Ugh, I need advice please

eminbmore · October 2010

Had yet another u/s this morning to confirm that this pregnancy is a dud. I've been heavily spotting since Saturday, so I was hopeful that things were passing - but, unfortunately not. The sac is still there, and to my eye it's grown since Saturday. There's no baby, no heartbeat, no fetal pole, etc - it's obviously not a viable pregnancy (I should be 6w, 2d today - there should be much more visible... most importantly though, my last beta on Thursday was only 580).

There are three REs in my practice, and each one is recommending I do something different at this point. The one who is actually my doctor is recommending that I wait and see what happens (well, this is what he said on Thursday - things might have changed since then - he's supposed to call me to discuss this afternoon). The one who saw me on Saturday is recommending methotrexate. The one who saw me today is recommending a D&C.

At this point, we're up against a deadline of the end of the year, when our insurance re-sets itself, and we have to start paying toward our yearly out of pocket max again (we hit the max already earlier this year, and now all our IUI treatments are covered - if we need to do IUI in January and after, we're going to have to pay). Financially, it's in our best interest to get in as many tries this year as we can, and looking at the calendar we're hoping to take one cycle on birth control and then hopefully fit in two IUIs before the end of the year - if necessary. The schedule is a little tight, but if this damn miscarriage moves right along, it should all work out.

So, now I need to decide how to proceed with this dud pregnancy. My options:

Let is pass naturally. Pros: seem obvious. Cons: We have no idea when this will actually happen - might throw our schedule all off and end up costing us a lot of money. If my betas went up again today, this might not even be an option.

Methotrexate. Pros: gets the show on the road, ensures the sac won't cause an infection or whatever, it's not surgery. Cons: my office wants you to wait 4-6 weeks after the injection to try again, this will totally eff up our schedule and potentially cost us a lot of money.

D&C. Pros: it clearly ends this, will hopefully get my betas dropping super fast, gets this going sooner than later, helps me avoid bleeding for 10 days (which I've done before - I've said in the past I never wanted to have a natural m/c again, because of all the mess, pain and stress). Cons: It's a D&C.

My RE will be calling me later this afternoon to discuss the options, and talk about today's betas (which may narrow the options, like I said earlier) - but I'd love to know what you would do in this situation. I'm kind of at a loss, not sure which direction to go.

dandyelle · October 2010

I am so sorry you are going through this Em....

In my experience, the D&C was quick and relatiely painless. I only had to go for betas a couple of times, and I had my period 4 weeks later. I know some ladies here have had the shot, and it took them a long time (months) for betas to get to zero.

Whatever you decide, I am really, REALLY sorry this is happening to you.

Scout05 · October 2010

Oh FFS, I am so sorry about that. Damn Bump. I'll try to delete in a minute.

Anyway, I was trying to say:

I was glad I elected for the d&c's. The proceedure is easy, recovery is easy, and then it's just over. My betas always fell quickly, and I felt like, at least physically, I could just move on. I couldn't see waiting for the natural loss to happen, not knowing when and where.

That's just my personal experience.

I am so sorry you even have to think about all this.

eminbmore · October 2010

LOL Allison. I was like, "WOW 10 people answered already!" Stupid bump fart :-P

babygirlpriest · October 2010

Good Lord AB!! Talk about bump fart!

E - I'm so, so sorry you are in this place. For me, one of the "PROS" of the D&C was that it WAS a D&C. Yes it's a surg. and yes, you're put under but it is a very minor procedure and though there are risks... they are minimal.

I did not want to deal with the emotional pain of passing the tissue, blood, etc. associated with my baby. With the D&C, I was just in a blissful sleep. Also, I found the recovery time very minimal.

This is a very personal decision and I'm guessing the reason your docs don't agree on a plan is that there's no right course of action... only what's right for you.

Depending on your comfort level with surg. you may want to consider the D&C as it sounds like it will put you on the IUI track fastest.

RunSchwartzRun · October 2010

I'm so sorry that this is a choice you have to make.

I am with Allison. I didn't have a D&C and I wish I had. It really sucks to walk around every day never knowing when it is going to hit. Plus, mine was very painful and I barely made it home in time to pass everything. A true nightmare. Also, I think there is a lot to be said for speeding things along and giving yourself the financial edge.

Huge (((hugs))

BabyMimi · October 2010

I elected not to have a D&C and I regret it but this is a very personal decision so you need to do what you think is best.

I'm sorry this is happening. Big hugs.

KristysRedBarn · October 2010

Emily, I'm so sorry, this is all so unfair and it just sucks. If you don't want to go the natural route, a d&c isn't that bad recovery wise and looks like it would fit your plan better.

hbkises · October 2010

I'm so sorry you're going through this...

if it was me, I'd go with the D&C. but that is just me. What does your gut tell you?

ColindaP · October 2010

Your betas are low enough that it probably won't take long to happen aturally, and it probably won't be that physically bad. The metho or misoprostol would get things moving sooner, and itt's not like you can try in less than 4 weeks anyway,since almost all docs recommend at least one cycle off before trying. I wouldn't do the d&c, especially since you're already bleeding/spotting. I definitely skew towars wanting as little intervention as possible,and not having the chance of something going unecessarily wrong with a surgery.

if I were you, i'd take metho or cytotec to get things out of there and move it along.

jcath · October 2010

I'm really really sorry. I've had a D&C and a D&E - both were easy procedures. I hope you can find a decision that works best for you.

ERICA21779 · October 2010

(((hugs))) I certainly don't envy you this decision/process. From what you've listed as far as pros/cons, personally I would go with the D&C, I don't think I could go thru a natural miscarriage if I had a choice of something much quicker.

Best of luck in whatever avenue you choose.

Clerk9 · October 2010

Oh no! I'm so, so sorry. ((BIG HUGS))

I don't have any experience other than having a D&C. As weird as this may sound, it was the best/easiest part of my m/c. I had started bleeding, I think, the day before the procedure was scheduled, so I wasn't sure if I should go through with it. But I'm SO glad I did.

The doctors gave me the option of whether to go under general anesthesia or just have sedation. I opted for the sedation...& don't remember a flippin' thing between when they gave it in the OR & when I was wheeled out afterwards. I took ibuprofen once that day, but probably didn't even need to take that. The bleeding lasted about the same length of time as a normal period.

One thing I will warn you about, though (which I wish my doctors would've warned me about): they put Pitocin in my IV drip, so I started having contractions pre-op. I think I may have actually passed most of what was in there while waiting to go to surgery (which made for a very intimate few minutes with the nurse in the bathroom, but she was AMAZING...turns out she'd had a m/c decades earlier...& I just didn't give a sh*t who saw what at that time). The Pitocin SUCKED but I don't think this is necessarily standard protocol, so your doctors may or may not do it. Thought you should know, just in case.

FWIW, I had never been hospitalized, had surgery or had even had an IV before my D&C. While it was a really difficult decision to make, I still know this was the right decision for me & DH. (Sorry this was so long.)

T&P to you & your family as you cope with this sucky situation, & I hope you are able to come to the most comfortable decision for you all as soon as possible.

((HUGE HUGS))

grr_aargh · October 2010

Will your doc entertain the idea of a medically induced m/c? I forget - did you have a c/s with your first? (If you did, misoprostal is out of the question).

You're 6w2d? Do you have a tilted uterus? There's a gestational sac- but no yolk sac and no fetal pole? If I had a gest sac w/no yolk sac and no tilted uterus at 6w2d, I'd call it and move forward - likely with a d&c OR a medically induced miscarriage.

If you feel in any way shape or form like that would be a regrettable decision, then wait.

millejj1 · October 2010

I would likely decide to have a D&C, it's the fastest option, will provide the closure you need the fastest without the emotionally stress of a natural m/c, and be the most likely to keep you on track for the future.

I'm so sorry this is happening.

Daisy07gray · October 2010

I am so sorry you are going through this. My T&Ps will be with you as you make a decision and figure out the rest of the year. I think that you have really well thought out +s and -s and looks like you're heading the direction that will give you the most chance this year- GL~

AppleRidge · October 2010

I agree with Colinda. With your betas being low and you already spotting, I'm guessing you'd m/c within the week without intervention. And while I was all for a D&C with my loss that was further along, I just don't think it will speed things up much for you and will carry risks that aren't worthwhile. I think if anything, I'd opt for misoprostol/cytotec.

eminbmore · October 2010

Thanks for all the advice guys!

I can't do cytotec or misoprostol because of my previous c/s.

My RE called and said that at this point he's recommending a D&C. They're getting me on the schedule for Thursday. So, at this point unless it happens naturally between now and then - that's the plan. I am not sure if emotionally and physically I can handle another m/c... my last one sucked.

babes12 · October 2010

just wanted to say i'm sorry.

(

damabo80 · October 2010

Hugs. I'm so sorry you're going through this. Will they let you cycle right after a D&C? If so, then I would vote for the D&C, as it seems to be the fastest and easiest choice.

For me, the actual proceedure was a breeze.

Court1 · October 2010

I'm sorry you're even dealing with this hun. I vote D&C. I thought that was the only good part of the shiitty process.

grr_aargh · October 2010

eminbmore:

Thanks for all the advice guys!

I can't do cytotec or misoprostol because of my previous c/s.

My RE called and said that at this point he's recommending a D&C. They're getting me on the schedule for Thursday. So, at this point unless it happens naturally between now and then - that's the plan. I am not sure if emotionally and physically I can handle another m/c... my last one sucked.

I was wondering if you'd had a c/s. I know it's contraindicated in women who've had them.

I totally understand what you're saying - I'm glad your doctor had a clear recommendation for you.

redstars93 · October 2010

ambrandau2:

Oh FFS, I am so sorry about that. Damn Bump. I'll try to delete in a minute.

Anyway, I was trying to say:

I was glad I elected for the d&c's. The proceedure is easy, recovery is easy, and then it's just over. My betas always fell quickly, and I felt like, at least physically, I could just move on. I couldn't see waiting for the natural loss to happen, not knowing when and where.

That's just my personal experience.

I am so sorry you even have to think about all this.

I've only had 1 d&c but I totally agree with ambrandau (including the "damn bump" comment )

{{{hugs}}} sweetie

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