ovarian cyst rupture and pregnancy loss

[Mikeal'smom]

Hello.  My husband and I have been ttc for number 2 for 3 1/2 years, I am now only 27 and he is 29.  My first pregnancy was in Feb of 04 which ended in a D&C due to blighted ovum.  My next two pregnancies ended early (around 6 wks) both of them with good HCG's and then had an ovarian cyst rupture (with both) and within days my HCG dropped by about half.  My last pregnancy was in August of 06 with perfectly doubling HCG, had a cyst rupture, and then #'s dropped by half.  I had a D&C a week later to find that it was actually an ectopic pregnancy, had methotrexate but due to bleeding into my left tube it was removed, at which time they also found some endometrium on my left ovary.  All ruptured cysts happened on my left ovary (which is the side I ovulated on- know this due to having pain a time of ovulation). I also just had a failed IVF in April of 07.  My questions are, do you think there may be a connection between my cysts rupturing and losing my pregnancies, and if so what can we do about it?  and I was also wondering if I had my left ovary removed (where I had all the cysts, and no tube on that side), would I be more likely to get pregnant on my own using the right side which is somewhat healthier?  I should also let you know that neither my RE or my OB believe in checking progesterone levels?  I want another baby so badly, and we have been through so much I was just wondering if you had any advice for me that will help us make the right choices? Thank you for your time!

[Forum-M.D.-SP]

I would not recommed removing any ovarian tissue unless absolutely necessary. I agree with not checking progesterone levels; in my opinion they are not helpful in determining between an ectopic and an intrauterine pregnancy, and giving extra progesterone will not help a pregnancy survive if the progesterone level is low. I am not at all certain that the cysts ruptured every time - that seems unusual - and even if they did I am not sure that is the cause of the losses. With three pregnancy losses, you might want to consider chromosome testing for you and your husband (a blood test), a hysterosalpingogram or saline utrasound if not recently done, and blood tests to rule out abnormal blood clotting as a cause of your miscarriages. Most of the time these tests come back negative but it is important to identify any abnormalities in these tests since, if there is an abnormality, it can often be corrected to improve your chances of a healthy pregnancy. I hope things work out for you and your husband.

[Mikeal'smom]

I wanted to thank you for taking the time to answer my question.  My husband and I have already had the chromosome testing, hysterosalpingogram as well as the sonohysterogram- everything has come back normal.  We have not had the blood clotting tests, due to the fact that we are unsure if our insurance will cover it, and it is a very expensive test to do- I will talk it over with my husband once again and maybe it holds the key to our problem.