Tests for recurrent miscarriage

[Jules_P]

Hi ladies - Just wanted to let you know the results of my doc appt yesterday. They found a problem! I have low levels of lupus antibodies and my gyn thinks that is what is causing the m/c. He wants me to start taking 150mg aspirin daily and the moment I fall pregnant again, he wants me to start progesterone suppositories just in case. He said I've had a hard enough year and he wants to throw whatever he can at this. I will be 40 in Feb 2008 so we don't have time to waste.

I am happy to have a plan, hopeful I will have some luck and optimistic that we can at least try a few things to prevent another m/c.

Good luck to all of you in finding answers!

[scarlet]

HI everyone,
I hope i can answer a few of these questions.

Jules - that is great that you found an answer! Good luck

Tempus - it is possible to have normal pregnancies and then experience problems. I don't know much else about this.

Meggsy - My lab report says 13 is top of the range for homocysteine. Mine was 12/13. Combined with MTHFR and other clotting disorders this can be a problem. A lot of docs don't deal with this or say it is in range and it doesn't matter. But it can be a problem. Yes you should get it re-tested. This may be a problem for you. Given that you have a family history of cardiac problems, you should certainly be tested for the thrombophilias - MTHFR, Factor V Leiden, Prothrombin etc etc. The good news is homocysteine can be treated - I took 5mg folate (Megafol - no script required) for a few months and my level is now halved. HTH.

I am sorry to hear of all these losses ladies. I hope this information helps.

[hj1981]

Question - i have had 2 MC this year - is it at least a good sign that i am falling pregnant even tho i keep miscarrying? could it be that bad a problem that i may never have a healthy sticky preg?
My fs is getting me to go through a whole heap of blood tests - the first lot came back all good - just waiting for the chromosomes ones to come back - DH was fine! and once i reach my PEAK day i have to continue with more blood test every 2nd day for the rest of my cycle!
he is leading towards a progesterone issue so he wants to monitor that!
im hoping it was just bad luck twice!

[satya]

hj - I had two early m/c's this year. I then started the testing and nothing was found in what I had done. Several hundred dollars later and whilst waiting for a D&C & lap before I headed off to IVF (as my FS said that was my only option at my age) I found myself pregnant again. This time I've made it to the 2nd trimester. Doctors don't always have the answers. You could just find nothing is wrong and that things will work out for themselves.

[hj1981]

Satya - thank you! i hope that is the case for me!
Congratulations on making it to the 2nd trimester - i bet that is a good feeling!

[annee]

Hi all
I have just experienced my 5th miscarriage over the past 3 years. No babies for me. I have had lots of tests through the recurrent miscarriage clinic and a private OB. Nothing wrong they say. Everything is "normal" I am now 43 and feel lost. Tried Chinese medicine, supportive yoga, eating meat(am usually vegetarian). Not only when pregnant but in the months leading up to ttc to make sure the egg quality can be best. I concieve easily. It just doesn't seem to match up with the outcomes. This last pregnancy went the furtherest, a day short of 9 weeks. I had u/s at 7 1/2 weeks as i was worried. There was baby the right size and stage and a very strong heart beat. Progesterone levels monitored and very good. I read that a strong heart beat at this stage raises the chances of a healthy pregnancy to 80 - 90% even with my history of miscarriage and age. I was sooooooo happy for the next 10 days until the follow-up scan revealed the baby of perfect size and development for 8weeks 5 days but there was no heartbeat and no movement. It seemed my baby had died that very same day....
I have been devastated. The pregnancy had felt so calm and promising. Now i don't know what to think, feel or do. And my partner is reluctant to try again.

Any one else out there who never got the baby they wanted to have? Any thoughts beyond "at least you can get pregnant", "be happy now", "well at your age" "what about other ways" "accept it"

[Inanna]

Annee I am so sorry for your goodbyes... It is very very difficult to endure loss after loss.

I am wondering what tests have been done??? Remember, there is always a reason, we just don't always know what that reason is...
Have you heard of NK cells??? There is a school of thought that believes that over abundance of these nk cells is sometimes the cause of recurrent miscarriage. Treatment for this is anticoagulant therapy - often from the luteal phase and steroids.

Dr Gavin Sacks is someone who you could consult with regard to this. I lost 6 babies on the journey to having my beautiful Imogen. This was after 4 quite non eventful pregnancies and births.
After much much much research and consultation with various specialists I found an obs who would support me in using Dr Sacks regime. 3 of my babies died in the second trimester (around 15-16 weeks). When I got passed that milestone I started to let myself think that I just might bring home this baby. It was a gamble but it paid off for me. My advice to you is research. I spent long long nights learning all I could. Consult MULTIPLE obs. Present what your research tells you and choose an obs who is in there with you.

Good luck my love...

[annee]

Dear FLowerchild

Thanks for your thoughts on all of this. I threw out the paper with the lists of tests, but i know it did include clotting factor and thrombosis ones. There were also the antiphoso??lipids, for SLE, diabetes., rhuematoid factor, gluten intolerance, ones for any sign of any infections anywhere in my body, karotype for me and partner, HGC and progesterone through pregnancy. and the otld favourite ultrasounds.

I can't imagine what losses at your stages of pregnancy must have been like. I am so sorry that happened to you and that it happens at all. There may be a reason biologically why all this happens, but i am at a loss to any other. I will follow-up with the OB and my GP and as you suggest maybe a couple of other Ob's but for now i remain numb...and my partner not keen.

I have done lots of research, in more depth after each loss, and can find nothing more to help. What drove you forward?
A

[Inanna]

Simply what drove me forward was an incredible urge to have another baby and the steadfast belief that there was another baby for me.

I was just past 40 when I birthed Imogen and with my history it seemed I just may not reach my desire.

From the little I know of your history NK cells could be your answer...

Dear Annee,

I do feel for you. I too have had multiple miscarriages at an early stage. I started seeing a fertility specialist and had all the tests you mentioned. Like you all came back normal which was a double edged sword- good that there was 'nothing wrong' but also frustrating because finding a problem might have meant it could be treated! I felt like I was on an emotional rollercoaster, excited that I could fall pregnant easily, but devasted that I couldn't hold onto it. My FS started me on clomid which I don't think made a difference. Then at my last appointment she thought she would try some extra progesterone support with injections. Although my blood tests had been normal she thought that at a tissue level, my progesterone level may be dropping too low to suport a pregnancy. At the same time, my husband who had been in a really stressful job, left work. Low and behold that next cycle I fell pregnant and am now 22 weeks.

I had started to give up hope and I can understand how frustrating it must feel. My suggestion is has your FS tried clomid and progesterone injections? I know stress is so difficult to measure but is that an issue? I know its stressful just trying to get pregnant and that was always the case for me, but I think my husband's stress levels also played a huge factor.

Some people feel the need to take a bit of a break from trying and revisit it later, and others like me just persisted hoping that my time would come. I'm thinking of you and hoping your time will be next!

Hugs and kisses,

Skipping girl

[annee]

Dear Flowerchild and Skipping girl

Thanks for you thoughts and sharing your experiences around this. I will look into NK cells further and also the Progesterone injections. Need to make a new list for when i visit the specialist again about these things and see if there is something more i can take up to help me support a pregnancy, rather than just go with the "preprogrammed" explanation

I really am glad you both took the time to respond

Annee

[Jocelyn King]

From a naturopathic viewpoint miscarriage is preventable, it is not just ' one of those things' and there is little point in giving just the advice to 'try again' unless attention is given to those factors which could cause miscarriage and which are amenable to treatment.

Naturopathically, miscarriage can be prevented by ensuring that the foetus is viable, the environment in which it grows is healthy and that undue stress, physical or emotional especially during the first trimester is avoided.

Most miscarriages are often the results of factors present at the time of conception. Because of this the best way to avoid them is for both parents to practice preconception care for a few months before your pregnancy starts. This helps enormously to ensure that the foetus is viable and the environment that it grows in the early weeks is healthy. I know that a few months seems like a long time but especially if recurrent miscarriages is a problem it is really important to stop and get everything in order before attempting another conception.

Causes of miscarriage may be divided into 5 main groups and the percentage of contribution has been estimated as:

Infection ( Chlamydia, mycoplasma and ureaplasma most common) = 1%

Anatomical defect of uterus = 5 ? 12%

Progesterone deficiency/ luteal phase defect = 20%

Chromosomal abnormality = 7 ? 50%

Immune mechanism = 30 -50%

Unknown = 15%

A lot of the tests that have been listed above are to check for immunological causes of recurrent miscarriages. I will write some more information about these in detail separately.
I am one of the naturopaths working at the Belly Belly centre in Canterbury so if you find you are not getting anywhere with all these tests do come in to the centre to see us - our approach might just help. Some of our medicines help regulate any hormone imbalance as well as help to prevent miscarriages. On top of this we can help with your preconception care to make sure you are in tip top condition for conception and development of the foetus.
Hope this is of some help
Do look me up on the new Belly Belly pregnancy centre website
Jocelyn King

[Inanna]

I agree that "just one of those things" is not an answer that is okay. Sadly this answer is given to most women who recurrently miscarry.

I am a great believer in natural therapies but I was one that couldn't be helped with it sadly...

I tried naturopathy, chinese medicine and everything in between. For me it was an autoimmune condition triggered by pregnancy - that is whilst not pregnant I did not have the dis order.

I think we should try all we can and take the best of what each mode of health care provides us. For me I combined my acupuncture and chinese herbal medicine with the western way of clexane/prednisolone. When we stopped the prednisone my body again went into fighting itself again and my baby had to be born in order to preserve my life.

Definitely the herbs and acupuncture aided my recovery from a very traumatic time...
ETA:
I think? I have read your book - would that be right? I loved it - it ceratainly helped me with my other babies...
I followed it to a T - the acupuncturist I saw was a big believer (and still is!) in your techniques. He though said he reluctantly had to hand me over to Western Medicine as all of the work was not helping. We now know why... :sad:

[Babyfever2007]

Hey ladies,

I am joining this tread because I have a few questions / concerns. I had a miscarrige on 7/25/08 at 6 weeks 1 day. They had me come in a week after my loss for some blood clotting disorder tests and some others, I do know one test I do remember being on the list which is the MTHFR test. They just now got my BT back and said I need to come in for a follow up to talk about it because there was a problem. I have no clue what all these tests mean and what a MTHFR test is about. My question is if there is a disorder what typse other testing do they do? And, What have you all been through any surgerys because of this? anything seious? I'm so scared...

[Darcy295]

Meg, I notice that you don't mention low progesterone on your list. I have been reading this wonderful website today with stories from many, many, many women who have had multiple miscarriages - the doctors telling them it was nature's way only to find after going to another specialist that her progesterone level was too low to sustain a pregnancy. I just had a failed FET and found out straight away that my progesterone levels were too low. Please everyone get your levels checked. I am not saying it is right in every instance but it certainly helped a lot of women. I can't believe many people are not aware of it. Many doctors don't even bother checking.

If you want to read the stories these amazing women have been through go to lowprogesteroneinpregnancy.com/subpage1.html

Good luck. Cheers

[Inanna]

So sorry for your loss and your unsuccessful FET.

Progesterone is a really debatable issue and one that often gets firey debate amongst professionals.

Progesterone is produced by our bodies after an egg has been released from a follie. This progesterone is necessary in maintaining a pregnancy - this is true. When we look at a HCG result we also look at progesterone. For a lowish progesterone and a lowish HCG often (but not always) do not augur well for a pregnancy. High progesterone creates an environment that is favourable for pregnancy - low progesterone makes it less favourable. If women have a short luteal phase (11 days or less) it can mean that the progesterone is low and thus it makes it more difficult to maintain a pregnancy - basically the progesterone is the glue that helps that embie to stick. Often clomid will be used for this issue as the multiple follies that it often stimulates creates a higher level of progesterone. B6 and vitex are used for this reason to good affect by some women. If low progesterone is the cause of a pregnancy loss it will be a very early loss and usually manifests in "chemical pregnancies" - where the pregnancy is chemically confirmed (by b/t or urine test) but the levels are low and the pregnancy is lost soon after.

When a woman has a pregnancy loss of a normally growing embryo with "normal" range ratios of hormones it is usually put down to a chromosomal or developmental issue with the baby. When a woman has multiple chemical losses it is often thought to be either lp issue or autoimmune. Autoimmune issues often manifest with later losses - this is not because "all of a sudden" an issue arises.

The placenta begis to develop from conception. It doesn't magically have a switch at 12 weeks. So the groundwork for that development (of the placenta) begins at the beginning! A bit like when you build a house - all the pipes etc have to have places for them in the house - the holes need to be big enough - the position needs to be correct.
It is theorised that this isn't occuring well in some pregnancies - so once the baby is reliant solely on the placenta if that placenta isn't tip top we run into trouble.

In failing pregnancies (early ones) the progesterone drops prior to seeing changes in the HCG. This is an early indicator of a pregnancy that is not going well. Yes, there are anecdotal stories of women with dropping progesterone who go on to have healthy babies - these are enigmas and miracles and wonderful! However, "usually" it does not augur well.

So, if you have low progesterone, sometimes that can be helped by pessaries - used sometimes for the first trimester. This can help maintain a pregnancy that will fail because of the mothers low hormone levels. The debate is that it can maintain a pregnancy that just won't survive.

Many fertility specialists use P4 pessaries as a par for course - especially in cases of recurrent early loss.

HTH

[Possums]

Hi everyone. In the past 12 months I have had an ectopic,then IVF, then a missed miscarriage where the baby stopped growing at 8 weeks and now a missed miscarriage where the baby stopped growing at 8 weeks 5 days.
I am wondering if I should be having further testing done? I had a D&C yesterday and the placental material etc has been sent off for testing (same as last time, which revealed no abnormal cells etc). My OB says further testing is not needed at this point. I am just worried about returning to IVF (and ttc naturally in the meantime, even though I only have one "dodgy" tube, this last baby was a natural miracle) and falling pregnant only to lose another one. Many thanks for your thoughts.
Emma

[annee]

Dear Possums
I am so sorry to hear of your losses. It sounds like you have solved the conception difficulty. There are quite a few tests you can read about on this thread for recurrent miscarriage. If you are with an IVF program I imagine they can organise these for you. They test for any autoimmune diseases, as well and things like clotting factors, lupus and Coeliacs disease. They are all blood tests so they are quick and easy to do. Take care of yourselves through this time and be kind to yourselves.