Trying again after 2 miscarriages

[forevermissed]

I have had 2 miscarriages. One in Oct 06 and the second one was in May 07.  Both resulted in d&c's.  However, I also had to have a repeat d&c's for both because of missed tissue.  So, I have had four d&c's in the past year.  The last d&c procedure was on Aug. 1.  They also did a hysteroscopy to see if there were any abnormalities in my uterus.  My dr said everything looked good.  There was a very tiny piece of scar tissue that he cut out.  He told us we could start trying again after one cycle.  I should start my period this week.  I really want to start trying again.  With the last m/c we ran chromosome testing and blood work to see if we could pin point any problems and everything came back normal with the exception of the MTHFR factor.  I tested pos. for one strand of MTHFR.  They checked my homocystine levels and they were normal.  Our game plan this time around is to start prometrium on day 12 of my cycle, take baby asprin every day, extra folic acid and prenatals.  Is there anything else that I should be doing before trying again?  
Thanks so much!

[Eliza101]

Just want to express by sympathy for you - I too have had 2 successive miscarriages resulting in 3 D&Cs. It has been 5 months since our 2nd miscarriage, and I am still reduced to tears thinking about it. It seems that everyone around is pregnant, and yet we are still trying just weeks after our first baby would have been due. I hope everything goes well for you - I will be thinking of you.

[Forum-M.D.-SP]

I have a couple of comments:

1) Was the pregnancy tissue tested for chromosome, or were you and your partner tested? It would be worthwhile to test both of you if only one of you was tested

2) I doubt that the single strand MTHFR finding is significant, but agree that extra folic acid cannot hurt and might help

3) I would hesitate to start prometrium on day 12 of your cycle. Prometrium is given to treat luteal phase defect, but there really is no evidence that we are able to diagnose luteal phase defect, or that luteal phase defect causes recurrent pregnancy loss. Luteal phase defect as a cause of recurrent miscarriages is something that we have talked about for decades, but without any good proof. In a normal menstrual cycle, your own ovaries do not start to produce progesterone until after you ovulate. Progesterone makes the cervical mucuous thick and impenetrable to sperm, and changes the lining of the uterus to allow the fertilized egg to implant. I am concerned that starting progesterone on day 12 is too early, since most women ovulate on or about day 14-16. I am worried that, just when we want the cervical mucuous to be easiest for sperm to swim through, we will be making things more difficult. Also, if we start too soon your uterine lining will be out of sync. Since there is no evidence that luteal phase defect causes miscarriages, I do not often add prometrium. When I do, I recommend that you test your urine daily with urine ovulation prediction starting on day 10 or 11, have intercourse the day the urine turns positive and the day after, and then start prometrium 3 days after the urine turns positive; this way you know that you are starting the prometrium at the correct time.

I personally would be very hesitant to start prometrium on day 12 - I think that is too early and could make things worse.

Finally, remember that after two miscarriages, although disheartening, the chances of the third pregnancy being successful even without any treatment would be in the 65% range.

Is your provider an ObGyn or a Reproductive Endocrinologist? You should discuss optimal timing of prometrium with your provider.

Good luck and I hope things finally work out for you!