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.

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 ;-)