Post-Op Dr Visit was today...

mcodea88 · January 2015

Hi lovely ladies!

I thought I'd share the outcome of my dr appt today. As a refresher, I had a mc at 9w. That day, they did a D&E (not sure why not a D&C but moving on...). Today I had to go in for my post-op visit. I had a lot of questions. I was hoping not to get the run around about "well, we don't start really looking into things until after the 2nd or the 3rd mc". I was prepared to walk out and find a new dr. Instead, the Dr was pretty comforting and quite aggressive. Aggressive in a good way - more so than the rest of the crew I've seen (I go to a group practice. I have a Dr that I call my own, but after becoming pregnant they like to toss you from Dr to Dr to get to know everyone - hate it, not doing that again). Anyway, so she said a few things:

I'm going to be 38 next month so I guess maybe it's why she's testing more, which I am happy about. So - she wants me to get an HSG. Not b/c I had "trouble" conceiving necessarily, but more to check everything out and see if there is anything that needs taking care of. She wants me to call back on CD1 to schedule (it would be done anywhere from CD5 - CD). In addition, on CD 3, I go for blood work. Um... I go for... FSH, Anti Mullerian Hormone and... trying to read.... something Estradiol? Then on CD 23 of the same cycle, I go for more blood work... progesterone, anti cardo lipin AS, Lupus Anti Coglant? (the last two are hand written, clearly by someone with no fingers). Oh and also, Karyotype.

In addition, this I thought was interesting... the Dr said that since the fetus was measuring more than 7 weeks (measured 9w3d at D&E) they want to test both mine and my husband's chromosomes. That may be part of what's listed at the Day 23 testing.

Then, the NEXT cycle, on CD 23 they will test my progesterone again. She also mentioned that if I do get pg again (after being benched until all this jazz is done) that she will put me on progesterone.

I just feel like she had an agenda with me. I felt more listened to this morning than I have at all my other appts when I was pg. I left feeling like there was a plan, and they weren't just going to let me flap in the breeze again.

So - I'm happy - just wanted to share that with you all. My last post I mentioned all the things I had issue with, so I'm hoping with all of this in the works, I'll be better taken care of the next time. I am saying that because I have to have faith there will be a next time.

Welcome any thoughts on any of the above, for those of you who have experience with it. Some of the test names may be slightly off as again, some were hand written on the Rx and I cannNNNOTTT read her handwriting!!!

kreardon11 · January 2015

Wow! That IS a plan! How great! My doc said "let's do baby aspirin for the heck of it". I'm seeing an RE in 2 weeks because I thought that was bogus.

renegadewhit · January 2015

I'm glad you got a solid plan and a doctor you're comfortable with! Good luck on all of your testing!

TheAerialist · January 2015

This is SO great! Congrats on getting a doctor ready to ACT! I went to a fertility center, and I had most of the tests listed, I don't think we did a second round of blood tests on day 23 though. That's interesting! I don't recall any specifics on my blood work, or what each of those tests is for, but they were looking for vitamin deficiencies and a specific hormone that let them know what the egg reserve was (might be!?).

On my end, the HGC was not bad AT ALL, I had read a few things that said it was painful so I was scared, but it was totally fine. Only one moment where it got uncomfortable, but she stopped pushing the saline in and all was better right away.

The chromosome test, I would think, is something like Counsyl, they send it out and test for genetic diseases, they have a website with more info if you are interested, it was super easy and inexpensive. IIRC, it was $99 total for both of us.

mcodea88 · January 2015

@kreardon11 WHAT??? I don't know what that's supposed to do. I did think I'd need to move right to an RE if My DR wouldn't be more willing to test but she seems game, so I'm excited.

TheAerialist · January 2015

@kreardon11 - if it makes you feel any better, my RE also said 'eh, we can also do some baby asprin just for the heck of it' so that's actually a legit thing, it's just not officially proven that it helps so they are kind of winging it that it might help. (all this is according to my doctor, and relates to my specific situation, so not any kind of advice for others) but I am glad you are going to see an RE because I think there is likely way more to it then that! :-)

Nikolie93 · January 2015

This is great! I have to admit I'm not quite sure what everything means right now but it's awesome you have a plan

cm312rn · January 2015

Sounds wonderful! I'm sorry for what you went through, but she sounds likes she has a great plan for you guys

dandb925 · January 2015

That sounds like a great plan! I'm glad your doctor is being so proactive.

rubysi · January 2015

I am glad you got a good plan and a Dr worth working with.

meredithcarole · January 2015

Yay! It sounds like she is really taking this seriously.

So here's the breakdown of the tests (since it seemed like you were asking):

FSH (follicle stimulating hormone) you want under 9 ideally (though some docs have different thresholds). The higher it is the more your body is having to work to release LH. This has to be done between CD2 and CD4. Estradiol is important because elevated levels of that can falsely lower FSH.

AMH (anti-mullerian hormone): measures (estimates) egg reserve. You want it above 1.

The rest measure other important things. Anti-lupus coagulant measures blood clotting (the whole "eh, take some baby aspirin just in case" thing is the preventative solution because they didn't bother testing that issue). Progesterone is obviously important to lining thickness and post O uterus health.

I think @ktlovess could explain karyotyping better than I.

Anyway, I think this is great news! I hope the testing goes well!

ETA: a little more clarification.

LittleMrsW · January 2015

Good luck! Sounds like you have a good plan in polace!

ellebelle2384 · January 2015

Good luck! Just wanted to echo what @Greeneyes842 said about progesterone checks. There can be a big difference between CD23 and 7DPO so definitely keep track of your cycle and check in with them about it. Hope you can get some answers!

mcodea88 · January 2015

@Greeneyes842‌ and @ellebelle2384‌ thank you both for the progesterone clarification!! That's so good to know. I absolutely do not ovulate at CD14... Never have since I started charting last July. So I will make sure I'm clarifying that and I will continue charting so that I can zone in on 7DPO!

@meredithcarole‌ thank you for that amazing info! You gals are all so stinking helpful! My DH is often worried about me coming here for advice because he thinks it will get me upset, confused, too fixated, etc. but really, I have no baseline for this type of doctor appt or information. This is all so new that who better to seek some good advice and opinions than from women like me?! I know I need to see the Dr for what to do, but it makes me feel so much more assured to then know you all think this is a good direction I'm going in, and the bonus is the extra tips I get along the way like the progesterone too.

So again, thank you all! xo

meredithcarole · January 2015

mcodea88 said:

@Greeneyes842‌ and @ellebelle2384‌ thank you both for the progesterone clarification!! That's so good to know. I absolutely do not ovulate at CD14... Never have since I started charting last July. So I will make sure I'm clarifying that and I will continue charting so that I can zone in on 7DPO! @meredithcarole‌ thank you for that amazing info! You gals are all so stinking helpful! My DH is often worried about me coming here for advice because he thinks it will get me upset, confused, too fixated, etc. but really, I have no baseline for this type of doctor appt or information. This is all so new that who better to seek some good advice and opinions than from women like me?! I know I need to see the Dr for what to do, but it makes me feel so much more assured to then know you all think this is a good direction I'm going in, and the bonus is the extra tips I get along the way like the progesterone too. So again, thank you all! xo

It's amazing what you learn on this journey. There is a lot of collective experience here

Have you introed on the TTC>35 board? It's a little quieter, but there is a lot of good information from the AMA veterans.

mcodea88 · January 2015

Oh yes @meredithcarole‌ I was a regular (ish) in the TTC>35 board for a few months. After my loss, I went back there before coming here. I, of course, was welcomed with open arms. I mentioned for my short stint as a pg AMA, the pg boards were.... Less warm? Like, don't ask the wrong question or the daggers were out

. Not to me thankfully, just noticed while lurking. I didn't want to come to this TTCAL board at first. Not denial, but I was so scared the stories would break my heart. They do, but here these ladies are, still helping others and offering support.

mcodea88 · January 2015

I think also I feel badly posting loss questions in the TTC>35 board. Like, when I was there, those posts would scare me. I was also paranoid... Was, or am.

meredithcarole · January 2015

mcodea88 said:

I think also I feel badly posting loss questions in the TTC>35 board. Like, when I was there, those posts would scare me. I was also paranoid... Was, or am.

That's right, you were there. Sorry, the overlap gets confusing.

Every board has their own culture. As you know, the 35+ board has a lot of experience with miscarriage so it is what it is. It is scary to think about it happening, especially if you haven't had one, but sadly it is a reality for 20% or more. I don't think there is any need to pretend it is all sunshine and roses. The ladies there I think have a bit of a different view point. Not better or worse, just different. I like the various perspectives

mcodea88 · January 2015

I do know that when I came back, I had mentioned that when I got pg, I didn't say. I just backed out of the board because I thought I was being respectful. But they said that reading about others' BFP gives them hope so I know better for next time.

I still lurk there, I like answering questions when I can.

you seek to have a lot of knowledge.. I actually thought you might be a moderator or leader of one of these communities?

lcwed · January 2015

mcodea88 said:

I think also I feel badly posting loss questions in the TTC>35 board. Like, when I was there, those posts would scare me. I was also paranoid... Was, or am.

That's why I joined here after this lost. With the first one, a lot of my vents on the board were centered around my loss and the ladies there were wonderful, but I thought here would be better this time around.

I'm so glad you have a plan and were able to actually read what each test was. My doctor ordered a lot of tests too but were only listed by numbers. She told me the tests she was running would tell us if there was a treatable cause for my losses. I hope I get as much info as you will at my follow-up.

meredithcarole · January 2015

mcodea88 said:

I do know that when I came back, I had mentioned that when I got pg, I didn't say. I just backed out of the board because I thought I was being respectful. But they said that reading about others' BFP gives them hope so I know better for next time. I still lurk there, I like answering questions when I can. you seek to have a lot of knowledge.. I actually thought you might be a moderator or leader of one of these communities?

That's very flattering, thank you. I am not a Mod or anything, I just research anything that affects me (and the testing is all stuff I have done).

alm288 · January 2015

It sounds like you have a solid plan moving forward - awesome. Glad your f/u appt went so well!

kreardon11 · January 2015

McSarah1104 said:

@kreardon11 - if it makes you feel any better, my RE also said 'eh, we can also do some baby asprin just for the heck of it' so that's actually a legit thing, it's just not officially proven that it helps so they are kind of winging it that it might help. (all this is according to my doctor, and relates to my specific situation, so not any kind of advice for others) but I am glad you are going to see an RE because I think there is likely way more to it then that! :-)

@mcsarah1104 - Do you mind me asking why your RE put you on BA? Mine is for MTHFR. Feel free to PM

peregrinefalconx · January 2015

I think it is great that your doc is being proactive. Yes, 1 miscarriage can be typical blah blah blah, but as you get older, I think they should be doing more testing earlier. TG I did all of mine after 2! All those tests look good. Question and maybe @Greeneyes842‌ and @ellebelle2384‌ can answer: is it normal to do the progesterone testing? is that standard fair, do you know? That was one test RE#1 did not do on me and when I finally got a baby (normal) and lost him, my new RE said it was bc of a P deficiency, which that test would have shown!

Also, the baby aspirin thing? That is also standard, but not worth much of anything if you don't have a clotting disorder, so I was told by a doc or two (not the prescriber). Feel free to come back if you have questions about your results. If you do have a low AMH, don't freak out. FX that it all comes back good and that your MC was a fluke!

peregrinefalconx · January 2015

@Greeneyes842
Thanks. I will look into that although the horse is likely out of the barn. I got an endo biopsy done last month which indicated low P, and questionable immature egg releases (maybe? not determined through that test) so we are doing the first medicated cycle soon. But nobody offered that test at a reknowned fertility center! They pushed P but never said there might be problem. Hope I didn't usurp the post!

TheAerialist · January 2015

kreardon11 said:

McSarah1104 said:

@kreardon11 - if it makes you feel any better, my RE also said 'eh, we can also do some baby asprin just for the heck of it' so that's actually a legit thing, it's just not officially proven that it helps so they are kind of winging it that it might help. (all this is according to my doctor, and relates to my specific situation, so not any kind of advice for others) but I am glad you are going to see an RE because I think there is likely way more to it then that! :-)

@mcsarah1104 - Do you mind me asking why your RE put you on BA? Mine is for MTHFR. Feel free to PM

@kreardon11 I don't mind answering that here, because there was no reason for it. All the tests/bloodwork etc... that they did came back totally clean and no reason for repeated loss (I have had 2 MMC and a suspected chemical).

For lack of a better word, he was very flip about it, I don't want to give the impression that he is that way in general, I like him a lot, but he was said something along the lines of 'there are no studies that show this works, but there is also no harm in it' (again, this is for my situation, so not a general pronouncement) so basically it's just a thing you can do that may or may not work!

The nurse called to check on me recently and asked again if I had been told to take the baby aspirin, so I am guessing this is just a standard thing at this practice.

Edit because I just caught up on the other posts, and my doctor also did say the same about the progesterone he put me on. The aspirin and the progesterone were together in the above conversation about 'eh, why not?'. I don't believe they tested my progesterone levels at all in the routine tests (I thought for sure that they did, but the lab results online say differently) not sure why.

mcodea88 · January 2015

@peregrinefalconx usurp away! I am reading everyone's comments and logging them in my memory for when I need them. It's all quite interesting to me and gives me some info to keep in my back pocket!

peregrinefalconx · January 2015

McSarah1104 said:

kreardon11 said:

McSarah1104 said:

@kreardon11 - if it makes you feel any better, my RE also said 'eh, we can also do some baby asprin just for the heck of it' so that's actually a legit thing, it's just not officially proven that it helps so they are kind of winging it that it might help. (all this is according to my doctor, and relates to my specific situation, so not any kind of advice for others) but I am glad you are going to see an RE because I think there is likely way more to it then that! :-)

@mcsarah1104 - Do you mind me asking why your RE put you on BA? Mine is for MTHFR. Feel free to PM

@kreardon11 I don't mind answering that here, because there was no reason for it. All the tests/bloodwork etc... that they did came back totally clean and no reason for repeated loss (I have had 2 MMC and a suspected chemical).

For lack of a better word, he was very flip about it, I don't want to give the impression that he is that way in general, I like him a lot, but he was said something along the lines of 'there are no studies that show this works, but there is also no harm in it' (again, this is for my situation, so not a general pronouncement) so basically it's just a thing you can do that may or may not work!

The nurse called to check on me recently and asked again if I had been told to take the baby aspirin, so I am guessing this is just a standard thing at this practice.

Edit because I just caught up on the other posts, and my doctor also did say the same about the progesterone he put me on. The aspirin and the progesterone were together in the above conversation about 'eh, why not?'. I don't believe they tested my progesterone levels at all in the routine tests (I thought for sure that they did, but the lab results online say differently) not sure why.

I had the exact same experience in regards to baby aspirin and P: might help, can't hurt. I did get preggo with a confirmed baby taking baby aspirin and CoQ10 (only difference between first 2 with BOs and the 3rd), but when I asked if I could stop taking the baby aspirin during an U/S, the doc said "I don't know why you are taking it in the first place." I'm going to ask new RE about it next week. As for CoQ10, docs like it--all of them have been supportive or recommended it. That was a totally different experience than all the other supps that ladies have mentioned (and that I've inquired about). I was on the IF board, and many other posters said they were on Theralogix brand (which is what I take). It is expensive but "clinically proven" to absorb. But as always, inquire with your doctor!

mcodea88 Making a list of questions is helpful (if you have crazy brain like I do). It gets it out of your head!

mcodea88 · January 2015

Interesting you bring up the CoQ10... I was taking it while TTC and then when I conceived I stopped. Now that I'll be TTC again after benching, I can't remember why I was taking it. I have the good kind - the more expensive variety... Ubiquinol (which is fully absorbable as opposed to the CoQ10). I haven't started taking it again b/c I couldn't remember when I took it and why so I wanted to dig in again before starting.

TheAerialist · January 2015

tkford216 said:

While I'm not sure what any of that means, it's good to hear the doctor is taking it all seriously. I find with woman issues in general, doctors tend to be far more laid back than at least I would feel comfortable with. It's always the runaround. So I'm glad for you! Good luck with all that!

I TOTALLY AGREE! I have to remind myself all the time that officially testing for different things that may or may not help/hinder a pregnancy (ie: different medications, effects of alcohol, different foods we should/shouldn't eat, etc...) would be medically unethical, but it just boggles my mind that simple things like if coffee is ok or not still remains a mystery!

I feel the same way about pregnancy statistics in general. The whole of the time of the existence of the human race and yet still so much unknown about pregnancy.

TheAerialist · January 2015

mcodea88 said:

Interesting you bring up the CoQ10... I was taking it while TTC and then when I conceived I stopped. Now that I'll be TTC again after benching, I can't remember why I was taking it. I have the good kind - the more expensive variety... Ubiquinol (which is fully absorbable as opposed to the CoQ10). I haven't started taking it again b/c I couldn't remember when I took it and why so I wanted to dig in again before starting.

CoQ10 is supposed to help with egg quality, but the supporting study is weak (IMHO). Here is the article I read about it.

https://www.advancedfertility.com/blog/coenzyme-q10-and-fertility/

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