Options after three miscarriages

[kristine625]

Hi there,  I am very confused about what to do after three miscarriages, all in first trimester.  I am 39 years old.  After two miscarriages, I went to an RE.  He did every blood test even the ink dye on the uterus, everything normal.  I have regular periods (28 days), ovulate on my own, and we get pregnant right away (first or second try).  He decided to put me on progesterone suppositories and baby aspirin (along with pre-natal vitamins, 2mg folic acid in addition to vitamins and 50mg of thyroid meds - not to prevent miscarriage, but due to some blood work results).

I am miscarrying for the third time right now.  Probably a blighted ovum.  The first two were not blighted ovum, we don't know the cause really.  Didn't test the tissue from the first miscarriage because my OBGYN said it was probably a fluke.  Second miscarriage, I started bleeding right when my period was due.

Since I ovulate on my own, that tells me I do not need to do HCG shots or clomid... or am I wrong about that?  What would shots or clomid (or similar medicine) accomplish?   How about IUI?  I thought those things were for women who can't get pregnant.  We can. We just can't keep it.

This last pregnancy I had my LH surge on day 11.  Is that early?  Would medicine to "time out" the ovulation be better so the eggs have more time to mature before release??

Thanks for any thoughts on this.  I really appreciate it.

[Elaine Brown, MD]

HI!
I'm sorry for your losses! That must be really disheartening!
There's not much of anything that can be done about a blighted ovum, unfortunately.
Its wonderful news that you are so fertile.  If I were you, I would do NOTHING to mess up what mother nature is doing so well--your ability to conceive.

As you put it, the problem is AFTER that.  I think your next step is to visit with a perinatologist and genetic counselor.  Baby aspirin and progesterone are both good adjuncts, some doctors might even consider a blood thinner like lovenox or heparin.

Your husband may wish to consider Sperm DNA fragmentation analysis--ask your re about that one.  You may wish to be tested for unusual problems like ureaplasma and antiphosopholipid antibodies.

A perinatologist's input might be helpful, as they might have more insight about what to do once you are ALREADY pregnant, a genetic counselor could help you decide if there is anything unusual in the family that you should test for.

I hope this is helpful.
Best Wishes!
Dr B

[kristine625]

Hello again,   I just received the tissue test results from the d&c and it showed normal female.  The results said:

Level of resolution:   400 to 500
Number of cells counted:  21
Number of cells analyzed:  5
Number of cells karyotyped:  2
Karyotype:  46,XX

I understand that this is inconclusive because we do not know if it was my cells that contaminated, or if it was in fact products of conception.

Could I just be in this really huge "mystery" category for why these recurring miscarriages are happening???

I have asked my RE about sperm testing and he didn't seem to think that would tell us anything, as it shows sperm motility and count.  And since I get pregnant so easily on my own, we know that those are not issues.  Should I press him on this?

He already tested for antiphosopholipid and it came back normal (or negative).  And as I mentioned, he did all the other blood work prior to this third failed preg including the ink dye test and karyotyping on my husband and me.

Thanks for your help.

[kristine625]

Thank you so much for responding.  I really appreciate it.  I am meeting with my RE tomorrow (our final us and probably schedule the d&c).  I will write down what you suggested and see what he has to say.

Thanks again.  Take care.