Looking for 2nd Opinion

[adgal]

Hi there.  I have a great OB that I am working with who is very optimistic, but I am still looking for a second opinion.  I have just turned 40 and my regular physical say's I am very healthy.  I have no children.  I have been pregnant 4 times since Nov. 2007.  The first pregnancy ended in miscarriage at 10 weeks.  I was given cypotec and wound up having an emergency D&C due to very severe hemoragging (my body was going in to shock).  2nd and 4th pregnancies were what my OB called chemical pregnancies....HCG levels never got much higher then a "positive".  3rd pregnancy was a missed m/c at 8 weeks, also ended in a D&C for heavy bleeding again from cypotec.  I have had extensive testing, blood work for everything possible (they also did blood work on my husband).  Testing on fetal tissue showed no chromosonal abnormalities at all.  Everything seems to be fine, with the exception of intrauterine fibroids.  After HSG and hysteroscopy, my OB decided it was best to leave the fibroids alone, she doesn't feel they are interfering with my pregnancies.  She has me on progesterone (3X100mg/day) starting right after ovulation, baby asprin and folic acid.  None of my tests showed anything abnormal, but she said it is precautionary, and can't hurt anything.  She has pretty much decided it is bad luck, and say's she is optomistic and to keep trying.  I want to do this, but am trying to also be realistic. I would love to know your thoughts on my situation...do you think this is primarily due to age?  Bad luck?  Do you also think I should keep trying?  I know that without full examination you can't give me a definitive answer, but based on history, do you think there is a chance for me?  Thank you so much for your answer, I appreciate any info you provide.  

[Elaine Brown, MD]

Hi!
I had my first child at 40 and my second third and fourth at 45.  So I recommend that you keep trying--motherhood is the absolute best thing in the world!

You are at risk for miscarriages because of your age, and at your age, miscarriages are probably a "good" thing, as they prevent the birth of a child with major birth defects.

Depending upon the location of the fibroids, you might get a difference of opinion about whether they should be removed.  If they are submucosal I might lean toward removal--there is a new "non-invasive"  technique involving MRI guided ultrasound ablation of firbroids which would not create a new risk of scar tissue around your tubes.

Another option to consider is IVF with PGD.  You would get many different opinions on this subject.  In Preimplantation Genetic Diagnosis, a cell is taken from each embryo, and only the genetically healthy ones are transferred back to the uterus--thus potentally increasing the chances of a continuing pregnancy. For a really good info site look at GOIVF.com  (Dr Zouves helped me conceive my triplets)

Your OB is correct about the aspirin/progesterone/and HSV.  I personally don't like progesterone until the preg test is positive, but that's a very minor point.  There is also some excellent data on accupuncture--that's the only thing I would add.

Go for it!
Dr B

[adgal]

Thank you so much for the words of encourgment.  You sound just like my OB, she had her first child at 41 after 4 m/c.  She is encouraging me to continue trying as well.  Thank you again, I really appreciate the info!

[adgal]

Sorry, I should also add that although I am in good health, I do have HPV.  My OB has assured me this is not a challenge in carrying full term, but best to give you all the information.  Thank you again.