Tuesday, December 30, 2008

Can she do it? Yes, she can!

Interestingly, I am finding that my resolve to have another baby has grown even stronger since my last, very disappointing miscarriage earlier this month.

A real life misdiagnosed miscarriage

Usually, when a woman begins bleeding heavily, and the doctor sees what looks like a blighted ovum (an empty gestational sac) on an ultrasound, the gig is up.

But here's a case where two weeks later, the woman found out that the baby was still there, and even had a heartbeat:

“What exactly is that?” I asked, propping up on my elbows on the examining table, scrutinizing the ultrasound monitor.

“That is a seven-week-old embryo with a heartbeat,” my doctor said.

“No, wait, is it human?” I asked, gasping for air, staring at the flickering heartbeat pulsing through the little body.

I couldn’t believe it. Two weeks before, I’d been diagnosed with a miscarriage—specifically, a chemical pregnancy. I’d raced to the doctor’s office after experiencing heavy cramping and bleeding, and an ultrasound seemed to confirm my gut feeling that my pregnancy was ending. There wasn’t an embryo where there should have been one. And yet, here I was, two weeks later, finding out that I was still pregnant.

I had spent the past two weeks saying goodbye to this pregnancy. My friends had taken me out and gotten me properly sauced. I purposely did everything a pregnant lady is not supposed to do—sucked down soft cheeses, exercised strenuously, and drowned my sorrow in wine and beer.

I’d even yearned for a D&C to end this “lost” pregnancy and clear the way for our next attempt at getting pregnant. Thank God I’d scheduled this second ultrasound before booking the surgery.

Because there was our embryo, with its tiny leg buds and that unmistakable heartbeat, alive and, apparently, human.



Monday, December 29, 2008

Wait and see? Or D&C?

I've suffered multiple miscarriages, but my last one, just a few weeks ago, was the first one where I asked for an immediate D&C procedure. I have had one D&C previously, but that was after 4 or 5 days of misery, waiting to finish miscarrying and developing a fever. With my others, I've miscarried naturally.

Based on my own experiences only, I would have to say that having the D&C right away offers many advantages. I bounced right back, and felt like myself again within 24 hours - literally. It was a really easy recovery.

Of course, the down side is that even with "good" health insurance, which I am lucky enough to have, I am sure we will end up paying well over $1,000 out of pocket in medical bills for the procedure once all the bills are counted.

Anyway, here is an interesting overview of the pros and cons of each approach to managing miscarriage.

Previously physicians and midwives have had their preferences, as do the pregnant women involved. Though a new study has shown that the rates of complications like infection are extremely low (2-3%) but consistent among all types of care. The biggest difference was that there were more unexpected admissions and surgeries following the expectant and medical management.


Friday, December 26, 2008

RESEARCH: MTHFR and other thrombophilic factors in recurrent pregnancy loss

I think that this study concludes that having several thrombophilic genetic markers (as opposed to just one) significantly impacts the risk for recurrent pregnancy loss.

However, I may not be interpreting the conclusion correctly. I welcome your thoughts on the meaning of this study in the comments below.



Tuesday, December 23, 2008

RESEARCH: N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss

The study:

Pregnancy could be associated with a state of oxidative stress that could initiate and propagate a cascade of changes that may lead to pregnancy wastage. This process of oxidative stress may be suppressed by the antioxidant effect of N-acetyl cysteine (NAC). The current study aimed to evaluate the effect of NAC therapy in patients diagnosed with unexplained recurrent pregnancy loss (RPL). The study was a prospective controlled study performed in the Women's Health Centre, Assiut University, Egypt. A group of 80 patients with history of recurrent unexplained pregnancy loss were treated with NAC 0.6 g + folic acid 500 μg/day and compared with an aged-matched group of 86 patients treated with folic acid 500 μg/day alone. NAC + folic acid compared with folic acid alone caused a significantly increased rate of continuation of a living pregnancy up to and beyond 20 weeks [P < 0.002, relative risk (RR) 2.9, 95% confidence interval (CI) 1.5-5.6]. NAC + folic acid was associated with a significant increase in the take-home baby rate as compared with folic acid alone (P < 0.047, RR 1.98, 95% CI 1.3-4.0). In conclusion, NAC is a well-tolerated drug that could be a potentially effective treatment in patients with unexplained RPL.


An interesting medical overview of miscarriage


Most spontaneous miscarriages are caused by an abnormal (aneuploid) karyotype of the embryo. At least 50% of all first-trimester SABs are cytogenetically abnormal. (Note that this figure does not include abnormalities caused by single genetic disorders, such as Mendelian disorders or mutations at several loci. Examples are polygenic or multifactorial disorders that are not detected by evaluating karyotypes.)

The highest rate of cytogenetically abnormal concepti occurs earliest in gestation, with rates declining after the embryonic period (>30 mm crown-rump length). The rate of normal (euploid) and abnormal (aneuploid) abortuses increases with maternal age.

Recurrent miscarriage may result from 2 chromosomal abnormalities: (1) a structural abnormality derived from 1 parent or (2) the recurrence of a numerical abnormality, which is usually not inherited.


Cytogenetically abnormal embryos are usually aneuploid because of sporadic events, such as meiotic nondisjunction, or polyploid from fertilization abnormalities. One half the cytogenetically abnormal abortuses in the first trimester involve autosomal trisomy. Triploidy is found in 16% of abortions, with fertilization of a normal haploid ovum by 2 sperm (dispermy) as the primary pathogenic mechanism. Trisomies may arise de novo because of meiotic nondisjunction during gametogenesis in parents with a normal karyotype. For most trisomies, maternal meiosis I errors have been implicated. Abnormal meiotic segregation results in either complete trisomies or monosomies.

Trisomy 16, which accounts for 30% of all trisomies, is the most common. Viable trisomies have been observed for chromosomes 13, 16, and 21. Approximately one third of fetuses with Down syndrome (trisomy 21) fetuses survive to term. All chromosome trisomies except for trisomy 1 are reported in abortuses.

Of interest, trisomy 1 is reported in embryos obtained with in vitro fertilization (IVF). This finding logically suggests that trisomy 1 is most likely lethal at the preimplantation stage.

Autosomal monosomies are rarely, if ever, observed. In contrast, monosomy X (Turner syndrome) is frequently observed, and it is the most common chromosomal abnormality observed in SABs. Turner syndrome accounts for 20-25% of cytogenetically abnormal abortuses.

Other abnormalities include those related to abnormal fertilization (eg, tetraploidy, triploidy). These abnormalities are not compatible with life. Tetraploidy occurs in approximately 8% of chromosomally abnormal abortions, resulting from failure of an early cleavage division in an otherwise normal diploid zygote.

Parental chromosomal abnormalities

Structural rearrangements occur in approximately 3% of cytogenetically abnormal abortuses. Structural chromosomal abnormalities are thought to be most commonly inherited from the mother. Of note, structural chromosomal problems found in men often to lead to low sperm concentrations, male infertility, and, therefore, a reduced likelihood of pregnancy and miscarriage. The exception to this situation is the couple undergoing assisted reproductive technologies in which selected sperm can be injected into oocytes to force fertilization by using potentially genetically abnormal sperm.

Among structural rearrangements, translocations (most commonly reciprocal and Robertsonian) can be balanced or unbalanced. The incidence of translocations increases with the number of abortions. Slightly more than one half of unbalanced rearrangements result from abnormal segregation of Robertsonian translocations. Approximately one half of all unbalanced translocations arise de novo during gametogenesis. In reciprocal translocations, children created from these gametes have normal and carrier karyotypes. Adjacent segregation results in unbalanced distribution of the chromosomes involved in the translocation, leading to partial trisomy for 1 chromosome and partial monosomy for the other chromosome. The severity of the phenotype depends on the chromosomes involved and on the positions of their breakpoints. The risk is increased if the female partner carries the translocation.

Other structural rearrangements, such as inversions or ring chromosomes, are relatively rare. These chromosomal abnormalities can be associated with congenial malformations and mental retardation, as well as SAB.

Genetic abnormalities

Certain genetic mutations thought to be involved with implantation may predispose a patient to infertility or even miscarriage. An example of a single gene disorder associated with recurrent pregnancy loss is myotonic dystrophy, an autosomal dominant neuromuscular disorder with high penetrance. The cause of the abortion is unknown, but it may be related to abnormal gene interactions combined with disordered uterine function.

Other presumed autosomal dominant disorders include lethal skeletal dysplasias (eg, thanatophoric dysplasia and type II osteogenesis imperfecta).

Maternal disease associated with increased fetal wastage includes connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, homocystinuria, and pseudoxanthoma elasticum.

Hematologic abnormalities associated with recurrent pregnancy loss include dysfibrinogenemia, factor XIII deficiency, congenital hypofibrinogenemia and afibrinogenemia, and sickle cell anemia.

Women with sickle cell anemia are at increased risk for fetal loss, possibly because of placental-bed microinfarcts.



Monday, December 22, 2008

Recurrent miscarriage is really, really hard


I found out I was pregnant again at the beginning of November. I was so happy. No, I was ecstatic. I was over the freakin' moon. I felt pregnant--unlike my last two unpregnancies. You have never seen a woman so happy to puke every morning. I made a doctor's appointment. I ceased drinking coffee (for the most part), exercising, eating anything artificial, anything that I might have done wrong the other two times. I worried at every twinge, but I told myself: no blood, no panic. I went to the first prenatal appointment bracing to be lectured about the nine pounds I had gained.

He didn't find a heartbeat. The doctor was nonchalant about it; I was in instant panic attack mode. When he was listening to--whatever they listen to on your back, your heart or lungs or both--he told me to breath normally. This is as normal as it gets.

Because no doctor likes hyperventilating maybe-pregnant-maybe-not women in their office, he offered to do a quick ultrasound. He found a water sac, a pregnant-ish uterus, but no baby. It's called a missed abortion. I lost the baby, and I never even knew it. 'No blood, no panic'? Apparently not a medically sound policy. I was almost ten weeks pregnant, but not really.

That is the biggest shock I have ever experienced. I felt bad for Dr. Davenport, because I knew he was counting seconds until this entire not-really-prenatal visit was over. Sheesh, he's like my baby brother's age. Just had his own first child. Such a nice guy, but he has to be thinking please, please, please, don't freak out. I started to cry, but stopped myself long enough to get out.

Read the rest of THIS BLOG ENTRY.


Friday, December 19, 2008

Recurrent miscarriage raises pre-eclampsia risk

A new study:

Researchers in Norway studied records of 20,846 singleton pregnancies in first-time mothers participating in the Norwegian Mother and Child Cohort Study (MoBa) between 1999 and 2005.

Findings showed women with recurrent miscarriages are 51% more likely to develop pre-eclampsia.



Wednesday, December 17, 2008

Luteal Phase Dysfunction - a good overview



Exhale Magazine launches

This sounds like a great project:

I get a lot of infertility reading material, both print and online, sent my way. Too much, too much. But that's my business, so I receive it and peruse the copy, sometimes meandering, other times slogging. Occasionally, I'm excited.

Exhale Magazine has just launched, and I'm very happy to tell everyone about it. And I don't even have a single pinkie toe in the project.
It's just so good.

The subtitle for this online-only zine (tres smart women here, what with the ridiculously calamitous world of print mags) says it all: A Literary Magazine for Intelligent People Who Have Lost a Baby, Or Who Can't Figure Out How to Make One in the First Place.

The mag's editor, Monica M. LeMoine, has done a fine job of culling from what could've no doubt been a wide swath of expressive unhappy campers. You know we Infertility Divas love to share our pain. This batch knows how to write for the Web. It's concise, it's vivid, and it's both poignant and entertaining.


Waiting to try again


I just found out that my former roommate's best friend from high school is 8 months pregnant. I had NO idea and I'm even friends with her on facebook! She and her husband ALSO got married around the time we got engaged. I guess it's the whole 2006 thing, since she hasn't been married for very much longer than I have. I don't know why things like this are so upsetting, since I honestly have no desire to be pregnant again anytime soon, but I'm still happy for her (and the others). I know it won't always be like the three weeks I knew about it, but it was miserable! I don't even know why I have no desire for it; a lot of miscarriage survivors (is there a better way to phrase that?) want to try again RIGHT AWAY. I do NOT want to try at all; maybe since we weren't even "trying" to begin with. Now, TWO of my friends are worried that I don't want it at all or that I think it'll never happen, and I don't want them to worry about me. I do want it, just not any time soon. I keep trying to think of the 'what-ifs' What if I get pregnant again right off the bat? What if THAT'S a miscarriage too? What if it's not? I just can't seem to wrap my head around the concept of going through a pregnancy again, let alone a miscarriage again. Not to mention all the other things I'd like to get done first. I'm still confused and frustrated. I'm glad they care about me, but I don't want people to worry that I think it'll never happen. I'm just even more okay with it not happening for a while now.



Monday, December 15, 2008

A miscarriage dispatch: let's begin again

I thought it was today, but my doctor's appointment is actually tomorrow. It will be my first post-(this) miscarriage meeting with my doctor, and basically, I want to throw out everything we've been doing and start over.

I want to start from square one, and for the first time, I want my OB-GYN, as well as the reproductive endocronologist to whom I'll be asking for a referral to see me as a patient with a real, specific, chronic problem - recurrent pregnancy loss- instead of a regular patient who just happens to have had the random bad luck to miscarry over and over and over again. I want to organize a case management approach to my care, with my OB-GYN, whom I really like, acting as point person - coordinating things.

After a lot of thought, I have also decided that if I do get pregnant again, I will not be returning to the perinatal group I've been seeing each time pregnancy has been confirmed previously. I like the doctors tremendously, as well as the office staff. I believe they are really great with high risk pregnancies after 20 weeks - probably the best in town. But they seem completely unwilling to take more aggressive action for me and my earlier losses, even though I am now 41 years old, and have now had eight miscarriages in the past three years. I think that since I have had one successful pregnancy during that time, they just figure that if we keep trying, something will eventually "stick," and we'll get us a baby, but I honestly don't have time any more for that laissez faire approach. For example, they insist that despite my MTHFR and PAI genetic issues, I do not need early treatment with lovenox or heparin because my homecysteine and PAI levels tested normal. But there are many doctors who now believe that all women with recurrent losses, and the pre-existing genetic thrombophilia issues DO need lovenox injections. Additionally, I think I likely need to start taking progesterone supplements BEFORE I get a positive pregnancy test, as opposed to afterward. And they won't prescribe it until I am actually pregnant.

So anyway, I am going to see my OB-GYN tomorrow, and ask that we start from scratch here regarding my problem. I am going to request that we immediately try a low dose of clomid in order to try for a "better" ovulation, and I am going to ask to be immediately referred to a reproductive endocrinologist. If I do manage to get pregnant again, I will need to have my regular OB-GYN help me find another perinatal group who will take a more hands-on approach in managing my care. Again, it will make me sad to leave the group I've used before, because I really do like them a lot. But you can't keep doing the same thing over and over again and expecting different results, right?

Last, I have to say I am pretty nervous about trying the clomid. Some of the possible side effects sound pretty unpleasant, and I will be honest, I do NOT want to end up with twins. But I think the potential benefit outweighs the risks.

Oh, and one more thing. This miscarriage was the first one where I asked the doctor to just immediately do a D&C instead of waiting to see how things would go naturally. I had one previous D&C, but it was after waiting almost a week to see if things would take care of themselves (they didn't). I have to say that I would definitely recommend the immediate D&C route. I had the easiest physical recovery I've ever had after one of my losses. I bounced right back immediately, which was really nice.

The pain of miscarrying again

Sarcastic Mom blogs about her losses:
I spent weeks upon weeks feeling tense. I spent almost 3 months checking my underwear multiple times a day, and staring at the toilet paper every single time I wiped.

Slowly, so so slowly, the tension had just started to recede.

I had seen and heard her tiny heart beating, quickly, with vigor. She was healthy, and moving. She was ALIVE. She was going to make it, damnit. She really was.

Surely, so so surely, the tension has just started to recede.

I found myself leaving the restroom and realizing, after the fact, that I hadn’t looked at my underwear. I hadn’t checked my toilet paper.

I believed. I wasn’t just saying I believed. I really did.

It felt so good.

And then on Tuesday morning, December 9th, everything fell apart around me (us).

It was as if I’d been walking carefully on a thin sheet of glass suspended over a black abyss for months, but somehow, I’d just started to believe it was cement, and I started tap-dancing. The bottom fell out - the floor exploded, and all I had to grab for as I fell were shards of glass that cut my hands as I dropped into the abyss.

No heartbeat on the fetal doppler for us to hear.

No little, pulsing muscle in her tiny chest for me to see on mini-ultrasound.

My lovely doctor trying so hard over and over to find it. My lovely doctor getting visibly frustrated, upset, but still trying and trying. My lovely doctor giving up and telling me she was so so sorry.

Ohhh, my inability to believe this was happening… and ohhhh, my immense guilt over believing for so long that it would end this way, anyway.



Sunday, December 14, 2008

Linkity linkage

I'm very pleased and grateful to have The Miscarriage Blog now added to the amazing blogroll over at the now-legendary women's health site with the unforgettable name - Stirrup Queens and Sperm Palace Jesters.

If you've never checked the site out before, and you are looking for the most comprehensive resource list available on issues related to infertility, adoption, and pregnancy loss, you should definitely go check it out.


Saturday, December 13, 2008

Finding peace with loss

Making sense of loss is a process:

This has been a hard couple of days for me, but I'm quickly becoming more at peace with the whole situation and through the support of family and a lot of prayer, I've found my silver lining. We conceived a baby! How cool is that??!! The way I see it, this was God's way of letting us know that we're going about everything correctly and we're working just fine. He wanted me to know that he's watching out for us and for our baby and that he's going to take care of us. He's going to make sure that when the situation is just right, that baby's going to stick around and be perfect for us. He won't let us settle for anything less. I still feel the pain of losing a baby and mourn what I know was there, even if it was only for a short time, but I am also comforted to know that God understands my grief.



An unexpected loss

A blogger talks about her recent miscarriage:

Unlike the last pregnancy, I had no idea this one was coming. With my first miscarriage, I never felt any signs of pregnancy throughout the whole first 2 months. I knew that that wasn't normal but was just hoping that I was one of the "lucky" ones to feel great in my first trimester. So when I starting miscarrying, I wasnt too surprised. I was sad of course, but not surprised. With this last pregnancy, however, I felt all the signs of pregnancy and was nausiated a lot during it. I thought that this was a good sign and got my hopes up! I even made it to the 10 week mark and was relieved that I only had 2 more weeks to go to get into the "safe" zone. Unfortunately, I couldnt keep the baby. On our way home from AZ, I started bleeding and knew what was coming since I had been through it before



Friday, December 12, 2008

Living with recurrent pregnancy loss

Almost unimaginable to those who haven't lived thru it:

I too have lost six babies. I've watched nearly all of my friends and relatives move into the next stages of life. I've attended their baby showers, given tons of gifts, visited their newborns in the hospital, and watched them grow up and start school in the past 7 years. I was 21 years old when I got married, and I thought that I would be done having kids by the time I reached 30. I'm about to turn 32 and am still at square one. There have been many tests and surgeries along the way and with each attempt at a pregnancy we have had some hope of success. Each time we have been disappointed. We've never named any of our babies, I think mainly because we've been in a form of shock or denial for 7 whole years, but also because we thought it would be too painful. Maybe it seems cold or informal to think of them in numbers, but each of those lives holds such a special place in our hearts. Each one captured our hearts and carried our hopes and dreams for the short time that we knew of them.
Baby #1 July 6, 2002
Baby #2 March 28, 2003
Baby #3 October 7, 2004
Baby #4 July 22, 2005
Baby #5 August 8, 2006
Baby #6 January 22, 2007
Those are my miscarriage dates. None of our babies made it past 12 weeks; some didn't make it to 6 weeks. It terrifies me to think of that list growing longer, but we have no idea what the future holds. Every day I wake up with a mixture of pain and sadness, joy and hope.

"And now, I shall have a margarita"

Alice at Finslippy on the experience of suddenly finding oneself UNpregnant:

So as I said. Yesterday, I was pregnant. Scott went to work, Henry went to school, and I… well, I went to the bathroom, where I noticed some spotting. It was spotting so tiny that I could have ignored it. I could have not seen it at all. It was an eensy brown smudge. Nonetheless, I promptly began hyperventilating. This is what I do. Because if I worry hard enough I can ward off any bad news. If I'm neurotic enough, the universe will laugh, pat me on the head, and rain disaster down on some unsuspecting sane person. I called my doctor, who was as unconcerned as any normal human being would be, but suggested that I come in, just for peace of mind. I made an appointment for the afternoon, and after that, there was absolutely no spotting. Nothing at all. I laughed at myself, at what a big deal I had made over this tiny one-time smudgy nothing.

Everything was casual and light at the OB/GYN, until the ultrasound. The first thing I noticed was the absence of movement. Maybe it's the angle? I thought. She was moving all around my abdomen, so it was hard to say. Then she began pointing things out to me. "Here, you see, here is where I should see a heartbeat." I'm so sorry, she kept saying, I'm so sorry. She began measuring. I'm so sorry, she repeated, it looks like growth ended at about eight and a half weeks.

Everything that follows is a blur. I believe the first thought I had was, "And now I shall have a margarita."


A father's experience of miscarriage

I usually read (and have even written for) the NYT "Modern Love" column, but I somehow missed this one from earlier in the fall. It's a father's account of pregnancy loss:

At 20 weeks, we went in together for the second ultrasound. The technician made small talk and popped his gum as he dimmed the lights. Lisa lay back on the table. I shifted in my seat, jammed my hands into my pockets, and stretched out my legs like a teenager settling in to watch a movie. As the technician slid the paddle around on Lisa’s belly, the image on the computer screen wheeled, dipped and blurred.

Finally my son’s image popped into focus. Arms and legs folded, he seemed to be resting on his back, as if lying on the bottom of a pool, waiting to spring to the surface.
I said, “Cool.”

The technician muttered something, hit a button to freeze the image and walked briskly out of the room.

A few minutes later, in walked a small man wearing a rumpled white coat and steel-rimmed glasses, his bow tie askew. He shut the door behind him.

I don’t remember exactly what he said; he looked as if someone had left him out in the rain. What we had taken for a frozen image, he explained, was in fact absolute stillness.


Blogging a past miscarriage

It's rare, I've found, for anyone to talk about past miscarriages--recent or more distant. Before I'd had my miscarriage, I'd heard people say that they'd had one in the same tone as a person might say "Oh, yeah--I've had apple pie before." Somehow, the way that I'd always heard it talked about, so lightly in passing, made it more difficult when I experienced it myself, because I wasn't prepared.I wasn't prepared for the rawness. The power. The overwhelming, shaking, trembling anger at the universe. It stunned me and took my breath away. I had not expected that a miscarriage would cause me to collapse on a bed and sob myself to sleep as I cried out, over and over, that I wanted my baby back. I did not know that people felt that way, about this.I hadn't expected that it would shatter my heart--the first time that I knew, with certainty, that I was broken inside. I experienced the burning of pure, undiluted sorrow. The rational, logical part of me stood aside and said, "You, my friend, have lost it. You have two beautiful children, a husband that loves you, and a wonderful life. Pull it together." I felt so guilty for feeling so sad.I went for my follow-up appointment with my obstetrician. He is a good man, and a kind one. I sat there on the table with my hands clasped together as he told me that it was perfectly common and normal. That as many as 1/3 of pregnancies end in miscarriage, so--this was my third child, it was my turn. I could hardly see straight. I could hardly breathe. I was trying so desperately not to let my grief show. I felt like I had no right to be grieving.It seemed to me, at the time, that grief was understandable for women who lost children, infants, or even babies later in pregnancy. But for those of us still in the first trimester, it wasn't allowed. Which is why, when my doctor handed me a pamphlet and encouraged me to join a support group, I recoiled. I wasn't about to compare my pathetic experience to others who had lost two year olds or had stillborns. They had a right to be devastated and grief stricken. I was simply weak.

Thursday, December 11, 2008

Caffeine and miscarriage - the link gets stronger

In my first pregnancy, when I was 23 years old, I was ULTRAcareful, and drank zero caffeine. This was difficult, as I am a caffeine addict. In my second and third pregnancies, resulting in healthy babies, I drank extremely, very, super modest amounts of caffeine - after the first trimester.

Then about ten years passed, and I became even more addicted to caffeine. The research on caffeine and pregnancy was mixed during this period.

Recently, the reseatch has become stronger that caffeine in early pregnancy presents a meaningful miscarriage risk. I didn't know the research had solidified until AFTER my most recent miscarriages, when I will admit, I likely drank too much caffeine.

Now that I've read the latest on this issue, I will avoid all but one small caffeinated drink per day in pregnancy - if that much - when I become pregnant again. It's becoming clearer that for those of us at risk of pregnancy loss already, caffeine is not something we want or need to add to our diets.

Clomid after recurrent pregnancy loss?

We've decided to keep trying to have a baby - or at least give it one more go. That's what feels right, mostly. There is certainly a part of me that says we should just call it a day, given that I have already given birth to four healthy children. But considering how much older H (17), J (13) and E (10) are, and the fact that they spend half their time with their father, giving up would mean that 16 month old C would mostly grow up in an only-child-like household. And while I have no issue with other parents who decide a singleton kid is the right choice for their own family, I don't want that for her. She already misses her big brothers and her sister when they are away every other week, and I know that will only become more pronounced as they get older.

Even before this last pregnancy ended in miscarriage, I'd been carefully charting my fertility for the past several years, using the great info in this book, and I've also been doing a lot of research into the causes of recurrent pregnancy loss. Many healthy women experience one or two miscarriages in their lives, and the reasons are random and generally unknown. But when someone miscarries over and over and over, as I have in recent years, there is generally a specific cause - or several specific causes - behind the problem.

After the first several losses, I had some genetic testing done, and it was discovered that I have a fairly common genetic thrombophilia condition that CAN be the cause of recurrent losses. Because of this condition, I am taking what my perinatologist believes are the appropriate preventive medications, but I want to have some discussion with him when we next see him in about 10 days about stepping up the medication protocol to the next level, something he told me I did NOT need to do in this past pregnancy.

But one other issue I've discovered in charting my fertility is that I likely have what is known as a luteal phase defect. This means that I ovulate less than 10 days before my next period starts, while an optimal cycle (for fertility purposes anyway) has ovulation occurring 14 days or more before the next cycle begins. During a cycle where that ovulation becomes a pregnancy, the short "luteal phase" makes for a less favorable hormonal environment for the pregnancy to progress. My doctor has been treating this by giving me progesterone supplements after pregnancy is confirmed, but some doctors feel like a better way to treat the issue is to use Clomid to stimulate ovulation earlier in the cycle in order to force a longer luteal phase.

So I am going to point this luteal phase issue out to my doctor, and I am going to ask him to prescribe Clomid. I am more than a little nervous about the higher risk of multiples with the use of Clomid, but I think it's a risk I'm willing to take at this point. I also know that for me, Clomid is as far as I am willing to go in the way of fertility treatments. If it works, great. If not, I'll be really disappointed, but I am at peace with the fact that you really don't always get everything you want in life just because you want it. I want to remain very conscious that I don't let this baby quest get in the way of enjoying what I am lucky enough to already have: children, husband, work, family, health... It has to remain secondary.

So we'll give this pregnancy thing at least one more try. Maybe two - max. And that's a scary thought. I know that if we manage to get knocked up again, this time I really won't tell anyone at all until I am at least five months pregnant (of course, by that time, it would be completely obvious to anyone with eyeballs). And I will have to assume a mindset that expects the pregnancy to end badly. That's the only way to handle it, I think, and it will be somewhat mentally torturous. But my heart tells me there is one more baby coming to our family.

I hope I am not just delusional ;-)

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Miscarriage black humor of the day

You know, “bitter” doesn’t really begin to cover how I’m feeling right now. I can accept that I was one of the unlucky women in their late 30s with unexplained infertility. Ok, I get that. I waited too long. Silly me.
And that first IVF, I mean, yeah, a miscarriage always sucks shit, but a miscarriage after seeing a heartbeat, a missed miscarriage that wouldn’t complete on top of all that? Ok, those are really tough breaks, kid, but hey, what are the odds of anything weird happening after that, eh?
At least I know my fabulous uterus likes being pregnant! Hell, apparently my fallopian tubes we so damned jealous of all the fun MsUterus was having that they decided to get into the game. Go tubes!
A negative IVF cycle, I could live with. I was even ok with - well, not ok, but you know, relatively speaking, I was ok with - a chemical pregnancy. I mean, bummer, but hey, it happens.
But this? What the bloody fuck? It doesn’t so much feel like I’m just coming down on the wrong end of all these teeny tiny “what are the odds of…” questions, as it feels like some huge colossal motherfucking old guy with a bigass beard and an outsized sense of irony is squatting on a cloud somewhere saying, “Nope! Sorry! Fresh out of babies, but I’ll let you get real close a few times, just so you really know what you’re missing out on. Hell, I’ll let you get so close that you’re going to have to poison your own baby so that it doesn’t kill you. How does that sound? Guess you don’t want that baby anywhere near as much as you thought you did, now, do you? How about the consolation prize? I’ve got some fantastic specials going on ‘dying alone and bitter’. whaddya say?”

All about MTHFR

No, MTHFR (which I also have) is not a cussword. Find out more about this common, yet significant genetic thrombophilia condition.

Talking about Miscarriage

A blogger remembers her loss:

When my first pregnancy ended in a miscarriage, I was mortified to think I must be the only person on earth to produce a blighted ovum – a bad egg. Even in those days, losing a baby at any point in the pregnancy was not talked about and it was only years later when I was to discover that just about everyone I know had experienced a miscarriage. In fact something like one in three pregnancies ends in miscarriage.

Secondary Infertility After 40

Another over-40 blogger I just discovered, dealing with the same scenario as my own...

A blog is born

An introduction: my name is Katie, and I'm the mama behind The Miscarriage Blog. I am 41 years old, and the mother of four children, ages (as of this writing) 16 months, 10 years, 13 years and 17 years.

I also recently suffered my EIGHTH miscarriage.

Yes, you read that right, I have now had EIGHT miscarriages. But I haven't given up hope; my husband and I continue to plan for another baby (our last).

As I've begun sharing my own miscarriage history with other women, I discovered a need for a blog just like this one - a place where women who have experienced one miscarriage - or multiple losses - can come for support, the latest information and research, and other resources that are available online. Sometimes it helps to laugh, so you may find a little black humor here as well. And I will share my own story as it progresses, as I hope you will share yours.

The Miscarriage Blog is a work in progress - you'll see it grow in the coming weeks. I welcome your feedback as I put the site together - so be sure to leave your comments below.