This time I opted for a NT scan with a MFM doc that my MW refers to but not because I was concerned about chromosomal abnormalities. After so many miscarriages (one that took 3 weeks from the time the baby died to occur) I needed the reassurance that my baby was still alive. The NT scan was fine but then the doc went into his schpeel about all the things I'm at a higher risk for because of my age.
In addition to the Level II u/s that I was already planning to have to make sure everything looks good for my home birth since I've had a previous c-section, he wants me to come in for extra monitoring in the 3rd trimester. Specifically, he wants me to have periodic growth scans and either biophysical scans/tests or non-stress tests. He says because of my age and other risk factors (PCOS and RPL) I'm at a higher risk for IUGR, GD and early placental deterioration. Oh, he also wants me to have a 1 hour GTT next week 3 days after I stop taking metformin, which is an insulin resistance drug that used to prevent miscarriage in women with PCOS, even though I have never been diagnosed with insulin resistance, pre-diabetes or diabetes. That would be next week when I'll only be 13w5d. I don't really buy into the whole GD thing, anyway, and would normally decline the later testing.
I'm really confused this time about what's really necessary and what's not, mainly because of my age. Does a couple of years, being in my 40s, really make that much difference? I don't want to do anything that would put my baby at risk so I do want to have the testing and screenings that are truly necessary (if there are any). But I don't want to fall into that trap of having a bunch of unnecessary stuff done that leads to possible false positives or assumptions of more problems and on and on.
The MFM doc understands that and agrees. For example, he told me that since the NT scan was fine he recommended against getting any of the blood tests like the AFP or triple screen because the NT scan is the most definitive (other than amnio and CVS, which I will not get done) and the blood tests result in too many false positives. In other words, I wouldn't gain anything from the blood tests but might be subjected to unnecessary stress and worry. Because of that, I'm inclined to believe him when he says that I should do this or get that but then again, I'm not.
I'd love to get other people's opinions on all of this. If you are in your 40s and are normally disinclined to testing, screening and monitoring, what do you think of all the AMA stuff?