The Miscarriage Blog

The D&C

2009-02-23T04:47:00.001-08:00

A little dark humor: "I survived my D&C and all I have to show for it is some lousy mesh panties."

Making miscarriage a crime

2009-02-20T06:16:00.000-08:00

I present for your horrified review, legislation actually being proposed here in Tennessee:

SB 1065 by Marrero B (HB 0890 by Hackworth)

AN ACT to amend Tennessee Code Annotated, Title 68, relative to testing for certain substances in pregnant women.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1.Tennessee Code Annotated, Title 68, Chapter 5, is amended by adding Section 2 of this act as a new part thereto.

SECTION 2.
(a) The general assembly declares that, as a matter of public policy of this state and in
the interest of public health, pregnant women who abuse alcohol and drugs pose a risk to their unborn children. Pregnant women who meet certain criteria, as determined by the department, through rules and regulations duly promulgated in accordance with the provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, shall be tested for alcohol and drugs in order to encourage them to seek immediate treatment for an alcohol-related or drug-related problem.

(b) If the department levies a fee or charge for the cost of testing, it shall use the same billing and collection methods normally used by independent private laboratories. Any fee shall be waived for patients who are unable to pay.

(c) The department, in promulgating rules to implement this act, shall consider the following as indications of the necessity for alcohol or drug testing:
(1) No prenatal care;
(2) Late prenatal care after twenty-four (24) weeks gestation;
(3) Incomplete prenatal care;
(4) Abruptio placentae;
(5) Intrauterine fetal death;
(6) Preterm labor of no obvious cause;
(7) Intrauterine growth retardation of no obvious cause;
(8) Previously known alcohol or drug abuse; or
(9) Unexplained congenital anomalies.

(d) The commissioner of health is authorized to adopt rules, using criteria established by the United States department of health and human services as guidelines for modeling the drug and alcohol testing program pursuant to this act, concerning, but not limited to:
(1) Standards for licensing drug and alcohol testing laboratories and suspension and revocation of the licenses;
(2) Body specimens and minimum specimen amounts that are appropriate for drug or alcohol testing;
(3) Methods of analysis and procedures to ensure reliable drug or alcohol testing results, including the use of breathalyzers and standards for initial tests and confirmation tests;
(4) Minimum cut-off detection levels for alcohol, each drug or metabolites of the drug for the purposes of determining a positive test result;
(5) Chain-of-custody procedures to ensure proper identification, labeling and handling of specimens tested; and
(6) Retention, storage and transportation procedures to ensure reliable results on confirmation tests and retests.

(e) Prior to acting on the proposed rules to implement this chapter, the commissioner shall submit the proposed rules to the house health and human resources and the senate general welfare committees of the general assembly for their review and comment. The committees shall have forty-five (45) days to review the proposed rules and transmit any comment it may have to the commissioner.

(f) Any woman who tests positive for alcohol or drugs on a test administered pursuant to this chapter shall be referred to treatment for an alcohol-related or drug-related problem. Every physician, surgeon or other person permitted by law to attend a pregnant woman during gestation shall report each woman who refuses to seek treatment for an alcohol-related or drug-related problem or who misses two (2) or more appointments to the department of children's services. Such reports shall be in a manner specified by the department, either by contacting a local representative of the department or by utilizing the department's centralized intake procedure, where applicable.

(g) A health care provider who makes a report of alcohol or drug abuse, as required by subsection (f), shall not be liable in any civil or criminal action that is based solely upon such report.

(h) Nothing in this section shall be construed to confer any immunity upon a health care provider for a criminal or civil action arising out of the treatment of a woman about whom the report of alcohol or drug abuse was made.

(i) All information, interviews, reports, statements, memoranda and drug or alcohol test results, written or otherwise, received by the covered employer through a drug or alcohol testing program are confidential communications and may not be used or received in evidence, obtained in discovery or disclosed in any public or private proceedings, except in accordance with this section.

(j) Laboratories, medical review officers, employee assistance programs, drug or alcohol rehabilitation programs and their agents who receive or have access to information concerning drug or alcohol test results shall keep all information confidential. Release of the information under any other circumstance is authorized solely pursuant to a written consent form signed voluntarily by the person tested, unless the release is compelled by a hearing officer or a court of competent jurisdiction pursuant to an appeal taken under this section, relevant to a legal claim asserted by the employee or is deemed appropriate by a professional or occupational licensing board in a related disciplinary proceeding. The consent form must contain, at a minimum:
(1) The name of the person who is authorized to obtain the information;
(2) The purpose of the disclosure;
(3) The precise information to be disclosed;
(4) The duration of the consent; and
(5) The signature of the person authorizing release of the information.

(k) Information on drug or alcohol test results for tests administered pursuant to this act shall not be released or used in any criminal proceeding against the woman who was subject to the test. Information released contrary to this section is inadmissible as evidence in the criminal proceeding.

SECTION 3. For the purpose of promulgating rules and regulations, this act shall take effect upon becoming a law, the public welfare requiring it. For all other purposes this act shall take effect January 1, 2010, the public welfare requiring it.

I read this with my mouth hanging open in shock. Unbelievable.

So if this law is enacted, it means that any woman who suffers a miscarriage, stillbirth, or other serious pregnancy complications, or who gives birth to a disabled child, will face state-mandated drug testing.

I really can't frame my own response to this vile legislation any better than fellow Tennessee blogger Aunt B already did, so I'll just quote her here:

But here's the best part. If your pregnancy just isn't going right-the placenta comes open or the fetus dies or you go into labor early for no discernible reason, or the fetus isn't growing fast enough, or the fetus has congenital anomalies-and let me remind you these are all things that just happen during pregnancies; things go wrong, for no reason, all the time-the State wants to drug test you.

And let's say that they do. Let's say that you start to miscarry. You have spotting and cramping and it's pretty obvious and inevitable what's going on. Maybe you have a bottle of wine to help you through. You've just done into labor early for no discernible reason and your fetus is dead for no discernible reason and when they drug test you, they're going to find that you've been drinking.

What do you think is going to come of that?

This is what I mean when I say that the reproductive rights fight is going to be had on the bodies of women who miscarry. And these legislators, Hackworth and Marrero are Democrats. These are the folks who are supposed to be on the side of women and they want to give the State the right to start sniffing around if your pregnancy doesn't go right?

This bill opens the door to the State blaming women who miscarry for those miscarriages. Shoot, it doesn't just open the door. It opens the door and escorts the State right in.

They cannot make it illegal, still, thank god, for you to be pregnant in your own way. They cannot legally require you to go to the doctor. They cannot hold you legally responsible for the death of your fetus.

But they want to. And so this is an end run around that. If you won't do what they want you to do, they will drug test you and force you into treatment if they don't like what they've found. In other words, you will be punished for, in the case of imbibing alcohol, something that is perfectly legal. Something most doctors will tell you is fine on occassion when you are pregnant.

In other words, the precident they're setting is that, once you are pregnant, your body is not your own. You no longer know what's best for you. Your doctor no longer knows what's best for you. You are not allowed to not realize you're pregnant. You're not allowed to be afraid. You're not allowed to be too poor to go to the doctor. You have to do what the State tells you to do while you're pregant, because, while you're pregnant, your body is not your own.

And here's the other thing. Can we just not beat around the bush about the subtext here? It's no coincidence that Memphis has an infant mortality rate so depressingly high that it might as well be a hundred years ago over there and that Marrero is bringing the bill. You cannot be a human being with a soul and look at what's going on in Memphis, or shoot, in neighborhoods here in Nashville, and not have your heart come right out sobbing into your hands.

But treating women like, once they're pregnant, the State needs to control them is vile. It just is. There's no way around it and wanting to protect babies doesn't make it okay to assume that the problem lies solely with the mothers.

If Marrero makes a medical decision I don't like, should I have the right to force her to take a drug test, make sure she hasn't been drinking too much?

The sad truth is that pregnancies end for all kinds of reasons. Some women can go their whole pregancies not even knowing they're pregnant, drinking and drugging it up, and their kids come out with no ill-effects. Many, many women in this State try their hardest to do the right thing every step of the way-doctor visits, vitamins, no alcohol use, etc.-and they still lose their pregnancies. They still have babies who are too sick to make it through the year. It's not anyone's fault. It just happens. And I know my fair share of women in that situation and they all blame themselves at some level. Adding to their suffering by having the state step in and act like they're to blame is cruel.

Yes, it's okay to talk about your miscarriage

2009-02-17T11:53:00.000-08:00

I love this perspective:

I don't think women have always known the other women in their life who've had miscarriages. In fact, when I told a friend at the beginning of the last pregnancy that I was pregnant she replied "Well, I guess I'm old fashioned; I didn't tell people until week 13." And I responded "Why? If I had a miscarriage, I'd tell you to!"

Am I supposed to be ashamed if I have a miscarriage? It it because we're discussing something that is vaguely associated with my nether regions that I'm not supposed to tell a soul that I'm pregnant until I'm showing? Helloo!!! WORLD!!!! Get past Queen Victoria and stop blaming the mother for everything that happens!!!

I do understand the awkwardness of having to explain to someone after the fact that you are no longer pregnant. I was thinking of inventing a button that says "I'm not pregnant anymore, but I'm OK!" But if I had kept my pie hole shut, I'd never been able to talk to my friends this weekend who needed a shoulder, some information, and a "sister's" about what they were going through.

So there. I'm not going to shut up. Not that I ever could.

But then, one of the commenters below that post makes an equally valid point, and one I can very much relate to:

well, after five miscarriages (and no babies) i feel like i have a much different perspective on when to tell. I always told, at least my close family and friends, but with this last pregnancy, i just found i couldn't anymore. You're getting a bit high-handed, i think, in dismissing the reasons not to tell. that decision often has nothing to do with any victorian mores, or even shame, often it's pure terror of even putting voice to something you know is so completely fragile. it's so very private. plus, after five of them, i just couldn't handle all the pity. and honestly, i think most people just don't know what to say anymore. false positivity never did it for me. so, yes, having support is essential, but sometimes you need to come to terms with what's happening (or might happen) before shouting it to the world.

Secondary infertility: one of the weirdest experiences of my life

2009-02-17T10:05:00.000-08:00

How I am feeling lately:

I also realized this week that my current evening medication regimen, designed to potentially get and keep me pregnant, looks rather like the pill intake of a very elderly woman suffering from numerous and serious chronic diseases. It’s THAT many pills and supplements. And then there is all the drawing of blood and ultrasounding of innards and karyotyping of chromosomes that comes with this experience. It’s something, let me tell you.

A great resource for educating yourself on miscarriage

2009-02-16T12:23:00.000-08:00

In my opinion, the best information currently available online regarding miscarriage is the Healthline "Fruit of the Womb" blog authored by Dr. Kenneth Trofatter. Dr. Trofatter has blogged very extensively over the past several years on the topics of miscarriage and recurrent pregnancy loss. His blog is searchable, so you can easily find any specific topics you are looking for, and be sure to read all the comments below each post, because they are filled with patient comments, and very specific and informative responses from Dr. Trofatter. He must commit a tremendous amount of time to this blogging, and I'll tell you, I am a fan. I wish he were located in my neck of the woods (he used to be), because I'd definitely be calling for a new patient appointment.

Thrombophilias, miscarriage and bloodthinners - a research review

2009-02-12T09:09:00.000-08:00

If you have suffered one or more miscarriages, and are trying to figure out whether or not you may need blood thinners (heparin or lovenox) next time you get pregnant, here is some data to ponder (and share with your doctor):

[Treatment with enoxaparin (“Lovenox”) adapted to the fertility programs in women with recurrent abortion and
thrombophilia]
Sarto A, Rocha M, Geller M, Capmany C, Martinez M, Quintans C, Donaldson M, Pasqualini RS.

Acquired and inherited thrombophilia are associated with recurrent pregnancy loss (RPL). Antithrombotic therapy could restore hemostatic balance and improve early placentation and gestational outcome. We evaluated the efficacy of enoxaparin adapted to the fertility program for prevention of pregnancy loss in 35 women (W) with early RPL and thrombophilia. Previous to the diagnosis of thrombophilia, they had had a total of 105 gestations of which 89 (85%) ended in early pregnancy loss. After diagnosis of thrombophilia, 35 subsequent pregnancies were treated with enoxaparin. In 5 cases assisted reproductive techniques were necessary to achieve pregnancy due to couple infertility. In 17 W who had had at least one preclinical pregnancy loss, enoxaparin (20 mg/d/s.c.) was started previous to conception and adapted to the fertility program. All the women continued with the gestational regime. Eighteen W with only clinical pregnancy loss started enoxaparin (20 mg twice per day s.c.) after biochemical pregnancy diagnosis. During gestations heparin dose was adjusted with anti Xa test, maintaining a range between 0.3 at 0.6 u/ml. With antithrombotic therapy, 30/35 (85%) of the pregnancies ended in live birth versus 16/105 (15%) of the pregnancies without treatment (p < 0.001).

--

American Journal Of Reproductive Immunology
Volume 49 Issue 2 Page 90 - February 2003

Successful Pregnancy with Low Molecular Weight Heparin in Two Women with Recurrent Miscarriage of Unknown Etiology

Yoshihiro Miyashita, Masako Waguri, Isao Nakanishi, Noriyuki Suehara, and Tomio Fujita

We report here two cases of recurrent miscarriages that were successfully treated with continuous intravenous administration of low molecular weight heparin (LMWH). One patient experienced 11 spontaneous abortions, and the other eight abortions. Previous treatments including prednisone, aspirin and mononuclear-cell immunization were all unsuccessful. They were negative for anticardiolipin antibodies and lupus anticoagulant, and had no inherited thrombophilic disorder. Intravenous administration of LMWH, 4800 units of dalteparin, was started as soon as the conception was confirmed, and was continued until 34 weeks of gestation. They were delivered of live born infants.

--

Clin Appl Thromb Hemost. 2005 Jan;11(1):1-13.
Recurrent miscarriage syndrome and infertility due to blood coagulation protein/platelet defects: a review and update.

Bick RL, Hoppensteadt D.

University of Texas Southwestern Medical Center, Dallas, Texas 75231, USA. rbick@thrombosis.com

Three-hundred fifty-one women were referred for thrombosis and hemostasis evaluation after suffering recurrent miscarriages. All patients were referred by a high-risk obstetrician or reproductive medicine specialist after anatomic, hormonal or chromosomal defects had been ruled out. These patients were assessed over a three year period. The mean patient age at referral was 34 years and the mean number of miscarriages was 2.9 (2-9). All patients underwent a thorough evaluation for thrombophilia and, when indicated, a hemorrhagic disorder. Of the 351 patients, 29 (8%) had no defect. Of the remaining 322 patients, 7 (2%) had a bleeding disorder: 3 with platelet dysfunction, 1 with Factor XIII deficiency, 3 with von Willebrand's and 3 with Osler-Weber-Rendu. The remainder of the patients had a thrombophilia as follows: 195 (60%) had antiphospholipid syndrome, 64 (20%) had Sticky Platelet Syndrome, 38 (12%) had MTHFR mutation, 23 (7.1%) had PAI-1 polymorphism, 12 (3.7%) had Protein S deficiency, 12 (3.7%) had Factor V Leiden, 3 (1%), had AT deficiency, 3 (1%) had Heparin-Cofactor II deficiency, 3 (1%) had TPA deficiency, and 6 (2%) had Protein C deficiency. There were a total of 364 defects found in the 312 patients harboring thrombophilia; thus, several harbored two and a few harbored three separate defects. All patients with thrombophilia were treated with preconception ASA at 81 mg/day with the immediate post-conception addition of heparin or LMW heparin (Dalteparin). Both ASA and heparin/LMW heparin were used to term. The first 120 patients were treated with unfractionated heparin at 5,000 U every 24 hours, subcutaneously and the last 192 have been treated with Dalteparin at 5,000 U/day subcutaneously. The patients with MTHFR were also treated with folate at 5 mg/day + pyridoxine at 50 mg/day. All patients were carefully monitored with CBC and platelet counts, anti-Xa levels, frequent ultrasounds and physical exams. Only 2 of the thrombophilia patients suffered another miscarriage; all others had a normal term delivery. There were no pregnancy-related thromboses, no delivery complications and no episodes of post-partum thrombosis. The only bleeding consisted of 1-4 cm bruises at injection sites. No episodes of thrombocytopenia (HIT) were noted. In our experience, thrombophilia is a common cause of recurrent miscarriage and all patients with no anatomical, hormonal or chromosomal defect should be evaluated for thrombophilia or a bleeding disorder. The success rate of normal term delivery in these 312 patients was 94% using ASA + heparin or Dalteparin. In addition, side effects of therapy were minimal.

--

Acta Obstet Gynecol Scand. 2000 Aug;79(8):655-9.
Birth outcomes in pregnant women treated with low-molecular-weight heparin.

Sorensen HT, Johnson SP, Larsen H, Pederson L, Nielsen GL, Moller M

The Danish Epidemiology Science Center at the Department of Medicine V, Aarhus University Hospital.

BACKGROUND: Pregnancy and puerperium are associated with an increased risk of venous thromboembolism. Low-molecular-weight heparin is the anticoagulant of choice in pregnant women because, unlike warfarin, it does not cross the placenta. However, there are limited data on the risk of adverse birth outcomes following use of low-molecular-weight heparin in pregnancy. PATIENTS AND METHODS: We performed a population-based cohort study to examine the safety of low-molecular-weight heparin use in pregnancy using data from the Pharmacoepidemiological Prescription Database, The Danish Medical Birth Registry and the Regional Hospital Discharge Registry in North Jutland County, Denmark. The birth outcomes in a cohort of 66 pregnant women treated with low-molecular-weight heparin between 1991-98 were compared with the birth outcomes of 17,259 pregnant women who did not receive any prescriptive drugs during pregnancy. RESULTS: No increased risk of malformations, low birth weight or stillbirth was found. However, an increased risk of pre-term delivery was found (odds ratio: 2.11, 95%, confidence interval: 0.96-4.65), which could reflect inherited thrombophilia as an indication of low-molecular-weight heparin. CONCLUSION: We have provided additional evidence of the safety of low-molecular-weight heparin use in pregnancy.

--

Fertil Steril. 2005 Sep;84(3):770-3.
Effects of enoxaparin on late pregnancy complications and neonatal outcome in women with recurrent pregnancy loss and thrombophilia: results from the Live-Enox study.
Brenner B, Ellis M, Yarom I, Yohai D, Samueloff A, Live-Enox Investigators

Rambam Medical Center, Haifa, Israel. b_brenner@rambam.health.gov.il

Women with thrombophilia and a history of recurrent pregnancy loss have poor pregnancy outcomes. Prophylaxis with enoxaparin 40 mg/day or 80 mg/day resulted in favorable gestational and neonatal outcomes.

PMID: 16169422 [PubMed - in process]

The other type of "two week wait"

2009-02-10T12:58:00.000-08:00

For those of us who have experienced recurrent pregnancy loss, the "two week wait" doesn't end when we get the positive pregnancy test. In fact, that's just the beginning of the very worst kind of wait - waiting to miscarry ...or to make it through the first trimester.

It's an agonizing experience. You can't allow yourself to become too invested or hopeful, but it's hard to remain completely detached. You don't get to really enjoy being a pregnant woman, but you have to observe all of the restrictive rules of pregnancy (no caffeine, alcohol, etc).

It's hard.

Entering the foreign territory of miscarriage

2009-02-10T11:51:00.000-08:00

A columnist opens up about her miscarriage experience:

I didn’t know that this could happen to me. I thought I was too young, too healthy. I didn’t realize that up to 25 percent of confirmed pregnancies end in loss. I had never heard of a “missed miscarriage,” which is characterized by a lack of symptoms of a baby’s death. I didn’t have any clue how painful the question, “Do you have any children?” could be to hear and how hard it could be to answer.

“God needed another angel in heaven”; “At least you won’t have to care for a handicapped child”; “You still have time, and at least you know you can get pregnant”; “It happens all the time”; “This baby just wasn’t meant to be.” I’ve heard these phrases dozens of times from well-meaning friends and family, but it’s hard to take comfort in any of them. Nothing can diminish my love for my child, and my heartbreak over what is a unique loss, not a statistic.

I was shocked after we lost our baby that so many women I know shared that they, too, had had a miscarriage—or more than one. Even women who had lost their babies 20 years ago cried with me. Even women across oceans and continents shared my pain through e-mails and online forums.

But why doesn’t anyone talk about it before it happens? Why is there a veil of secrecy behind which we can only share our grief with others who have experienced the same grief? When I found out that our baby was no longer alive, I felt alone in the world. Indeed, there were people who seemed frightened of me, as if I had a contagious disease. And there were others who just never said anything about our baby at all. How was I to realize that a large percentage of women I know had suffered a similar loss? This wouldn’t have made my loss any less devastating, but I think it would have made a difference. It would have helped me to realize that I should not blame myself.

A few HCG questions

2009-02-05T12:40:00.000-08:00

There is a whole lot of info on HCG in early pregnancy out there on the Web, but there are a few specific questions for which I cannot find answers. Perhaps some of y'all know the answers, and can reply in the comments below:

-Should HCG double every 48 hours in early pregnancy? Or is 48-72 hours considered the normal range? Online info seems to vary on this point.

-Are there any studies quantifying miscarriage risk based on HCG levels in early pregnancy?

-Does the day on which the embryo actually implants - which can vary by several days in a cycle - account for the wide variance in starting HCG #s in early pregnancy?

-Does a higher progesterone level offset a lower HCG level in quantifying miscarriage risk? Or vice versa?

All about Hughes Syndrome

2009-02-02T14:17:00.000-08:00

An interesting article from the UK:

Hughes is a relatively new condition that is just beginning to become recognised by the wider medical community outside the specialised area of auto-immune diseases (in which the body's immune systems attacks itself). The professor first began to note the condition in the mid-Seventies when he was working in a rheumatology clinic in Jamaica. "I noticed there were a whole group of women, paralysed, and forced to use wheelchairs, with the same antibodies in their blood."

When he returned to the UK a few years later, he set up a working party to study the antibodies he had found. Very quickly, his unit had collected up hundreds of patients whose blood carried the antibodies and whose symptoms all resulted from clotting around major organs. "They weren't just suffering clots in their veins but also in their arteries which led to strokes and heart attacks."

Significantly, the clots were also found to have serious effects when they occurred at two particular organs: the placenta and the brain. In the former cases, this led to multiple and unexplained miscarriages. In the latter, they starved the brain of oxygen, leading to migraines, memory loss and what many patients simply described as 'fogginess'.

By 1983, Prof Hughes' team had gathered enough evidence for two papers to be published: one in the British Medical Journal and the other in the Lancet. For the team, this felt like a 'eureka' moment. "We were finally getting our message across. We all celebrated with a long lunch at the local Italian restaurant," says Hughes.

Gynecologists picked up the news fast; the respected royal gynaecologist Dr Anthony Kenny called it the major discovery in obstetrics in the 20th century, and it has revolutionised treatment of women with recurrent miscarriage. Where the antibodies are present, and blood thinners are given, to prevent clotting at the placenta, the rate of successful pregnancy soars from about 20 per cent to 80 per cent.

The miscarriage mantra: "just try again"

2009-01-28T07:32:00.000-08:00

This blogger nails it:
When you can't conceive, there is treatment, but for recurrent unexplained pregnancy loss, there is just keep trying. I'm not entirely convinced infertility treatment will help overcome pregnancy loss. I think it might help you get pregnant quicker and more often and give you a better chance that a pregnancy will take sooner rather then later.

Okay, I am now already officially sick of the two week wait

2009-01-27T09:13:00.000-08:00

I'm over this already.

(And embarrassingly, I must admit that I already took a HPT. It was - not surprsingly - quite negative.)

For those of us who have miscarried repeatedly, waiting for the positive test is exciting, but also kind of scary. If we get one this month, I will then have to steel myself for the "Three Month Wait," after which I will no longer live in mortal fear each day that I will lose the baby.

But still, I'd like a positive. My due date would be October 14, which is when my eldest child was due. A good day.

A product recommendation - FertilityFriend.com

2009-01-26T12:49:00.000-08:00

After reading Toni Weschler's amazing book, Taking Charge of Your Fertility, I knew I wanted to start following my own body's cycles via Basal Body Temperature charting. But being an online kinda gal, I wanted to find a way to enter my temperatures online, and have them charted via software. Enter Fertility Friend. Somewhat silly name. Great product.

Every morning, I take my temperature, make note of any other fertility signs, and just enter them at the FF site. The software does the rest. It tells me when I ovulated, whether I ovulated, and allows me to follow my cycle through the month with an easy-to-read visual chart. It also allows me to compare my chart to other people's - so I could filter for charts that belong to 41 year old women on clomid, after miscarriage. Then I can see how my chart this month matches up to other people's - particularly folks who actually managed to get pregnant.

If you are trying to get pregnant, I HIGHLY recommend this online tool. It's well worth the $25 or whatever it costs for two or three months of using it.

-Katie

The MTHFR-Miscarriage debate

2009-01-23T13:37:00.000-08:00

Does MTHFR in and of itself lead to a higher miscarriage risk? Or is it only when MTHFR actually manifests as higher homocysteine levels that it presents a risk? Here's a clear overview of the current debate on this topic in the medical community.

The infamous two week wait....

2009-01-23T05:14:00.000-08:00

I am now in it.

Oh joy.

A Catholic perspective on miscarriage

2009-01-22T06:22:00.001-08:00

Catholic columnist Leslie Sholly wrote a lovely piece about her own sad loss:

I’ve written so many times about the dangers of assuming we can plan and control our lives. We’ve never planned any pregnancy as deliberately as we did this one. I failed myself this time to remember that life is a gift and none of us is promised another day after today. Just yesterday we received the tragic news of an 18-year-old family member in Maryland who was killed by a drunken driver on his way home from senior week at the beach. He had just graduated from high school. His fate was certainly never part of his parents’ plans for him when they decided to conceive a second child.

For the moment we have no plan. As I heal physically and our family heals emotionally, we are praying to discern God’s plan regarding another member for our family. We both still want another one, but we’re scared. No one needs to tell us we should be grateful for our five healthy children. I was reminded of that just today, talking to a pharmacy tech at the drugstore who is afraid to have a baby because she doesn’t want to pass on the kidney disease she inherited. But it’s because of our five healthy children that we wanted another. Every child is different and adds something special and irreplaceable.

Sometimes I think I’d like the comfort of the belief some people have—that this baby’s soul is lurking somewhere and if we have another, that soul will still be born. But I know that isn’t true. That particular immortal soul will never come down to earth, and that makes me sad. I didn’t want an “angel” in heaven just yet but a baby on earth. Still, both John and I have been comforted by the thought that my grandmother, who died in January, is rocking our baby in heaven as she did the others when they were little, singing her special lullaby.

Miscarriage - an "invisible phenomenon"

2009-01-20T04:46:00.000-08:00

LINK:

Expectant women are often advised that they should not publicly reveal their pregnancy until they are past the 12-week mark. One reason given is the high chance of miscarriage in the first trimester. The assumption is that if you were to have a miscarriage, the last thing you’d want is for anyone to know about it. It is a misfortune which we are expected to keep to ourselves.

Dux goes on to recount her own recent experience of miscarriage. It is not actually such an uncommon event amongst adult women. Indeed, for every three women who have given birth by their early 30s, one has had a miscarriage. Yet, Dux argues, despite its frequency, miscarriage is an “almost invisible” phenomenon.

It seems our society is not geared towards grieving, or even acknowledging, the loss of an early pregnancy. As the American author Peggy Orenstein has observed, the English language doesn’t even have a word for a lost foetus.

It makes you wonder: would grieving women find more support if the subject wasn’t hidden away as an shameful “women’s issue”? Or do many women actually prefer not to talk about? I assume there are 10,000 different answers to the question. A little acknowledgment might go a long way though.

A MTHFR discussion forum

2009-01-16T11:47:00.000-08:00

Lots of women discussing MTHFR and pregnancy issues right here.

Lisa Marie Presley opens up about miscarriages before twins

2009-01-14T08:15:00.000-08:00

It sounds like she has some type of genetic thrombophilia. Presley says:

I really wanted these babies," says Presley, 40, who tried for two years to get pregnant before conceiving the twins.

"My blood was too thick and would clot, which caused several miscarriages," she tells PEOPLE. "The moment I took blood thinners, I got pregnant."

What it's like to be pregnant after multiple miscarriages

2009-01-12T09:29:00.000-08:00

What she says:

Pregnancy, for those of us who’ve had the misfortune of experiencing recurrent pregnancy losses (RPL) is not actually a happy time. In fact, the number one emotion I recall experiencing with my last pregnancy was anxiety. Constant, never ending anxiety. Anxiety when you open your eyes first thing in the morning, anxiety throughout the day, anxiety when you try to sleep at night. Anxiety that builds and builds and builds and in my case has even resulted in panic attacks. I think I speak for all women who’ve suffered the misfortune of RPL, that the level of anxiety increases with the number of pregnancies lost.

As sick as it may sound, the only relief I’ve had from the terrible anxiety has come in the form of a miscarriage. Miscarriage I know, miscarriages I know what to expect and what to do, I know how it happens, I know the signs of it happening and as soon as its been confirmed I feel…….. resigned relief….. sick I know, but I feel a sense of resigned relief at not having to live with the constant anxiety that eats away at my mind every second of every day that I carry a pregnancy. My anxiety was so out of control with my last pregnancy that I’ve already arranged with my RE that the second I get my positive result I’ll be going on some safe anxiety medication for the remainder of my pregnancy.

Now I know what the non-RPL’ers will say, just relax. Stay calm, don’t get yourself so worked up. But everyone who’s suffered RPL will tell you, relaxing is impossible. EVERYTHING is terrifying. Every mile stone in the pregnancy achieved is frightening. My first reaction on seeing the two lines on a pee stick is crying. I immediately get this overwhelming sense of foreboding and anxiety and I can’t stop crying. Then we face the next hurdle, the blood test, once you’ve passed the first blood test its the agonizing wait for the second and third blood tests, analysing the HCG counts with each and everyone. Squeezing your boobs constantly, wondering why they’re so sore? Is it because of the pregnancy or because of your constant poking and prodding. Convincing yourself that they’re not as sore as they were the day before and hence a miscarriage is imminant. Going for the first scan………. God scans terrify me, I’ve never had a good one. They’ve always been bad and so for me scans will always be terrifying.

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Folic acid for the guys, too

2009-01-09T06:18:00.000-08:00

Your man should be taking folic acid:

Men with relatively low levels of folate had increased risks for sperm containing either too few or too many chromosomes, according to researchers at the University of California, Berkeley. These types of deficiencies can cause birth defects and miscarriages, the experts noted.

More women taking unprescribed clomid to try to get pregnant with multiples

2009-01-09T04:52:00.001-08:00

That's the controversial topic I tackle over at my Babble blog today.

clomid - day #2

2009-01-07T06:20:00.000-08:00

Still absolutely no side effects. Keep your fingers crossed for me that I can make it through the whole five days without any of the nasty possibilities rearing their ugly heads...

RESEARCH: Miscarriage makes next pregnancy riskier

2009-01-07T04:58:00.000-08:00

From the study:

"Our work, based on the analysis of pregnancy records of more than 32,000 women, shows that a single initial miscarriage increases the risks of pregnancy complications in the next continuing pregnancy," Dr. Sohinee Bhattacharya of the Aberdeen Maternity Hospital told Reuters Health.

For their study, in the medical journal BJOG, Bhattacharya and colleagues analyzed the pregnancy outcomes of 1561 women who had previously had a first miscarriage, 10,549 women who had had a previous live birth, and 21,118 women who were pregnant for the first time.

Compared with the women with a previous live birth and the women with a first pregnancy, the miscarriage group was at greater risk of a variety of adverse outcomes. These included threatened miscarriage, the need to induce labor, instrumental delivery, postpartum hemorrhage, and preterm delivery.

"While for most women these risks are small," Bhattacharya commented, extra vigilance "should not be restricted only to women with multiple miscarriages."

Clomid - Day One

2009-01-06T07:25:00.000-08:00

Took my first dose of the clomid last night. I was REALLY worried about side effects, but so far I feel 100% normal.

This is good.

I'll keep you posted.

The miscarriage in "Marley & Me"

2009-01-04T15:35:00.000-08:00

People are debating whether the miscarriage (along with some other topics) of one of the main characters in the new movie "Marley & Me" should have garnered a stronger rating:

We made the mistake of taking our 7-year-old daughter to see Marley and Me, a PG-rated movie we thought would be an innocent story about a family's connection to its dog. Unfortunately, what we saw was a movie that contained a stabbing, a miscarriage, skinny dipping and other sexual connotations, vulgar language and a scene that shows a dog being put to sleep by a veterinarian.
This is a very good movie for adults. Shouldn't this type of subject matter be limited to PG-13 movies?

What do you think? Should miscarriage be lumped in with vulgar language and violence as a topic when deciding movie ratings?

An Exact Replica of a Figment of My Imagination

2009-01-02T12:25:00.000-08:00

I heard an interview with this author on NPR this morning, and now I want to read her memoir about her stillbirth, which she beautifully describes as her lost child's biography.

Can she do it? Yes, she can!

2008-12-30T12:52:00.000-08:00

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

2008-12-30T09:26:00.000-08:00

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.

READ THE REST OF THE STORY

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Wait and see? Or D&C?

2008-12-29T04:43:00.000-08:00

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.

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RESEARCH: MTHFR and other thrombophilic factors in recurrent pregnancy loss

2008-12-26T08:28:00.000-08:00

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.

-Katie

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

2008-12-23T07:09:00.001-08:00

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.

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An interesting medical overview of miscarriage

2008-12-23T07:03:00.000-08:00

LINK

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.

Aneuploidy

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.

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Recurrent miscarriage is really, really hard

2008-12-22T05:48:00.000-08:00

LINK:

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.

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Recurrent miscarriage raises pre-eclampsia risk

2008-12-19T05:27:00.000-08:00

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.

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Luteal Phase Dysfunction - a good overview

2008-12-17T06:10:00.000-08:00

LINK

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Exhale Magazine launches

2008-12-17T06:04:00.000-08:00

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.

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Waiting to try again

2008-12-17T05:54:00.000-08:00

LINK

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.

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A miscarriage dispatch: let's begin again

2008-12-15T11:33:00.000-08:00

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

2008-12-15T06:21:00.000-08:00

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.

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Linkity linkage

2008-12-14T18:04:00.000-08:00

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.

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Finding peace with loss

2008-12-13T07:01:00.000-08:00

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.

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An unexpected loss

2008-12-13T06:55:00.001-08:00

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

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Living with recurrent pregnancy loss

2008-12-12T19:00:00.000-08:00

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"

2008-12-12T10:35:00.001-08:00

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."

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A father's experience of miscarriage

2008-12-12T09:56:00.000-08:00

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.

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Blogging a past miscarriage

2008-12-12T04:26:00.001-08:00

An aspiring author recalls:

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.

Caffeine and miscarriage - the link gets stronger

2008-12-11T17:51:00.000-08:00

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?

2008-12-11T17:32:00.000-08:00

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 ;-)

The Miscarriage Blog on Twitter

2008-12-11T17:29:00.000-08:00

You can follow The Miscarriage Blog on Twitter. Please do!

Miscarriage black humor of the day

2008-12-11T16:09:00.001-08:00

LINK:

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

2008-12-11T13:49:00.000-08:00

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

Talking about Miscarriage

2008-12-11T13:46:00.000-08:00

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

2008-12-11T13:42:00.000-08:00

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

A blog is born

2008-12-11T13:05:00.000-08:00

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.

Thanks-

Katie