when to move on from your OB/GYN?

Cubslove12 · March 2016

This may be a dumb question....

I'm wondering when do you seek out a specialist? And what specialist would you seek out?

My my husband and I started trying to get pregnant in Sept 15. We were blessed to get pregnant quickly est. due date July 22. This ended in a blighted ovum the end of Nov/ Dec. We then got pregnant again est. due date Oct 18, which got changed to Oct 29. This one ended at 7w 3d and we heard a heartbeat at 6w1d 6w3d and 7w1d. At our 8 week apt we found out there is no longer a heartbeat.

We appear to have little difficulty getting pregnant, but we can't keep it. With two in a row I asked a family member about it (she's had 3 miscarriages with infertility treatments) and they suggested I seek out a second opinion from a specialist. I was doing some online research and all fertility clinics seemed to focus on IVF... So I'm not sure where to look. I have lots of friends who have gone through IVF, and two that miscarried with IVF. None that have had only miscarriages.

So im not sure if it's too early for a second opinion or who to even look for...

Sorry if this is a dumb question,

chloe97 · March 2016

Hi @Cubslove12 The day before I had my BFP this month we met with an RE. It was after only one loss, but my Dr was happy to refer me bc of my age. I was a bit disappointed how quickly the RE jumped to starting a medicated cycle and IUI. I wasn't ready for it, but assuming things go the way they are going now, I will be.

Most importantly, the RE should do a full work up on you-check your hormones, your uterus for scarring or endometriosis, and blood tests for clotting and other disorders. After that, they will discuss your options.

I remember that you're also in Illinois so if you get your insurance through a large employer, there's a good chance you have infertility coverage. With 2 losses, you should be able to get testing covered, but I would definitely check with your carrier before proceeding if you don't want a hefty bill. The good news is that there are a ton of RE options in Chicago, so you probably won't deal with a wait to get in like other places. Good luck!

Cubslove12 · March 2016

I'm only 32, I don't know if I'm jumping the gun.

ladipale · March 2016

I think the standard is different depending on age and when loss occurs. Some OBs will refer to specialist after 2 consecutive losses, some wait for 3, but a loss after 10 weeks on your first pregnancy may be enough for OB to refer.

I'm 35, have 2 kids and just had a loss at 13 weeks - doc is willing to send me to MFM, but we are going to try again on our own first.

I think it depends on your relationship with your OB - I LOVE my OB and we have a great relationship and I trust her so I'm sticking with her and her medical opinions for now. If you have a good relationship with your OB - its worth talking with him/her about any concerns.

RiverSong15 · March 2016

The recommendations are slowly changing, and the American Society for Reproductive Medicine now states that there is a role for clinical evaluation after 2 losses, as your chances of another MC aren't much higher after 3 losses vs 2. @chloe97 covered the critical info but I'd definitely go through an RE. Maybe do some research to find an RE that specializes in recurrent loss... Not all REs are as well versed in recurrent loss as other infertility issues. Definitely do some research on tests you can expect and possible treatments (the ASRM has a good fact sheet if you Google it). I'm sorry you find yourself here!

ETA: IVF with PGS is often the recommended treatment when no underlying problems are found for recurrent loss and thus they assume the problems are chromosomal and recommend pre-screening embryos before implantation. I don't blame you for being hesitant on that front though

ETA2: the RE in my area that specializes in loss does say that if the wait to see her is too long, that the clinic can provide directions to your OB or PCP about recommended testing. That way, you can get the ball rolling and have a more productive first meeting. This is really helpful if you don't have IF insurance coverage (I'm in this camp).

https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Committee_Opinions/RPL.inpress-noprint.pdf

fmannino85 · March 2016

I'm sorry you find yourself here. My lost pregnancies almost match up to yours, and both ended around the same time (6 1/2 weeks, give or take a few days). I'm 30 and have had two MCs within 3 months. My OBgyn didn't really give me an answer when I asked if my husband and I should see a specialist. He said most people opt to do chromosome testing on the embryo and leave it at that. I've read that most dr's won't recommend seeing a specialist until you've had 3 miscarriages in a row, which I think is crazy. My husband and I decided to do the chromosome testing on the baby, but to also see a RE. We just had our first appt yesterday, and we are both glad we decided to go. I personally can't handle trying again or having another loss, especially without trying to find out reasons why both losses happened. The RE is going to run a bunch of blood work on me once my cycle returns, and is sending my husband for a semen analysis, although he seemed pretty positive my husband isn't a factor. I would definitely recommend at least researching RE's in your area and if they take your insurance, and then take it from there. Wishing you all the best!

ThePax89 · March 2016

After my second loss I started looking into fertility specialists.

Instead, I switched doctors. My new ob is 45 minutes away but I feel safe and comfortable. She ran a ton of recurrent pregnancy loss tests on me which I appreciated.

fivetimesnoluck · April 2016

@Cubslove12 I am sorry for your losses. Definitely not a dumb question! I am in the no trouble getting pregnant, but can't keep it camp. It sucks. In my small city, there are two REs that everyone talks about - one who specializes in Recurrent Pregnancy Loss (RPL) and one who is more focused on getting people pregnant.

There are likely some offices or at least individual practitioners who specialize in RPL in your area, especially if you're in a larger city. Try searching that term and/or call some of the offices and ask if they have any doctors who focus on miscarriage as opposed to conception issues. You may ask your doctor about specialists, she may know (some may require a referral)... And if your doctor isn't interested in advocating for you, don't hesitate to find one who will!

I wish you luck!

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