after my first mc and in hindsight I probably should have been in counseling and possibly even medicated for a short time. I feel like there is so much out there re PPD but nothing re PPD/ depression after mc - which carries a double whammy bec you are obviously depressed after your loss too.

My OB's office treated mc as something that just happens and after both mcs never followed up to see how I was doing both mentally or physically. Suffering a mc is so lonely and isolating as it is that I feel when you get little or no support from your drs office it makes it even more scary.

I can see that in a lot of cases there is very little they can do to prevent mc but I wish how the healthcare system treated mc through insurance coverage and how people are treated through out it all could be revamped.

E2theB

I agree with you @TScalei. I felt like my OB's office as a whole reacted rather insensitively.
The nurse that handled scheduling all my HCG blood work was the most sympathetic person I interacted with. That being said, I do feel like they were making sure my physical well-being was adressed with the follow up appts and blood work, but I agree that the mental aspect is overlooked too frequently.

My doctor's office had scheduled me for a 20 week ultrasound at a secondary facility, and I never even set foot in that facility's door. Yet they were kind enough to send a sympathy card and I had technically never even been their patient.

I also found it a little unsettling that the first ultrasound I was going to have was at 20 weeks and my first OB exam was scheduled at 11 weeks. That seemed like a long time to me, especially for first time moms. I never had a pre-conception appointment, but I imagine it's similar to the counseling appointment I had where they pretty much told me what not to do, took our families' medical histories, and then determined I needed glucose testing eventually based on my BMI and family history.

rainbowwishes5

@RiverSong15 my losses were at 4.5 & 5 weeks and there was no u/s so they are chemical. But that's for the promising stats!

and @chloe97 amen to the mental health conversation here. I'm very sorry to hear you are suffering. I know. I'm a wreck. After my first mc my OB didn't even do an exam. She was mildly apologetic and sent me on my way. So glad I'm seeing my RE because my nurse is awesome (RE himself could use a little class on patient interaction but I don't deal with him really so it's not as important to me).

KyCade3013

I did a whole genetic testing panel, thousands of dollars. Came back we have no mutations that match, all the blood work came back normal except one related to lupus was positive and one was completely negative. The doctor said that makes it inconclusive and sometimes it's wrong and has to be drawn again by a Rumatologist... I just feel like the RPL testing is a can of fruitless worms.. They test and test to find nothing. My left arm has had bruises up and down it for a week because the lady left vials hanging off my vein. I'm just so done with this whole process and while I would have loved to know if anything was wrong prior- it does come back to the damn Baby Aspirin fix all. My doctor was like, well if the Rumatologst finds something, we can put you on baby aspirin. Like said above- would have been great to know like a stupid year ago. 

KyCade3013

Also- I wanted to thank this whole group for recommending going to a RE and MFM. I feel like if I have a shot at all of finding anything, I feel mentally at peace that I covered both my bases... Even tho the process is so mentally and physically hard. (And I just vented) it really did help.