The D&C

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

Secondary infertility: one of the weirdest experiences of my life

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

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

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"

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.

All about Hughes Syndrome

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"

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.

The MTHFR-Miscarriage debate

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....

I am now in it.

Oh joy.

What it's like to be pregnant after multiple miscarriages

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.

READ THE REST.

Can she do it? Yes, she can!

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

Wait and see? Or D&C?

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

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

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

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

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

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RESEARCH: MTHFR and other thrombophilic factors in recurrent pregnancy loss

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

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

-Katie

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

The study:

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

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An interesting medical overview of miscarriage

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.

READ THE REST

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The pain of miscarrying again

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

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

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

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

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

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

It felt so good.

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

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

No heartbeat on the fetal doppler for us to hear.

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

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

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

READ THE REST

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An unexpected loss

A blogger talks about her recent miscarriage:

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

READ MORE

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Living with recurrent pregnancy loss

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

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

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 ;-)

A blog is born

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

I also recently suffered my EIGHTH miscarriage.

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

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

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

Thanks-

Katie