TTCAL w/o 1/11

fitzfizz · January 2021

**This is a general trigger warning that CP, miscarriage, selective termination due to medical complications, and/or stillbirth may be mentioned.**

Introduce yourself and anything you think is important: number of loss(es), when you had the loss(es), diagnosis/conditions surrounding loss, etc.

Status:

How are things going? What is something that you are struggling with and/or what is going well?

Any testing coming up/any recent results?

Questions?

GTKY: If you could time travel to any time period to hang out, what would you choose?

fitzfizz · January 2021

Introduce yourself and anything you think is important: number of loss(es), when you had the loss(es), diagnosis/conditions surrounding loss, etc. One loss at 22 weeks (TFMR for non-chromosomal genetic mutation) in June, also with CP in Nov.

Status: WTO technically, but I think today is O day

How are things going? What is something that you are struggling with and/or what is going well? Things are going the same way they have every TWW since my first loss: terrified it will happen again. I want so badly to have a healthy baby, but I’m scared every month that even if I get a BFP I will lose another one. I want to get off this ride.

Any testing coming up/any recent results? I’m very much ready to stop peeing on OPKs

Questions? I have a question that I am going to post in the questions thread because it is kind of at the crossroads of IF and RPL, so feel free to check that out.

GTKY: If you could time travel to any time period to hang out, what would you choose? I want to go back to Victorian England, but only if I can hang out with the rich people haha

bumblebee0210 · January 2021

@fitzfizz Sorry your anxiety is peaking-- it's totally normal to feel that way. The only thing that helps me is to try and stay in the present moment as much as possible (easier said than done). Also, therapy. And yeah, I used to be jealous of pregnant people, now I am just jealous of people who are like, done having kids.

Introduce yourself and anything you think is important: number of loss(es), when you had the loss(es), diagnosis/conditions surrounding loss, etc. 2 mmcs, most recently in Sep 2020, also 2 CPs

Status: WTO (tomorrow?)

How are things going? What is something that you are struggling with and/or what is going well? Ok-- getting impatient (both in the very short run for O to come, and in the longer sense), but not at my worst.

*tw pg*

I have some feelings about how dead it is in here now. Obviously I don't want lots of people to experience loss, and I know logically people are going to graduate out of here quickly because people who experience loss get pregnant! But I am just jealous I guess.

Any testing coming up/any recent results? RE Appointment tomorrow! Interested in what she has to say, and whether or not I will get laughed out of her office. By some measure, I am clearly "fertile" in that I do in fact get pregnant, and I don't have classic RPL so who knows. Guessing she will at least do blood work? But I'll report back on what she says and what tests she recommends.

Questions? None now

GTKY: If you could time travel to any time period to hang out, what would you choose? I would love to be a short-term tourist in lots of time periods, particularly any time in which subsistence farming/low technology was the norm, but I would not want to relocate there (the smells alone...). Also, like, Downton Abbey.

inthewoods23 · January 2021

@fitzfizz I'm sorry you're always feeling scared. A totally valid feeling. I try really hard not to think about it to keep myself from getting sad. I hope 3rd time is the charm and you don't have to worry in your next pregnancy!

Introduce yourself and anything you think is important: number of loss(es), when you had the loss(es), diagnosis/conditions surrounding loss, etc. 1 loss in Oct 2020 at 8 weeks

Status: TWW

How are things going? What is something that you are struggling with and/or what is going well? Guess who started SS at 1dpo because I wasn't feeling great Things are going well. I feel really confident about this cycle but that "I'm totes KU" vibe I had late last week is gone. Probably because I finally had some sense come to me haha. You can't know these things while before implantation has occurred.

Any testing coming up/any recent results? I'm going to test at 10dpo on Saturday

Questions? nope

GTKY: If you could time travel to any time period to hang out, what would you choose? I like the idea of being a viking, but sometime in the 1800s might be interesting.

rgn12 · January 2021

Introduce yourself and anything you think is important: number of loss(es), when you had the loss(es), diagnosis/conditions surrounding loss, etc. CP in December

Status: WTO

How are things going? What is something that you are struggling with and/or what is going well? Okay, I guess. My OPK’s have been negative, despite what seems like my normal signs of ovulation. I’ve been dealing with headaches since the CP, went to my PCP today and they encouraged me to wait a few cycles before trying again. I felt kind of defeated. Also hated the look they give you when you have to explain what happened, and all the “I am sorry” comments. It was super nice and caring, but kind of sucked too.

Any testing coming up/any recent results? Questions? None.

GTKY: If you could time travel to any time period to hang out, what would you choose? I would love to go back to the Classical/Romantic Era to listen to some of the greats with classical music! 🎶

bumblebee0210 · January 2021

If anyone is interested, RE tests/recommendations for RPL in the spoiler
(*includes mention of lc*)

Just a quick history on me: I had a missed miscarriage (8 weeks) in Dec 2017, then a CP in June 2018 (after 3 months benched, so ~3 months trying), a full-term healthy pregnancy Oct 2018-June2019, then a mmc of mono/di twins (11 w) in Oct 2020, and a CP Nov 2020. Historically I have gotten pregnant fairly quickly (within 3-4 months), which matters for recommendations.

She basically recommended the standard RPL workup, which includes blood panel for all of the auto-immune things, thyroid and A1C [which I have already had, but are standard], plus DOR day-3 testing (FSH, Estradiol, AMH), also karyotype screening, and a physical examination of my uterus [she said we could also do tubes, but since I am getting pregnant quickly, this matters less], and carrier screens for me. She also recommended SA and karyotype screens for my husband.

She said most of the time, this all comes back normal, and in that case there are basically two courses of action:

(1) Progesterone supplementation after ovulation

(2) IVF with genetic screening for the embryos

For someone like me, she said everything in between (medicated cycles, IUI) is basically useless-- it won't even really help me get pregnant any faster.

Two interesting things that were new to me and might be relevant to those of us with RPL:

(1) I have to re-do all of my day-3 tests because my bHCG was 18 at the time, which is enough to potentially screw them up. So, wait to do tests until your betas are zero!

(2) My twins were genetically tested at the hospital post D&C, and the results came back 46XX (normal female). But apparently, unless you get your genetic material sent out to a special lab (and I had my D&C at a fancy teaching hospital so this is likely true everywhere), it's not always possible to tell whether you have mistakenly actually gotten the maternal DNA (if you get a normal/female result). So it is possible that they were genetically abnormal, we just don't know (and my first mmc was not tested).

So basically, the next steps for me are to get my bHCG tested tomorrow to just be 100% sure it's zero, then re-do the Day-3 tests in my next cycle, and also do all of the other blood/physical screens then, and then if there is something that comes up, to treat that, and if not, to decide whether/when we would want to pursue aggressive treatment vs. rolling the dice. At this point I have NO IDEA, but I guess it is useful to feel like we have options.

bumblebee0210 · January 2021

@rgn12 I'm sorry you're not feeling well and that your cycle is being wonky. I would not listen to your PCP about waiting-- I have never heard this recommended for a CP, and even after my D&C for 9-week twins, the MFMs were fine with my trying again right away. [Though I would also not recommend you take medical advice from strangers o the internet, so do your own research!] Obviously if you don't want to try again right away it's totally fine to take a few months off.

@inthewoods23 GL with that 2ww madness. I would have thought at this stage I would be over it, but it gets me every time.

inthewoods23 · January 2021

@bumblebee0210 that's some good info! My RE had done the RPL panel of tests with me when our FET failed with a PGT-A tested normal embryo. I know that's usually done after 2 or 3 losses which I thought was interesting. Nothing was a major red flag there so we did other testing to find a cause for the failure. I find it interesting that some REs/OBs recommend the progesterone supplementation while others don't. I talked with my OB about this during a follow up from my MC asking if I should be put on progesterone when I get a BFP and she said it's not worth it. She would entertain the idea after a 3rd loss in a last ditch effort kind of thing. There's not a lot of data that supports whether or not it's helpful for those that have had losses since it's not clear if progesterone dropping is a cause or effect of MCs. My progesterone was around 20 when I was having my HCG checked and had dropped to 8 2 weeks later.

@rgn12 in my case my OPKs start very negative and within a few hours go to positive (vs a more gradual darkening of the line over a few days). Hopefully that's all that's going on with you. I also don't think it's necessary to hold off on trying again after a CP. MCs I can understand with the long period of time it takes for HCG to reach 0, but with CPs it likely never got that high so I don't see how it could affect your following cycle. Some people don't even know they've had a CP because they don't test early so for many it could just look like a longer cycle than they were expecting. I wonder if your PCP made that suggestion due to the emotional aspect of losses. Resume trying when you are ready

bumblebee0210 · January 2021

@inthewoods23 Yeah-- I was curious about progesterone too because it seems pretty divisive. This RE said basically like "it probably matters for some people and not others, but we don't no who so we generally recommend trying it". Given my early pregnancy symptoms I am worried I'll have side effects but who knows. I know also blood progesterone can vary a lot even within a given day-- the only time I had mine tested was the month I had my only full-term viable pregnancy and it was like 9.2 at day 21 which is normal but considered a bit low by some docs (I didn't know I was pregnant at the time-- it was just to confirm ovulation). I also did proov on a recent cycle and it was positive for days 7-10, which seems fine? Who knows.

sienna221 · January 2021

@fitzfizz I totally understand the anxiety you are feeling and totally valid feeling. I agree that I hope 3rd time is a charm for you.

@bumblebee0210 I get what you mean about it being quiet in here. You obviously don't want people to experience loss and you want those that do to move on quickly...but, at least for me, with some like this it is nice to have people to relate to and the quieter it is in here...the less people there are to relate to. Also that is really helpful information that the RE said. Again, I'm a visual learner so seeing it written out by you helps and I wonder what the tests I did last week were (did I mention I have the memory of a goldfish). I know they are testing my thyroid and then to see if I was a carrier for anything and that was something MH would also have to do. But my OB also said what @inthewoods23 mentioned...she said progesterone didn't really have the scientific evidence to show it actually helped so they don't usually prescribe it. But she said it also doesn't hurt, so if someone wants it...they will always honor that.

@inthewoods23 Fingers crossed for this Saturday! I love the SS on 1dpo! haha

@rgn12 I know how you feel about having to explain everything to people. I was still pregnant when I had my last 6-month teeth cleaning and my last facial...so I am actively avoid going back to either of those so I don't have to tell them. Those two were the only other than like a handful of friends and family I had told. And I agree with everyone (even though I am not a doctor or anything close and had a bad experience doing this same thing) but not waiting after a CP. I can't remember if you've already said...but have you had a negative HPT yet? If it makes you more comfortable, you could have your HCG levels tested to make sure you have reached 0.

Introduce yourself and anything you think is important: number of loss(es), when you had the loss(es), diagnosis/conditions surrounding loss, etc. MMC October '20 and MC or RPOC December '20

Status: WFAF...I think I ovulated 1/8 but not sure. Since I'm benched I haven't been testing consistently...just periodically to kind of have an idea if I do and when AF will come. I had a positive OPK on 1/7...didn't test again until 1/10 and it was low/negative. So I am guessing (hoping) a peak came in around 1/8.

How are things going? What is something that you are struggling with and/or what is going well? Going a lot better than it was. Knowing (or hoping) I O'd and expecting AF in another week is nice. A different kind of anxious 2 week wait haha.

Any testing coming up/any recent results? I'm still waiting on all my test results from my blood work last week. Even my HCG result hasn't been uploaded to my portal which is super annoying.

Questions? I said no at first but after doing all my @'s I thought of one to get your opinions...My OB said if/when I do get pregnant again, they still wouldn't typically test my HCG to make sure it is rising appropriately since there is really no intervention should something not be right. But she did say, if I wanted it...they of course would do it for me. Just wanted all your thoughts on if you plan on testing your hcg or not if you get a BFP?

GTKY: If you could time travel to any time period to hang out, what would you choose? I agree that I'd love to be a short term visitor in a lot of time periods...but maybe especially during Marie Antoinette's time in mid 1700's France. As long as I was part of the court. haha.

fitzfizz · January 2021

Will return for full tags later, but I just want to comment for @rgn12

Obviously take everything you read from strangers on the internet with a grain of salt, but I can confirm as a PCP, that she likely doesn’t know what she is talking about. Unless she has a lot of specialized pregnancy care training (which is unlikely), she probably doesn’t know more than I do, and most of what I know about these things I only know from having gone through it. My OB told me there was no *physical* need to wait after a CP, because for your body it isn’t really much different than a period. Now emotionally, it can be much more, so if she was recommending it because you had talked about having a hard time with it, that is totally valid. But physically, no reason you have to wait if you feel ready emotionally.

rgn12 · January 2021

@fitzfizz thank you so much for this perspective, especially as a PCP! Emotionally I really do feel okay about it, the only thing I can think of is that I was there for having some pretty bad migraines and headaches and she seemed to think they were from the CP. I have a history of migraines though, way before all of this. I guess it also kind of bothered me that she was pushing meds on me that are not for pregnancy (migraine rx), knowing that I want to try again as soon as I can.

@sienna221 thank you! I totally get that, explaining over and over is the worst. Yes, I have had a negative HPT, so I think I should be good to go with all of that.

@inthewoods23 I finally got a positive OPK! Kind of validating to know my intuition/observations were correct. Moving in the right direction at least! 🤞🏻

@bumblebee0210 thank you! I’m hoping it all levels out soon! My migraines tend to be triggered by hormones anyways, so I’m sure that’s not helping.

bumblebee0210 · January 2021

@rgn12 I also get migraines that are often hormone-driven. They are the worst-- and I am married to a neurologist! One thing that is safe to take while TTC is migrelief-- it's just magnesium and b-vitamins. I also take immitrex (and sometimes reglan) if I get a bad migraine and I'm not in the 2ww. Otherwise just tylenol, hydration, and a nap.

inthewoods23 · January 2021

@rgn12 aaayyyy!! Yep, for some people those LH surges come up fast. Glad you got confirmation and all the signs line up!

demimondaine · January 2021

@rgn12 FWIW I take imitrex for migraines, which is apparently not too bad to take in pregnancy and never had a problem. There's nothing wrong with getting the rx for when they are really unbearable. The imitrex makes me nauseous so I have to sleep it off to use it - which makes you really think if you need it!

rgn12 · January 2021

@bumblebee0210 I will have to try that! I’ve never heard of it, but I did take magnesium supplements several years ago! I’ll have to try that one! I used to have an rx for Imitrex but it has been years, I may have to look into that again too.

@demimondaine good to know! I may mention this one to my PCP because I think what she sent it was one of the “bad ones” for pregnancy! I can’t remember what it’s called, but I think it starts with a Z maybe? 🤷🏻‍♀️

bumblebee0210 · January 2021

@rgn12 I know way too much about this as a neurologist's wife who gets migraines and has been TTC for too long. Super long explanation in spoiler.

Immitrex (sumatriptan) is the most studied of the triptan class (there are a bunch of them and they all end in "triptan", yours is probably one of those). Immitrex/sumatriptan is one of the drugs that is considered pretty ok-- I can't remember if it is class B or C, but generally if you are a person with bad migraines they say it is ok to take during pregnancy. There is no real reason to think any of the other triptans are worse in pregnancy, I think they are just not as well-studied. These are by far the most common abortive therapy, and typically MH recommends those with or without Aleve, tylenol, and/or reglan for nausea when you get a headache/aura. Of those actually Aleve (naproxin, which is just longer-lasting ibuprofen) is the one that is least safe in pregnancy/TTC. The rest are generally ok. The things that are typically not ok are the preventive therapies (topamax, and the new ones emgality and amovig), which is why migrelief is nice because it's one of the only preventive therapies that is totally safe. You can also do botox, which is also not super well-studied in pregnancy, but it's localized (it doesn't travel through your body) so there is no real reason to think it would interfere with pregnancy. It is very hard to get insurance to pay for it though. I do get botox injections sometimes while TTC.

Other than that all of the boring stuff does help-- getting enough sleep, exercising, and staying well hydrated, plus avoiding known triggers especially around your period and/or ovulation (whenever you get them).

On the plus side some women's headaches go away during pregnancy! So you may have that to look forward to.

rgn12 · January 2021

@bumblebee0210 thank you! This is super helpful! I get all these things haha, nausea, aura before, and period/ovulation is a trigger!

demimondaine · January 2021

@rgn12 Fioricet is another one that is supposed to be pretty safe, and it's not a Triptan. I stayed with my tried and true though!

sienna221 · January 2021

@bumblebee0210 that is all good information. I got cosmetic Botox the week before this most recent incident in December (whether it was another MC or RPOC) before I even knew my tests were getting positive again and I was possibly pregnant again. Ever since I’ve wondered if that had anything to do with what happened. I’ve also been going back and forth trying to schedule my next appointment around ovulation so I was WTO at the appointment and not in the TWW and possibly pregnant. 😂 But it sounds like it doesn’t really matter? Or is it different with cosmetic Botox? I probably wouldn’t proactively get Botox during the 9 months since it’s is for cosmetic reasons and not migraines...but if it were before you found out you were officially pregnant...

fitzfizz · January 2021

@rgn12 It is probably zomig/zolmitriptan, so one of the triptans she mentioned. I am not a neurologist, but basically can confirm everything @bumblebee0210 said is true to the best of my knowledge. I am annoyed that your PCP didn’t at least comment on whether it is safe in pregnancy knowing you plan to try though. It is one of my pet peeves when doctors don’t inquire about pregnancy plans before prescribing anything, and it is even worse to not comment on it when you know someone is trying.

@sienna221 Cosmetic Botox is never going to be something anyone says is safe in pregnancy just because it is never necessary so no one is ever going to risk liability to test it, but it is almost certainly completely fine. It doesn’t go systemic so there is no reason it would be a problem. Definitely do not let yourself worry that that was in any way a cause!

rgn12 · January 2021

@fitzfizz yes, I think that’s it! I haven’t picked it up yet, but that sounds familiar!

bumblebee0210 · January 2021

@fitzfizz I truly hope that you leave our group ASAP, but man I will miss having a well-informed PCP around. You're like our internet doctor. You should be charging us for telehealth

sienna221 · January 2021

☝️ Agreed! Always insightful and thoughtful answers!

sienna221 · January 2021

Random question- I called my OB today because my HcG hadn’t been uploaded to my portal and it’s been a week. Apparently the lab lost my order. 🙄She rattled off the tests they took blood for last week and I was able to jot them down since I couldn’t remember last week. Curious what y’all’s experience and knowledge on each is. I’m sure it’s been discussed before...so sorry for having repeat questions.

- HCG (I know this one)
- Thyroid Stimulating Hormone (TSH)

And then these two I jotted down what I heard but didn’t hear right...wondering if anyone can decipher and knows what she actually said 😂

- anti cardi lipid?

- lupus? Would that make sense to test for lupus?

and then they did the Invitae Karyotype and will get results back 1/26.

bumblebee0210 · January 2021

@sienna221 Yes on lupus-- auto-immune-type things can cause repeat loss. Typically I think they test for thyroid, diabetes (A1C), a bunch of auto-immune things, sometimes celiacs, and then the genetic things, plus anything structural. @keikilove did you have a list of these at one point or am I hallucinating that?

fitzfizz · January 2021

@sienna221 Those are the two antiphospholipid antibodies. Anticardiolipin and lupus anticoagulant. They are the two autoantibodies that are the most common autoimmune causes of repeat losses. The names are confusing but not everyone with lupus has them, and some people without lupus can have those antibodies and have repeat losses associated with them.

@bumblebee0210 If it is anything like last time, I won’t be able to avoid butting in with medical opinions long after I should haha

sienna221 · January 2021

Thanks all for info! I’ll get results back 1/26. But found out my Hcg was at 1 on Thursday. So really hoping it was low enough the week prior and I did actually O around 1/9ish so AF comes this week.

inthewoods23 · January 2021

@sienna221 my cycle after MC I still had HCG around 25 or so (can't remember if the dollar store tests were still positive or not at the time) when O occurred. So I would guess you did O!

bumblebee0210 · January 2021

@sienna221 I also got my first post-D&C period with HCG in my system. At day 3 I think it was something like 18. Guessing you did O and AF will come soon!

keikilove · March 2021

@bumblebee0210 I’m so sorry for this late reply. I couldn’t find the RPL test list that you asked about. But someone reposted it online so I will be saving this in my files now. Will cross-post this in TTGP as well.

The TTC bibles are “Taking Charge Of Your Fertility” and “It Starts With The Egg”. For those having a long journey to their take-home baby, this book is invaluable:

“Is Your Body Baby Friendly?: How "Unexplained" Infertility, Miscarriage and IVF Failure Can Be Explained” https://www.amazon.com/dp/0978507851/ref=cm_sw_r_cp_api_i_4MO9Eb1E24Q4M

LIST OF TESTS FOR RPL PANEL

- Activated partial thromboplastin time (aPTT);

- anti-thrombin III activity

- beta 2 glycoprotein1 IgA, IgG, IgM;

- dRVVT

- Factor II

- Factor V Leiden

- Factor VIII
- Histamines

- MTFHR Mutation

- Natural Killer Cells

- Protein C activity

- Protein S (total)

- Protein S antigen (free)

- Protime (prothrombin)

- Partial Thomboplastin Time

- Rh blood type

Hormonal

- Thyroid Panel (TSH, T3, T4, T-Free)

Immune

- AntiOvarian Antibodies

- Antiphospholipid Antibodies: anti-phosphatidylserine (IGG/M/A)

- Antiphospholipid Antibodies: anti-cardiolipin (IGG/M/A)

- Antiphospholipid Antibodies: Lupus anticoagulant

- Plasminogen activator inhibitor-1 (PAI-1) activity;
- Leuokocyte Antibody Detection (LAD)

Other

- DHEA-S

- Vitamin D
- Progesterone

- Karyotype

- Semen DNA fragmentation

- SIS for uterine polyps, cysts fibroids

- ERA

- ReceptivaDX (BCL6)

- Myriad Foresight Analysis

- Food Sensitivities Test

- Heavy Metals Hair Analysis

- GeneticGenie.org Analysis

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