new RE and questions i should ask

ufsandra85

backstory because i haven't posted much in a while and i dont recognize a lot of people :ok so i moved from CT to VA (well in the process) and I have left my amazing RE who I am very attached to. i have had 4/5 losses (i say 4/5 because i lost 5 babies but one pregnancy was twins and I lost them at different times). Anyway. the first 1/2 were explained by my septum. then i proceeded to have 3 more losses that havent had a really good explanation. I got pregnant on clomid 2 times and the other time was natural. i had 2 surgeries to remove polyps in my uterus and they think that could be the reason for losses 3 and 4. She ran the RPL blood work but didnt do MTHFR because she said my losses were too early (7 weeks, 10 weeks, 6 weeks, 6 weeks, 5 weeks) and said that usually effects later than my losses.

So if you were in my shoes what should i ask for? I was thinking asking for MTHFR testing anyway, another SHG because i havent had one since the 2nd polyp surgery and the 4 polyps i have had grew within a month. I can get pregnant but can't stay pregnant. I really hate clomid but respond well to it (always done with monitoring) and I know there are other options. what have your REs done when you have had this problem? I was about to start a new game plan with my RE but never got to because we moved. Before i just followed what my RE said and didnt really ask questions and wasnt really an advocate for myself because she was the RPL and mullerian anomily chair at yale and I trusted her. Now i am going to a military facility which has a good reputation but sometimes in military facilities you might not get the best care if you arent proactive...

s.alarie

I do not see an RE, so I do not have recommendations for you. But I do want to express that I'm sorry for your losses. 

Military facilities are tough, so I'm glad you already know to be your own advocate. Good luck. 

Laurakat81

I don't have a lot of advice but I'd definitely ask for MTHFR testing. Even if it results in later losses it's still a common issue and one easily treated with extra folic acid and B vitamins. And it'd be better to know if you needed blood thinners early on IMO.

Good luck!

ufsandra85

thank you both! I learned the hard to that you have to be an advocate for yourself when i was misdiagnosed with 2 uteri. i guess you live you learn. And i think you are right, i am going to ask for MTHFR because there is no harm in testing

buckeyebaby814

I've been wondering where you went- glad to see you back!

I would absolutely ask for the MTHFR testing and maybe even karyotyping and genetic testing if you've not had it done yet.  MH and I opted to have that done after our fourth loss just for peace of mind.

As for a new game plan, my RE had me try Follistim (FSH injection) this cycle.  I'd always responded to clomid, but in the end my response did go down and my lining was pretty thin.

Good luck to you  

killian09

I don't know what you've had done already, but I recently had an RPL workup, so I can tell you what was on it, since I have the test results in front of me.  I know you probably already went through most (if not all) of this, but it's all I've got that might help, so I thought I'd share.

 -karyotype of me and DH

-imaging (typically SHG, but I'm getting an MRI)

-thyroid TSH test

-an array of blood tests for blood clotting disorders:

antithrombin III, activated protein C resistance screen, Anticardiolipin IgG, Anticardiolipin IgM, INR, PTT-LA (Lupus Anticoagulant Screen), Protein C (Func.), Protein S (Func.), Prothrombin Time, aPTT 

...I know that the clotting disorders are more often thought to be linked to late first tri loss and 2nd tri losses, but some docs think they may also have some relationship to recurrent early loss.  So it is worth asking about if you haven't already had the work up.

Also, if there is any reason to suspect diabetes or autoimmune disorders, there is testing that can be done for that.

 I haven't had any fertility interventions, so I don't know what to ask about in regards to those.  If you haven't already, definitely request and bring copies of your medical records including all your RPL testing.

Hope your new RE can help.  Sorry that you had to go through all of this and now switch doctors.   

Holly TH

Sandra,

 I am so sorry for your losses.  Do you take extra folate now?  You might want to ask your doctor about active L-methylfolate.  I know you don't know your MTHFR status but I have rarely encountered a woman with RPL who doesn't have some form of the polymorphism.  Women with the MTHFR mutation have a very limited ability to metabolize synthetic folic acid (the type found in most supplements and enriched foods).  This puts this at risk for folate deficiency related pregnancy complications.  L-methylfolate bypasses the MTHFR mutation and is 100% bioavailable for DNA synthesis and repair.  It is a better type of folate for everyone, regardless of MTHFR status.  I hope you are able to get some answers with new blood work and I will cross my fingers for a healthy pregnancy in the near future.  Good luck! 

ufsandra85

thank you guys. i do take folate now but i am going to ask abotu the MTHFR. she did the complete RPL work up except MTHFR. we are in the process of moving so i am not sure of everything she has checked but i am definitely going to ask for it. thank you all again for your suggestions