What is the infertility treatment for recurrent miscarriages?

[ktcl]

I've now had 3 miscarriages. So miscarriage is my fertility issue. I seem to get pregnant, but not stay pregnant. This last one was even on progesterone. So what else do they do? Is there any actual treatment for this or you just keep trying and trying until your heart hurts too much to try anymore???

[by-the-lake]

Have you seen an RE? Because if progesterone supplements don't do it, have they looked at thyroid and clotting factors?

[ChristyMarie]

See an RE who specializes in it. They ran about a billion blood work tests on me and came up with a slight clotting issue so I'm on baby aspirin and once I (hopefully? finally?) get pregnant again I'll go on an Rx blood thinner.

[FtMPapa]

Originally Posted by ktcl

Is there any actual treatment for this or you just keep trying and trying until your heart hurts too much to try anymore???

for all three of you.

There are a few things:

1. Baby aspirin - it's supposed to help a lot of people by thinning the blood. You get the 81 mg (I think?) - the coated low-dose aspirin that a lot of people take for their heart health. I bought the CVS store brand for maybe $3. Take one a day.

2. I don't remember your donor situation, but if you're not stuck on that donor, it's not a known donor, etc, you might want to think about switching. I would just up and switch, but I'm known for having absolutely no investment in any particular donor.

3. Definitely talk to your fertility doctor and see what ze says. Actually, this should be # 1 - or even # 0. Do this before anything else.

4. At the extreme, if there's something wrong with your egss, you could think about donor eggs, and if there's something wrong with your uterus, you could think about a gestational surrogate. You could also think about IVF and doing early genetic testing on the embryos to rule out genetic abnormalities. These are, in my opinion, pretty extreme options. But they exist.


5. Think about non-western medicine. Lots of folks have had TTC success with acupuncture/acupressure, massage therapy, etc, etc.

6. But above all, please let yourself heal and be gentle on yourself. You might want to seek counselling if you haven't already. You have lots and lots of options to explore, but your first priority should be to grieve these losses, to heal.

[LisaG]

I would strongly recommend the book "Is your body baby friendly?" It's not uncommon for immunological factors to play a role in repeated miscarriages. Your doc should be very pro-active in running tests such as:

1. thyroid panel - including thyroid antibodies
2. thrombophilia panel
3. hysterosalpingogram to rule out uterine fibroids, polyps and uterine septum/other uterine cavity anomaly

The book mentioned above also has a list of tests that should be run with repeated miscarriage. Typically these are best done under the supervision of a reproductive immunologist vs. RE.

I'm so sorry you've gone through so much and I hope you are able to get some answers

[Happily Blessed]

Big hugs to you and I am so sorry you are going through this.

The ladies above said exactly what I would have said. The lab we went through to have our testing was http://www.millenova.com/tests/preglosspan.cfm

It went as expected, and I was found to have a blood clotting factor and high homocysteine levels (which means my body doesn't use the folic acid it needs or the baby needs.) I was had a bicornuate uterus which had to be corrected.

Hang in there!

[LisaG]

Happily Blessed - so glad you found some answers! Just out of curiosity, did you have a bicornuate uterus or a septate uterus? I had a bicornuate uterus corrected surgically, but it's so rarely done I hardly ever run into anyone else who's had it surgically corrected.

[Happily Blessed]

LisaG- yep, we had her repaired. They said the septum was classical heart shaped and it had been possible that one or more of the pregnancies had attached themselves to the horn where there was no blood flow.

[LisaG]

Happily Blessed - sorry, not trying to beat a dead horse, and maybe you already know this, but just in case someone else in a similar situation is reading this - a septate uterus and a bicornuate uterus are 2 quite different scenarios although they look very similar from the inside view especially via HSG.

A bicornuate uterus is heart shaped from both the inside and the outside and the tissue that dips and creates the heart is the actual uterine wall. A septate uterus looks like a normal uterus from the outside but from the inside there is a sheet of fibrous tissue (typically with poor blood supply) that did not get properly reabsorbed during the formation of the uterus. So from the inside, a septate uterus looks heart shaped. A septate uterus actually carries a higher risk of miscarriage because, like you said, if the embryo implants on the septum there typically isn't enough blood supply to sustain the embryo throughout the pregnancy.

It's pretty easy to correct a septate uterus usually with a laparoscopy/hysteroscopy. They'll just snip the septum as close to the wall of the uterus as possible without perforating the uterus. The septum then retracts and the uterus is pretty darn close to normal.

To correct a bicornuate uterus it's major abdominal surgery with an incision similar to a c-section and they cut through the wall of the uterus from side to side across the top and then fold the left half to the right half and stitch up the incision which now runs up the front, across the top and down the back of the uterus. It's kind of like origami Because it's such major surgery, it's rarely done.

Unfortunately, it's pretty common for docs to use septate and bicornuate interchangeably and they are 2 completely different scenarios with very different ramifications. Without seeing what the outside of the uterus looks like (via MRI or laparoscopy) it's pretty difficult to distinguish between the 2 just from looking at the inside because they look so similar.