Miscarriage/Pregnancy Loss

After Miscarriage - trying to understand my blood work numbers

I’m curious if you guys can understand my test results after my miscarriage. 
I had a miscarriage a couple of weeks ago. On Monday at just about 7 weeks, I started spotting and went to the doc where he did an ultrasound. He saw a heartbeat and called it a threatened miscarriage but didn’t do blood work. Said to just see what happens and I’ll know either way if I bleed heavier and if not comeback next week. 
From that night after i saw the baby, for the next 36 hours I bled heavier and went back. Saw a NP (my doc was on vacation) who did bloodwork and sent me to radiology where they couldn’t find the baby any more. 
I’m reading my blood work numbers that were taken two days after I started spotting and my hcg is 430 and my progesterone is .4.
The progesterone is very very low- would it fall so quickly? Could progesterone have been the issue? Trying to determine if doc should have done bloodwork at that initial spotting appt, would that have helped to get me on progesterone or am I just fishing to figure out how I can have another healthy pregnancy.
**this is my third loss, but I also have had 3 healthy babies.
thanks if you made it this far!
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Re: After Miscarriage - trying to understand my blood work numbers

  • @blond1230 I'm sorry for your loss. There's really no way of knowing if progesterone was the issue. There is debate among doctors whether dropping progesterone leads to MC or if progesterone drops because you are having a MC.

    In my experience with my MC, I saw my RE at 6.5 weeks for an ultrasound and was measuring a week behind (no HB at that point). My progesterone at that point was lower than they'd like to see (around 14) so they had me on progesterone 1x a day. When I went back a week later not only had I only progressed 4-5 days, she couldn't get a consistent HB. Her first measurement showed 120, but from other methods she was getting more like 78-80bpm. My progesterone had dropped even more to around 7 so they told me to start doing 2x a day. Later that day I started brown spotting which I knew was normal so I wasn't too worried (although MC was in the back of my mind) and chalked it up to cervical irritation from the progesterone. 5 days later the spotting became more like a light period and was read so I called my OB (I wasn't exactly pleased with my RE's manners at the time). I had an appointment that afternoon to check on things but ended up naturally miscarrying at lunchtime so then I was just there to confirm nothing was retained.

    And as far as my progesterone numbers at the start, when I had my HCG checked for doubling, I started in the upper teens and was 20 or 24 at some point so my progesterone started off in the proper range. In 2 weeks it had dropped to the 14.

    In essence, my progesterone dropped first and was behind gestationally, then spotting, then heavier bleeding a few hours before the MC. In a follow up with my OB she said she wouldn't put me on progesterone the next time I conceive since there are no concrete studies that show it helps with preventing MCs. After the 2nd or 3rd one she might add it as a "why not" to see if it helps, but supplementation sometimes just delays the MC from happening.
    *TW* History:
    Me: 34 DH: 36 | Together since 2007 | Married July 2016

    TTC #1 since 7.2017
    Dx: low morph (1%), ANA positive, low decidualization score, high TSH and testosterone, histone antibodies

    IUI #1-3 all BFN
    IVF #1 | 6.11.19 | 24R, 17M, 15F, 6B, PGT-A tested - 5 normal, 3 girls & 2 boys
    FET #1 | 9.10.19 | BFN "I know you, but we've never met. I'm with you, but I don't know your name"
    RPL, Receptiva, & ERA testing | all normal/negative, recommended going on gluten and dairy free diet for next FET
    FET #2 | 3.31.20 | Opted to cancelled due to pandemic, continued diet and tried naturally over the summer
    2nd Opinion with another RE | 8.20.20 | Not immune to measles (received 1 dose); SA results similar to 2 years ago; decided to move forward with FET #2 redo at start of next cycle
    Surprise natural BFP! | 9.22.20 | MC 10.23.20 at 8 weeks
    TTCAL naturally | starting 11.22.20

    Initial consultation with Reproductive Immunologist | 9.14.21
    Decidualization score biopsy | 10.1.21 | abnormal - low score of 1; endometrial scratch recommended and progesterone supplementation
    Saline sono | 10.15.21 | normal
    Bloodwork | 10.21.21 high TSH, high testosterone, positive for anti-nuclear antibodies and histone antibodies, high protein S, multiple genetic mutations
    BFP! | 11.3.21 | EDD 7.14.22 B) | biopsy provided same effect as endometrial scratch; added supplemental progesterone and estrogen, prednisone, levothyroxine, and MTX Support to maintain pregnancy
    DS born 7.19.22 after induction

    TTC #2 begins 6.2023
    Consultation with RI | 6.6.23
    Saline sono, endometritis biopsy, skin & eye check | all normal
    Labs | high TSH, Factor XIII mutation, high %CD56
    Follow up | 8.8.23 | prescribed metformin, prednisone, plaquenil, and levothyroxine
    Repeat labs after 3 weeks on meds
    Follow up | 11.9.23 | Green light!, increase in prednisone, added lovenox
    Repeat labs in 8 weeks
    Follow up | 1.16.24 | Green light continues
    TTC put on pause
  • @blond1230 I'm so sorry for your loss. as the PP said it's very hard to determine the cause of the low progesterone. If you've had those losses consecutively, you may want to talk to your OB about getting some testing run and possibly supplementing with progesterone when you get pregnant again, or at least check your progesterone early on to see if it is in the healthy range. I had two losses between my two children and did end up supplementing my progesterone with my youngest, as it was on the low end when we checked it. My doctor told me it would not prevent a miscarriage if the pregnancy wasn't viable, but could help my body support a healthy pregnancy if low progesterone was the only issue. 
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