What kind of doc do you see for repeated pregnancy loss?

[MarineWife]

I've just found out I'm pg again. This is pg #10. I've had 3 live births. I saw a wonderful RE in 2002-03 for infertility when dh and I were ttc our 1st together. We have since moved and the closest RE to me is about a 2 hour drive. I've seen a couple of OBs who say they treat infertility over the last few years who have tried to help with my the RPL but I don't think they are really helping (since I still m/c). I'm wondering if there's a particular specialist other than a RE that one sees for RPL. There is a maternal/fetal specialist in town. Maybe that would be the place for me to go.

[collieflower]

I'm very sorry for your losses. I'm in a similar situation; I've had 4 pregnancies and one live birth. My OB/GYN ran some tests and then told me I was simply too old (I'm 36). However, from my reading, I don't think she has run all the necessary tests.

I have read that many ppl make the mistake of staying with an OB/GYN for too long, which is what I think I did. So I googled "recurrent miscarriage clinic" (you could also try "recurrent early pregnancy loss") and discovered a clinic about 6 hours from where I live. I have an apt there in 2 weeks and hope I will get some answers.

If you live in the US, I believe there are some excellent clinics. I've heard that Mary Stephenson (Director of the Recurrent Pregnancy Loss Program at the University of Chicago) is amazing.

Even if you have to drive a long way, there is a chance that the clinic could coordinate with a doc in your hometown. The clinic I am visiting said they would run some initial tests there, and then work with my my OB to do follow-up. Hopefully this plan will work out, and hopefully you will find some help too! Good luck.

[collieflower]

Whoops-read your post in a hurry and didn't realize that you are already pregnant! I don't think much of the testing for RPL can be done while you are pregnant. My clinic told me that if I get pregnant again, there is not much they can do for me, until I am not pregnant again (let's hope that doesn't happen). So, since you are already pregnant, maybe the maternal/fetal is the place to go.

[christophersmom]

I would see the maternal/fetal. Maybe you can at least call and see if you can get in for consult/testing/monitoring.
I went to a miscarriage specialist at the local University Hospital when I had my most recent one and they were able to run a bunch of tests (after I lost the pregnancy). I know they ran genetic testing and blood tests for things such as clotting disorders. I was told there was no reason discovered in the testing though.

[MarineWife]

I've had a battery of blood tests done plus all the testing and evaluations I went through when I saw a RE. I've been diagnosed with PCOS and a double mutation on my MTHFR gene. I was taking metformin, low dose aspirin and mega doses of folic acid for all of that. Plus, I used progesterone suppositories as a precaution as I was told my progesterone levels were always good. Even with all of that I still miscarried several times. Oh, and I'm now 40. I was over 35 when I became aware of my m/cs.

I called the maternal/fetal specialist but he only sees patients who have referrals from other docs (not an insurance thing). I don't have a regular doc who I can get in to see quickly to get a referral. I'm afraid I won't get to see anyone fast enough. I'm going to try to get in with an OB just to get the referral out.

[Jenne]

I second the ask for the battery of tests for genetic markers and clotting disorders. Also, some doctors check homocysteine levels instead of checking for the MTHFR gene mutation. Unfortunately, homocysteine levels in women are not always indicative of the mutation. I found this out when all of my testing came back fine but I had another loss. Then I switched REs and she caught that I hadn't had the MTHFR genetic test, just the homocysteine level check, I pleased to say that with the metanx and baby aspirin I'm well into my 2nd trimester.

I could not get into to see an MFM without a referral. You might also check with an RE (I know, you said 2 hours way, would they partner with your local OB/Gyn though ie the RE orders the tests but you have them done at OB/Gyn and the Ob/Gyn reviews the results???).

I wish you all the best, an answer, and success!

BTW- My RE put me on baby aspirin prior to the results of the MTHFR test and would have put me on progesterone even though my P4 was fine--she said that there was evidence that if you needed these things they were helpful but that there was no harm if you did not...

Jenne

[MarineWife]

Originally Posted by Jenne

I second the ask for the battery of tests for genetic markers and clotting disorders. Also, some doctors check homocysteine levels instead of checking for the MTHFR gene mutation. Unfortunately, homocysteine levels in women are not always indicative of the mutation. I found this out when all of my testing came back fine but I had another loss. Then I switched REs and she caught that I hadn't had the MTHFR genetic test, just the homocysteine level check, I pleased to say that with the metanx and baby aspirin I'm well into my 2nd trimester.

I could not get into to see an MFM without a referral. You might also check with an RE (I know, you said 2 hours way, would they partner with your local OB/Gyn though ie the RE orders the tests but you have them done at OB/Gyn and the Ob/Gyn reviews the results???).

As I said, I've already had all these tests. Believe me, I've been through a lot. I've been doing this for 10 years now. So, there's no need to coordinate a RE with an OB. I'm already taking everything that I'm supposed to but I still m/c.

[fierrbugg]

Have you had your IGf-1 and AM/PM cortisol levels checked? I also have blood cotting issues - but my main problem - after 10 years, 3 pregnancies and 0 live births is turning out to be an undiagnosed adult growth hormone defect. RE figured this may have been a problem because of low IGf-1 and high cortisol. It relates to alot of different things including egg and embryo quality. The actual tests for diagnosis came from a normal Endo - who told me that they couldn't have figured this out ten years ago when my first loss occured because they didn't know enough about it then. idk if it applies since you seem to have no issues conceiving, which my RE insisted for a long time wasn't my problem either (although after 3 years of tests things look a bit different).

idk if this will help, but it's a different avenue to explore - that again took me 10 years and 8 doctors to find.

ETA: I guess the moral of the story is - keep asking questions and don't take their answers as gospel - until they can tell you why it happens. There have been so many advances in medicine in the last 10 years (as I'm sure you've seen - having jumped through these hoops) - you never know what you'll find when you get a dr. who knows what they are talking about and isn't afraid to step away form western medicine if need be.