3 Miscarriages

[MichelleMH]

I have had 3 miscarriages in the past year (going through the 3rd one right now).  I have a 3 year old son who I had no problems with during pregnancy.  I had blood work done after the 2nd miscarriage that showed I have an MTHFR gene mutation.  I was referred to a MFM specialist who told me that my homocystene levels were normal and my mutated genes were C677T and A1298G.  He told me that this should not have any effect on my carrying a baby.  But he did prescribe folic acid and told me to take baby aspirin if it would make me feel better (in other words, it can't hurt).  We got pregnant right away after being given the okay (getting pregnant isn't the problem, staying pregnant is).  I have miscarried between 6-8 weeks each time.  My question is, where do I go from here?  I am in the Tampa area and plan to contact one of the USF physicians- but do I find a MFM specialist or a  Reproductive Endocrinologist?  Thanks for any info.  

[Elaine Brown, MD]

Hi!
I'm sorry that you've had so many losses!  I'm so glad that you have one child (blessing) to count on to help you through the hard times.  The MTHFR gene has been identified by REs as possibly playing a role in failure of embryos to implant during IVF cycles.  (Implantation is not your problem either).  Nobody really knows for sure what if anything it means or what to do about it--other than Folate and baby aspirin.

If I were your doctor, I would discuss with you the possibility of doing karyotypes on you and your spouse.  MOST early miscarriages are caused by genetic abnormalities in the fetus--and there is a potential for the karyotypes to diagnose the problem.  On the other hand, genetic abnormalities in normal people are exceedingly rare, and karyotypes are quite expensive.

There are some other tests that can be done including testing for anti-lipid antibodies (if you have not already had those).

Also, jess(above) is correct that a saline ultrasound or HSG to rule out abnormalities of your uterine cavity would be a good idea.

If you were my patient,  I would agree with Folate, baby aspirin and progesterone suplementation were you to conceive again.  Because you can conceive so easily, your chances of a sibling for your son are quite good.  Hang in there!

Good luck!
Dr B

[jesshopes4baby]

Have you had your progesterone levels checked? I have always miscarried between 6 to 8 weeks and I have the same MTHFR gene mutation. I have the same issue (staying pregnant). I have had four miscarriages but I also have 5 uterine fibroids, not trying again until I get rid of the fibroids but in the mean time I am using natural progesterone cream. Maybe you should look into that as well as consulting with a specialist.