When to take the next step?

SnobunnieMel · June 2016

Hi everyone. My DH is asking me when we want to start trying again and i honestly dont know. We have now had 3 losses this year. One a MMC from multiple chromosome issues in Feb and 2 very early losses (CP). I am know PCOS, endo, hypothyroid and now + for 2 copies MTHFR. I am starting to feel like we need to see a RE for further testing and that pregenetic embryo transfer is going to be the end result. My NP had originally told us she wanted us to see someone after 6 months if we didnt get pregnant but i dont know is she will be recounting each loss. Its been 7 months total. we seem to get pregnant easily but i cant keep it so i am thinking i have shit eggs from all my other issues.

When did you guys decide to see a RE or did you wait until your doctor mentioned it?

(Sorry, if it rambles, i am feeling so lost this week and my NP is out of town so i have gotten ZERO answers or help from her office without her here. Sadly I know she is going to be devastated when she sees my labs on monday)

iceandsnowflakes29 · June 2016

I would call the RE.

I know it is not normally a popular opinion to jump to an RE but, you already have known issues and keeping you pregnant is out of your OB's league TBH.

In the meantime, if it were me, I would take a break. But that's just me. I just came off a break. I didn't temp, test, or time anything and I took BCPs. It really helped me build strength to try again.

If I have another loss, I've already decided to call the RE myself. (I've had 3 m/cs and 1 ectopic ).

BornReady · June 2016

Sorry you are at this point in your journey. For me I took the initiative myself. My OB actually told me to wait longer, but I don't need a referral with my insurance and I called on my own. Most REs I looked at actually have a consultation line you can call for a chat to see if you would be an appropriate referral/patient for them at this point in time. Maybe you could look around and see what some of your options might be? With your known issues of PCOS, endo, MTHFR and loss history I tend to think you are a candidate for seeing an RE, but they could obviously give you more information there. I also recommend checking out the Resolve infertility website, it's a wealth of information.

In my case I had a gut feeling we had a sperm problem, and my OB wasn't listening so I went ahead on my own to the RE. We ended up having a sperm issue and are doing IVF with PGS this cycle after doing 1 unsuccessful IUI cycle.

Thinking of you...

SnobunnieMel · June 2016

thanks. i think im just going to request an appointment at an office I found that has high success rates and a big focus on holistic care. They stress emotional support, have a clinical psychologist on staff and an acupuncturist. We dont seem to have a sperm motility issue and my tubes arent blocked so we can skip some testing i think. I feel its an egg problem in my gut and we will need PGS to get through this. Their website mentions recurrent miscarriages as a condition they manage so I am going to have to get proactive.

RiverSong15 · June 2016

I'm so sorry for your losses. After three losses (and 2 losses qualify for many REs) and with your known issues, you are well within recommendations to seek a specialist regardless of how long you've been trying. The RPL specialist RE in my area will see women after 2 losses. Have you had any other of the RPL tests? (FSH, AMH, estradiol, thrombophilias, APS, parental karyotyping, etc.?) If not, it may be worth getting your OB to run those before you see the RE - the parental karyotyping takes 3-4 weeks in some labs. I'd recommend googling to see if you have any REs in your area that specialize in recurrent loss - there may not be, but if there are, they may know more than a regular RE. Hugs and best wishes!

Wishilivedinflorida · June 2016

Hey girl. I would hit up the RE now. You meet RPL criteria as long as they count CP's, and with your other endocrine stuff I would think that would be plenty to provide the RE with to sift through. I myself plan on demanding an early beta whenever I next get pregnant to document that I am pregnant, just in case it ends up
a CP. I can't believe I'm planning ahead for a third loss, but that's what happens when you've lived through this. So I think you are totally justified in your thought process. Maybe waiting until an RE appointment will give you and DH time to lay low and heal some. Sending hugs.

SnobunnieMel · June 2016

@RiverSong15i had a thrombophilia panel drawn after my second loss, all clotting factors were normal and all my TSH labs have been great. the MTHFR came back + for 2 copies but we havent run ay full genetic panels on DH or myself

yolandamunoz · June 2016

It's just so sad @SnobunnieMel

I've had 2 losses this year myself. It's been so hard on me, and on us as a couple, but we are hanging in there.

+++ TW losses mentioned ++++

Like you, I seem to get pregnant easily, but I just cannot stay pregnant more than 6 or 7 weeks. I had many tests done and they discovered I have hiperinsulinemia (high insulin). I also have a history of diabetes in my family. My OBGYN says this could cause recurrent early pregnancy loss. I was referred to a nutritionist to go on a diet to have this levels of insulin lowered, and she also said that this insulin can cause MC. She is confident I can correct this and get a successful pregnancy soon enough.

I'm also seeing an internist (internal medicine) that will check my tests again after a month of diet, and we'll see if I need to take daily meds (metformin).

I don't know if this is something for you to consider, but I wanted to share this with you just in case. I didn't know any of this before TTC, and even though I told my OBGYN I had diabetes history, he didn't ask for these tests to be done before hand (I am kind of angry at him for this, though).

I hope you can get all the help you need to recover from this awful path we are in. Hugs!

iceandsnowflakes29 · June 2016

@Wishilivedinflorida you brought up a good point about getting the CPs documented. I never thought of that. My first CP was, my second was not. I recognized it for what it was and didn't bother. My latest loss was a 9 week blighted ovum in March. Now that you've said this, I will make sure to get a beta even if I think it is a CP because I never thought to get official.

Anyway, I'm rambling. That makes so much sense and I feel like a ding dong.

Wishilivedinflorida · June 2016

@iceandsnowflakes29 Don't feel bad. I wouldn't have had the knowledge to advocate for certain things without hanging out here and learning. You ladies are a wealth of knowledge and though I'm sad because we are all here for the same reason, I'm so thankful we have this community. My in-network RE has a three loss rule, so if I have to go through three losses, I'm going to make sure they're on paper. Hopefully it won't happen.

roxgibbons · June 2016

@SnobunnieMel I think seeing an RE would be a good idea. I saw one after 6 months but that's because I'm AMA. I like the whole holistic approach as well. My clinic does not do that but I do see an acupuncturist separately, which has been great. It's really helped keep my stress levels down and having her advice has been so wonderful. The RE will help get deeper into any potential issues and set a good plan for you guys. I'm sorry you are here again but I'm glad this little corner of the Internet is here to support you.

brooklyngirl18 · June 2016

@SnobunnieMel I think you should at least to a little research about RE in your area and set up an appointment. that will give you and dh a little time to heal and gather your thoughts. sending you lots of positive thoughts.

SnobunnieMel · June 2016

So the practice I want to go has 3 offices. The one closest to me doesn't have an opening until August 18. The one farthest (45 minute drive) can see me this month. Having a hard time deciding if getting in sooner is worth possibly being at the farther place for all testing and work up

HLD3194 · June 2016

Honestly, I would go to the further one for testing. I know I wouldn't be able to wait. Could you do testing at that one and go to see a RE at the office closer to you in Aug? From my understanding testing could take a well for results and hopefully you'd have results by the time of your visit?

chloe97 · June 2016

So the way it usually works is that the first visit is a consultation and then they will do the tests based on your cycle. Mine is having me come in starting at CD3 for ovarian reserve blood tests and all the other blood tests and then sometime between cd 6 and CD 12 I will have an ultrasound and HSG to check my tubes and fibroids etc. They may let you do your tests at the nearby offices and just use the doctor at the further away office for consultations and any procedures. I'm new to this game but I get the feeling that most of your contact is with the nurses, PAs, and techs who draw your blood and you only see the Dr to make the plan and for the procedures. I'd just call the clinic back and ask them how it works.

On the other hand, given what you've been through it may be good to book the August appt and take a few months to focus on other things. I don't really have a choice bc I'm just had my 2nd D&C in 6 months, but I'm REALLY enjoying this time without temping or obsessive peeing on OPKs. I know you are in the Southwest so this doesn't apply as much, but I'm loving having my summer to focus on me, DH, and out puppy and not on TTCAL.

BornReady · June 2016

I would go for the consultation at the one farther away, but that might just be me and my sense of urgency. In my case my doctor works out of 4 different locations and I've seen her at 3 of them. It's pretty fluid and you are mostly working with a nurse coordinator to arrange your testing etc. Do the doctors move around? Could you do testing out of multiple sites? For me, my ultrasounds and blood draws were offsite at independent providers close to my home.

In terms of treatment, not much is particularly quick, you will likely be told at your first visit to call them when you get a cycle day 1 next to begin testing. I had my consultation on CD2, so my testing began pretty quickly (cd 2/3 blood draws, antral follicle ultrasound, HSG). After all those tests were done I had to go back and see my doctor again to discuss the results before doing anything else. All in all, my point is that just because you have your consultation, doesn't necessarily mean anything will happen anytime soon in terms of treatment. To give you reference I had my first appointment in March and am just starting stims for IVF now, and likely won't have a transfer until July or August.

You've been through so much, hopefully you get some answers along the way.

Aera11 · June 2016

I went off birth control and a year later nothing happened and only one period, so my ob/gyn referred me to an RE and it was the best decision I/we made. Not only do I love her and her practice, I've learned so much about women's health and my body.

It can't hurt to go and talk to an RE. They can discuss options, go over what you've already been through, and come up with a plan. If you need to think about it or take time off from TTC, then you should but you'll have the plan and the option if/when you're ready. From my experience, it's been helpful even when hard, but it isn't a fast process. I did two HSG's, DH had to do two SA's and meet with a urologist, bloodwork, all before I could start anything. But it gave me a peace of mind knowing there was a plan in place.

Best of luck to you on this journey @SnobunnieMel!

ladipale · June 2016

I know the difference between an RE and a MFM but I'm wondering when it is appropriate to see which? My OB has suggested I go see a 'high risk doctor' and would refer me to one and I met with her (my OB) to talk about it and ask her why and which kind of doc. She said MFM and the why was because she thinks I need to be reassured with more data/another doctor (I'm an engineer/scientist) Husband and I decided to wait and try again without seeing MFM. We have 2 living children.

iceandsnowflakes29 · June 2016

@ladipale what is a MFM?

BornReady · June 2016

ladipale said:
I know the difference between an RE and a MFM but I'm wondering when it is appropriate to see which?

In my understanding an MFM is more for when you are actually pregnant and higher risk and an RE will assist you in getting pregnant in the first place.

I saw an MFM during my first pregnancy due to a family history of pregnancy loss and premature birth. I saw her 3 times during the pregnancy to check in.

SoonToBeMommaHowe · June 2016

@iceandsnowflakes29 MFM is maternal fetal medicine. My understanding is that they take care of women and pregnancies that are deemed high risk for any reason. I know with multiples I was instantly referred to MFM.
My OB said the MFM office had the ability to run more in depth tests than the OB office.

iceandsnowflakes29 · June 2016

Thanks @SoonToBeMommaHowe

ladipale · June 2016

Thanks @BornReady - so far I don't have problem getting pregnant, but the late first tri loss in my 3rd pregnancy was a shock!

chloe97 · June 2016

ladipale said:

Thanks @BornReady - so far I don't have problem getting pregnant, but the late first tri loss in my 3rd pregnancy was a shock!

@ladipale REs also help with recurrent pregnancy loss too. Like you I don't have any problems getting pregnant, but I'm still going to an RE. In my case, my 2nd loss was due to a chromosomal abnormality and my 1st loss likely was as well. I'm starting to suspect I'm superfertile and my body holds on to bad embryos that most women's bodies reject. From what I understand, most late first trimester losses are due to chromonsonal abnormalities.

RiverSong15 · June 2016

@ladipale, I too have no problem getting pregnant but can't stay pregnant. I'm considering seeing an RE to discuss the results of all my RPL testing. Some cities will have fertility clinics with REs who specialize in recurrent loss. That's the ideal situation if you can find it.

@chloe97 APS is also implicated in later losses. The criteria for APS is usually 3 early first tri losses or 1 loss after 10 weeks. I think APS is worth testing for in any case if you're already doing testing, but it is a common culprit of later losses.

SnobunnieMel · June 2016

I have my appointment with an RE next Monday to discuss my RPL issues. I will keep you posted @RiverSong15 on what their recommendation is.

RiverSong15 · June 2016

Good luck @SnobunnieMel! I hope you get some answers and a good plan for moving forward!

brooklyngirl18 · June 2016

Good luck @SnobunnieMel thinking of you

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