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.


  1. Hi,

    If they continue to refuse you progesterone, you might try something called natural progesterone cream. It is topical and better than nothing.


  2. Welcome and I look forward to reading your story from the beginning.


  3. Living here in K-town, there really aren't many choices for specialty physicians. I too think that they are handling your situation much to cavalier. I only had 1 m/c, long time ttc & 1 preemie. If we were to decide to have another, I would have to be on progesterone while TTC & up to 17 weeks again like I was with my "successful" pg. I hope you get everything you are needing & find a wonderful dr. I have enjoyed reading your blogs over the last few years, but am so sad for all of your losses. {hugs}

  4. It is your body, your baby, and your life. you have shown yourself to be educated and have a really good understanding of what is going on. Find a group that sees you as an intelligent woman who is in the driver's seat, not one of the gals along for the ride. I am very happy with the group I see. They have wonderful care that I felt was sometimes over the top when I went through my second pg (high risk). They took my single miscarriage very seriously and worked with me to make sure that I was healthy prior to trying again, healthy as possible while pregnant and after. Make sure they answer your questions head on. If someone hims and hahs they may not be for you.

  5. I am a new reader of your blog and want to say thank you for sharing your experiences however painful they may be. I just went through a miscarriage (my first) about 2 months ago - the day after my best friend gave birth and the day before my sister gave birth ... talk about timing. Anyway, I thought that I was coming to a good place emotionally when a close friend shared that she was pregnant a few days ago. So, I've really been struggling with my emotions a lot...and the tears having been flowing freely. But, it is helping me to read that this is a normal reaction and to hear what other strong women like yourself have been through/are going through. I have blood-clotting abnormalities (Factor V and others) as well and was actually on lovenox during my pregnancy. My homocystine levels were normal too if that helps you at all. Thanks again for sharing.

  6. i think the reason they don't give progesterone before pgcy is because it can prevent ovulation? you are supposed to only take it in the 2nd half of your cycle if you are TTC - i think! fwiw...