Tuesday, August 21, 2012

Pt. 2: Miscarriage x 2....What now??

A few quick points before I get back to the epic novel about my lady guts.

1) I would like to thank all of y'all for not pointing out my glaring math fail when describing my giant milkshake.  26 + 8 actually equals 34, not 32-- whoops!!

2) Thanks so much for reading and responding to these mini-novels --  it really does help hearing everyone's feedback/suggestions.


Anyways, where was I??  Oh, yeah.

I came home from the hospital and spent the rest of weekend in a pain med induced haze.  I probably didn't actually need any pain meds, but my Doc indulged me some light meds after I told him that: 1) it's the weekend so I can't easily call you tomorrow if I am in terrible pain AND 2) I am in no kind of emotional mood to contend with any unnecessary discomfort.

Since the reason for the D&C was concern for an ectopic pregnancy the Doc sent all the "stuff" that was removed off to the lab for testing just to confirm that it was pregnancy type tissue.  The Doc put a "rush" on the tests so the results were supposed to be back 2 days later on Monday.  I was supposed to get the "Everything is normal" call sometime mid-Monday.

Instead, I got a call from the Doc's nurse that was a very urgent "He wants you to come in immediately.  He wants to do another ultrasound and more bloodwork."  To which I was all, "Um, is everything okay??" And she replied,"I really don't know anything other than he sent me a text that he wanted you in here ASAP for ultrasound/bloodwork."

Cue the total panic attack.  I drop what I am doing, get showered and dressed comfy (you know, in case I have to go straight to the hospital), make The Hubs clear his work schedule for the afternoon to drive me to the Dr.'s office.  I spent the 20 minute drive to the Doc's freaking out -- convinced that my fake baby was actually some mutant ball o' cancer.  *dramatic much???* 

We get to the Dr.'s office, ultrasound done, bloodwork done --- now, just waiting in the exam room for the Doc.  He pops through the door all bouncy and chipper about how everything looks "Really good!!" at which point I totally lose my shit.  I go off about how I really don't appreciate being dragged into the office on the premise that I am rotten on the inside only to have him bounce in like everything is fine and dandy.  All the color drains out of his face and he is completely embarrassed and apologetic. Apparently, there was a HUGE misunderstanding between his instructions to his nurse and her instructions to me.

Needless to say, he felt really, really bad.  And you know what happens when your Dr. feels really guilty???  He takes you and your husband into his office and spends 2 hours having a detailed discussion about all the options available to you.

It goes a little something like this: There are a handful of major causes of recurrent miscarriages.

*Note: I am being super simplistic in my descriptions because I know that, while you guys care, you didn't sign up for Intro to Baby Science 101.  If you are/have experiencing fertility issues please don't be insulted by my simplicity.

1) Anatomy -  Problems with the shape or condition of the uterus.  Septate uterus/bicornate uterus, uterine fibroids/cysts, scar tissue, etc.  Basically, these types of things can be a barrier to the embryo implanting in the uterus or being able to grow properly. 

*This is not my problem. I recently had a hysterosonogram in which saline is injected into the uterus during an ultrasound.  My uterus is "awesome"- the doctor's term, not mine.

2) Immune-  There are a bunch of chemicals in the body that are capable of having an immune reaction to a pregnancy.  In many cases, this reaction produces blood clotting in the super tiny blood vessels that feed an embryo/fetus.  When clots occur in these tiny blood vessels -- it essentially chokes off the blood supply to the fetus and can result in miscarriage.  Most times women are not aware that they are susceptible to this immune response until it causes the problem.  The treatment ranges from as little as a daily baby aspirin (81mg) to daily Heparin injections, sometimes these are only necessary during the 1st trimester but can be required throughout the entire pregnancy.

* I am waiting to find out if this might be an issue for me.  A couple weeks ago, my Doc drew about 4 gallons of blood to test for the 73 different types of chemicals that are capable of causing this issue. He warned me that the testing would take a couple weeks so I should be getting something back soon.

3) Genetic/chromosomal -  This is actually what most doctors believe causes the vast majority of miscarriages.  It could be that the sperm or egg were somehow genetically flawed.  It could also be that when the cells started dividing the copies didn't copy properly and ultimately the development couldn't continue.  While these circumstances may be the most likely cause of many isolated, single instance miscarriages, recurrent miscarriages are often a different story.

When it comes to recurrent miscarriage and genetics, there is possibility that My Eggs and The Hubs Sperms are genetically incompatible, as in they are incapable of mixing up properly.  Even though this is possible -- it is very rare.

*It will be a while before we explore this avenue.  The testing process is expensive and not always covered by insurance. If it is covered by insurance, it is usually not until numerous miscarriages have occurred and all other causes have been ruled out.

4) Progesterone Deficiency - Progesterone is the "pregnancy hormone".  It does 2 big things:  1) It gets the uterus "ready" for an embryo to implant during the Luteal Phase (aka the 2 weeks between ovulation and your period) by thickening the uterine lining.  2)  It is also what tells your body you are pregnant so it won't be trying to "get rid" of what's in the uterus.  

For the 1st 8-12wks of pregnancy it is produced by the corpus luteum (this is what spits out your egg from your ovary when you ovulate)  around 8-12wks the placenta fully forms and takes over the job of producing progesterone for the rest of the pregnancy.  Low progesterone from the placenta can also lead to preterm labor.  

Progesterone deficiency is believed to be a major cause of recurrent miscarriage.  Fortunately it can be supplemented either, by a pill, vaginal suppository, or injection.  My Doc prefers to use injections bc it is believed to be the most "effective" form.  However, I have been warned that the injections are HELLA unpleasant, but honestly I don't care -- I am pretty sure that having miscarriages sucks harder than some shots.  Some women only need to be supplemented during the 1st trimester until the placenta forms but some women have to be supplemented through their entire pregnancy --- again, either way I don't care,  I am pretty sure having miscarriages is more annoying than having to get shots 2-3x/week for 9mos.  

***This is the BIGGIE.  Many of you commented on my last post about possible issues w/ low progesterone.   If I had to place a bet as to what I believe the cause of my miscarriages has been I would bet on the low progesterone issue.   I base my completely non-medical, non-professional opinion on the symptoms/timing of my miscarriages along with the TONS of research/reading I have done about low progesterone.

The next big question is determining where the progesterone problem occurs.  Does it occur during my Luteal Phase (aka 2wks between ovulation and period) meaning that my uterus isn't getting properly ready to implant an embryo????  Or does the problem only during pregnancy meaning that I produce enough progesterone to GET preggo but not STAY preggo???

If it is a Luteal Phase problem --- then I would need to supplement my progesterone right after I ovulate each month and then continue through into pregnancy (if I get preggo that month).  If it's not, then my Doc recommends testing/supplementing for progesterone immediately after I pee on a stick (and get a +)

The only hitch is that in order to find out when I would need to get the progesterone -- I have to take a 3-4 month break from baby making in order to follow my Doc's cycle charting regimen and testing.   He gave me the option not do the charting but if I don't we can't address the Luteal Phase issue.  So that only leaves the option of supplementing after a pregnancy is achieved ---which he will still do for me.

I will be honest.  I am not loving the idea of waiting 3-4 months to try getting preggo again.  But I have decided ( after lots of soul searching and research) that I want to get all the answers I can ---  I need them desperately.  I also know myself well enough that if I go ahead and get pregnant again and it doesn't work out AGAIN that I WILL beat myself up for not doing the full regimen.

YAY!!!  There is a strategy!!  I have a plan!!!

(I really wanna talk about the charting regimen because I wanna see if any of you have heard of it but I am gonna save it for another post bc this one was too effing long about 6 paragraphs ago. )













3 comments:

  1. I know 3-4 months feels like forever, but I also think you would beat yourself up if you didn't follow through with everything. I just know this will all work out and in no time you will have a cute little baby bump! Hugs!

    ReplyDelete
  2. ((hugs)) The fertility stuff can be maddening. The 3-4 months will fly by quicker thn you think. We have moved on to adoption now and we were put "in the book" last March. I can't believe it has been over 5 months already. Super fast. Hang in there!

    ReplyDelete
  3. i know it sounds like so far away and that you've been waiting a long time already...hang in there.

    and i totally 100% agree about the progesterone. after years of infertility my research finally led me to progesterone and the importance it plays in miscarriage and trying to conceive. i tried and tried to convince my docs to look into it and look give me progesterone BEFORE actual conception but they wouldn't listen so i started medicating myself. i bought some over the counter progesterone cream (happy PMS cream) and used it for several months. when i finally got pregnancy my doc finally put me on both suppositories and injections for the first trimester.

    as you know so well now, the research about progesterone is so important not only DURING pregnancy but before, during and after. i whole heartedly believe in it!

    {{{HUGS}}} I KNOW HOW FRUSTRATING ALL OF THIS WAIT AND SEE STUFF IS!

    ReplyDelete