# What's the protocol for treating recurrent miscarriage?



## chrissy (Jun 5, 2002)

In mid-March I miscarried my 3rd baby. We had seen the heartbeat at about 5ish weeks but at 8.5 weeks I started bleeding and the u/s showed the baby had died about 2 weeks before. I miscarried naturally. Apparently I conceived this past cycle but had a very early miscarriage. My period was late and I had several very faint + tests, but I started bleeding today and now my hormone levels are just barely above the level of officially pregnant.

I went in to see my ob/gyn today and he said it is "probably just bad luck" and that they don't usually do testing until after 3 miscarriages in a row. Well whatever. I'm not waiting several months to get pregnant again only to miscarry again before they'll even do tests.

I asked him about progesterone and he said that there are conflicting studies on it but that basically he doesn't think it is really an issue. He said that if I wanted to take it there is no downside to it and he'd be happy to prescribe it if it will make me feel better.

He said that the next step will be to test me for auto-immune disorders and do an hsg to rule out uterine abnormalities (like a fibroid) that could be inhospitable to a pregnancy.

Then I asked him if he thought that my ovulating late could be a problem- if it could be causing me to ovulate substandard eggs (I usually ovulate in the the early to mid 20's. this cycle was on cd25). He said it's possible and if the auto immune tests and hsg come back normal that he could prescribe Clomid for that. He mentioned too that the Clomid would also help with progesterone levels.

So, I guess what I'm wondering is if this plan sounds good or there is anything important he is leaving out. I do have 2 live children- and no miscarriages prior to these 2- so I don't know if that changes the protocol any.

Thanks for reading this and I appreciate your help.

Feeling wounded and worn out,
Chrissy


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## 5thAttempt (Apr 22, 2006)

What you dr told you is about right. These tests are very good start. He did not mention genetics - but since you have 2 kids - this is probably not an issue. Ask him to run some tests or refer you to fertility specialists or reproductive endocrinologyst - these people have some more ideas on what to do. However, he might only do that after 3 m/c - stupid but this is the reality of insurance situation in this country. I actualy had all the work-up done after m/c #3 and then had m/c #4. Then they run something called thrombofilia panel and found that I have a clotting disorder that is more rear and usually person is not tested right away for it. He might be right - it might be just a bad luck. I hope that you will have a good pregnancy soon.


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## hopeful1 (Mar 30, 2006)

*I hope this question isn't too personal, but are your other two children from a previous relationship? The reason I ask is I have a healthy daughter from a first marriage; then when dh and I got together, we had a miscarriage and an infant death.... I started thinking, maybe our genetics aren't compatible... we had karyotyping (sp?) done and found that wasn't an issue... but it's just a thought. Good luck with conceiving a sticky bean soon!!







*


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## chrissy (Jun 5, 2002)

thanks you guys.

no question is too personal for me.







both of my children are from this relationship though so i'm not too worried about chromosomal problems.

i had the auto-immune panel blood drawn yesterday and i should hear about that in a week or two. i'm going to do the hsg on day 7 of my next cycle. i am taking this cycle off from trying, so i'll see what all this shows and go from there.

thanks again.


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## shannon0218 (Oct 10, 2003)

It's generally done with an autoimmune panel but ensure he also ordered the thrombo panel. Miscarriages after live children (as in as you get older) are common with clotting issues.
As for his "we only test after 3 miscarriages" He's approx 5 yrs behind on that one. The standard of care now is to test after the second miscarriage, especially if the patient is over 30.

Good luck and come back and let us know how your tests come back!


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## UrbanEarthMom (Jul 20, 2004)

I am so sorry about your losses - it must be so heartbreaking.

I am recovering from two miscarriages right now. I saw a miscarriage specialist, Dr. Danny Schust, in Boston who is moving to COlumbia, MO.

I had tests done for prolactin, thyroid, immune issues, blood clotting and some others I can't remember right now. Nothing showed up as being a problem.

He told me that if I wanted to do "something" - I could try baby aspirin or progesterone and then maybe blood thinners - but all these suggestions didn't have data behind them. He said that it is hard to test for progesterone so doctors suggest it because there is nothing else to suggest but in actuality it's only really helping 1 out of 10 women.

Right now I am opting for acupuncture. I've had 12 sessions and I feel incredibly better. It is giving me hope. I was influenced by the book "The Infertilty Cure" by Randine Lewis she has a chapter on recurrent miscarriage.

Wishing you health and healing.

Mary


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## shannon0218 (Oct 10, 2003)

Quote:


Originally Posted by *UrbanEarthMom*

He told me that if I wanted to do "something" - I could try baby aspirin or progesterone and then maybe blood thinners - but all these suggestions didn't have data behind them. He said that it is hard to test for progesterone so doctors suggest it because there is nothing else to suggest but in actuality it's only really helping 1 out of 10 women.

I think I may be misunderstanding what you're saying here








If he says there is no test for progesterone (which there actually is, blood and endometrial biopsy) and that there's no data behind it....how can he know that in actuality it's only helping 1 in 10 women???


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## chrissy (Jun 5, 2002)

thanks guys. i will check to see if my auto-immune panel included the clotting tests. i still haven't heard back but should early next week, i think.

mary, i have been getting acupuncture for a while now, and i absolutely love it too. i do have faith that it will help. i should read that book- i keep hearing about it.


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## Aurora (May 1, 2002)

Chrissy,









I am so sorry! I had 2 miscarriages last year after having 3 healthy children. I was also told that they wouldn't run any tests until I had my 3rd loss. That didn't fly with me either.







: I had all sorts of tests done and everything came back fine. We don't know why I lost those two sweet babies.

I got pregnant again last Fall and 2 weeks ago I gave birth to a beautiful baby girl.







I wish you the same joy! Please let us know how your tests come back.


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## chrissy (Jun 5, 2002)

oh aurora! it is so good to hear from you. i was just thinking of you the other day. i knew you were pregnant, but had no idea when you were due. i am so glad to hear of your happy arrival! huge congratulations to you. lots of fall knitting to do, huh?!

anyway, thank you for your support. i do have confidence that i will get to carry another little babe soon.


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## babybugmama (Apr 7, 2003)

Chrissy and everyone else with losses...

The autoimmune should include the clotting stuff. I had 2 m/c in a row and the dr. tried to give me the after 3....blah blah blah. I insisted on doing the tests. My progesterone was done on cd21 and the autoimmune and other tests around the same time (cycle day was irrelevant). Mine came back for in the indeterminant range (I think that's it) and he went ahead and said to try the lovenox injections (blood thinners). I'm at 17 weeks now. Good luck and best wishes! I have read that if it's clotting issues, with treatment the m/c rate is decreased to almost that of a "normal" pregnancy.


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## UrbanEarthMom (Jul 20, 2004)

Quote:


Originally Posted by *shannon0218*
I think I may be misunderstanding what you're saying here








If he says there is no test for progesterone (which there actually is, blood and endometrial biopsy) and that there's no data behind it....how can he know that in actuality it's only helping 1 in 10 women???

My doctor told me that the tests for testing progesterone levels are unreliable. Therefore, he doesn't even perform them. He also says that there isn't strong data that shows that progesterone helps. He doesn't think it hurts but he puts it in the "shot in the dark" category.


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## shannon0218 (Oct 10, 2003)

But what I'm getting at is how does he know it's only helping one in ten women if he doesn't even feel the tests are accurate and doesn't bother to do them???
Just FYI, endometrial biopsy is considered to be VERY reliable at gauging actual progesterone levels.
I think short of having an official diagnosis, most recurrent miscarriage protocol is complete shot in the dark....however, as a mom who's had 4, I'm prepared to take any and all shots in the dark.


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## chrissy (Jun 5, 2002)

mary, that's basically what my dr said too. he said he's willing to prescribe progesterone for me, but he doesn't even want to test mine.

i do think i'll take him up on the prescription though, once we're back to trying.


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## 5thAttempt (Apr 22, 2006)

Recurrent miscarriages are the most difficult poblrm to treat. My test for progesterone came back normal and so did immunologycal panel - Dr still prescribed progesteron and aspirin. By the way , thrombofilia panel is not part of immunological panel. Thus I was not diagnosed with my clotting issue until a separate test was done. If you decided to take progesteron - take 2-3 days after ovulation - do not wait till your positive pregnancy test. I had 4 m/c and during the last 2 I started taking progesterone after the test - did not help a bit. With my current (I am 18w) - I started it right after ovulation and the first series of hcg levels were much better then in previous pregnancies. This series were done even before I started blood thinners. Progesterone numbers were much better too.


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## shannon0218 (Oct 10, 2003)

5thattempt, I'm thinking that may be some of the misunderstanding here, all the evidence is based on starting progesterone no later than 7 days po. Those studies actually show VERY good results (as MANY on this board will attest to) Where progesterone is truly a crapshoot is when it's started after positive preg test--then yes, it's VERY up in the air as to whether it helps.

I look at it this way, you go to a fertility clinic or an expert in recurrent miscarriage and they ALL say that all these things help....but joe blow OB says "nah...they don't make any real difference" I have to wonder who's done more research. (and I say this coming from a spot of hearing "nah, none of that crap works")


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## chrissy (Jun 5, 2002)

yeah, my ob isn't a fertility specialist so maybe that's it. i don't know. i'm planning to take the progesterone, and do it from right after i ovulate so it doesn't really matter to me if he believes in it or not. i have done a little internet research though and it did seem to me that the evidence is mixed on whether or not progesterone supplementation is actually helpful.


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## ninafel (Apr 14, 2003)

Chrissy:

I wish you the best as you try to figure out next steps. Very sorry for your losses.

My two cents:
I agree with Shannon that clotting issues have more of an impact as we get older.

Also think that endometrial biopsy would show more than an HSG--after all, you are getting pregnant so pathways must be clear (which is what I thought an HSG determined). The uterine "earth" if you will, for supporting a pregnancy is what the biopsy shows and with early miscarriage that might be an issue. The biopsy will show conclusively whether you need to add progesterone to your system.

I took progesterone for awhile at my ob's advice but later when I saw a fertility specialist and all tests came back normal (HSG, endometrial biopsy, immune and blood panels--except clotting disorder!!--clomid challenge and sperm analysis) and she said that her hunch was that the progesterone was maybe causing a problem. She said if you take a perfect system and add hormones you can cause problems and she didn't believe the "can't hurt and might help" line of thinking. Her advice was to take the blood thinners to combat my clotting disorder but to cease the progesterone and aspirin. Within two months of stopping progesterone I was pregnant again (and pregnant with spontaneous fraternal twins, no less, probably due to my age--often more eggs are released per cycle as we get older).

Again, all the best to you.


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## 5thAttempt (Apr 22, 2006)

I agree that most doctors say "can't hurt and might help" words








This is what I am doing now. Actually my fertility doctor's line of thinking was: you do everything possible you can do so that if you have another m/c you will not blame yourself that "you should have done this and that etc". Actually this is what happened with me - I did not started progesterone before the test during the previous pregnancy because it was messy (I used suppositories)! So for 2 weeks every month I had to do progesterone and for another week I had my period. Only 1 "normal" week in between. I tried to use it as she told me, did not get pregnant for a couple of month - but still had all that mess and stopped it. I did blame myself for that after m/c.

By the way she also suggested to me do IVF with pre-implantation diagnosis to make sure every genetic problem is evaluated before they put embrio inside - better chance for the healthiest cells. We decided against it since I do not have any problems of getting pregnant, it is holding a pregnancy a problem. Plus, all the hussle of ivf (and pre-implantation diagnosis is not covered by any insurance - $3,500).

By the way, Shannon, nice to hear from you. I hope that you are fully recovered from you recent scare.

Chrissy, good luck to you!


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## chrissy (Jun 5, 2002)

okay, i will definitely check into the endometrial biopsy and make sure he does the clotting tests. i'm really not that old, almost 32, but i guess it's still kind of old for babymaking.

i think the reason he wants to do an hsg is to make sure there isn't a fibroid or something in there making it not a good environment for a baby.

oh boy, so much to think about. thanks for all your input, really i appreciate it. and i wish you all the very very best.


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## shannon0218 (Oct 10, 2003)

If it's just fibroids he's checking for, you can get a saline sonohysterogram done instead (I may be off on the name of that) it's considered better than the HSG for looking at the uterus but not as good for looking at the tubes. The biggest benefit is it doesn't hurt at all








The only problem with that is I'm not sure that regular hospitals do it, you may need to go to a fertility clinic to have it done....but realistically, I think that's the way to go with stuff like that, have it done and read by the guys that do that every single day. I had a normal HSG but an abnormal SSH and a SMALL fibroid was found, not the problem, but visible on the ssh but not on the hsg.


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## Canadianmommax3 (Mar 6, 2006)

I had my first son no problems, had two m/c, had my other son, than a m/c, so went to my ob about getting tested and he said they waited until at least 4 m/c! The fact i already had two children was good, so when i got pregnant with my daughter and started bleeding right away he put me on progesterone.
She was born healthy.


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## Tummy (Feb 24, 2005)

Ok, I have not read the entire thread.. so I am just going to say....

If you have had/having m/c over and over.. go to the herbal store near you, get some 'sepia' and start taking it.

I have read that women who have 'sepia' as their constitutional personality (homeopathic talk there) have reoccouring m/c.

Just a thought to ponder.


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## shannon0218 (Oct 10, 2003)

What dose Tummy?


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## Aurora (May 1, 2002)

Thanks Chrissy!

I had the clotting tests run too. When I was in the ER after my 2nd loss(I hemorrhaged)the doc ran a clotting test and came back in and told me all was well. When I went to my doctor a few days later she looked at the result and I guess he had run a test for blood clots in my legs?







I don't know, things are a bit of a blur. She ran the right tests for me. Anyways, what I am trying to get at is I agree with Shannon about seeing a Doctor who deals with this kind of thing regualarly.


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## shannon0218 (Oct 10, 2003)

The tests for genetic clotting disorders take between 3 and 6 weeks to come back. He would have just run a d-dimer on you if he got it back that quick. (and if it was a test to make sure you didn't have a DVT)


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## Aurora (May 1, 2002)

Thanks Shannon.


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