We were able to get an apt. with the RE today to discuss his thoughts on my recurring miscarriages. As always, Dr. Vaughn did not disappoint. Did I mention I love this man? He keeps it simple, while also being very thorough and caring. I already knew he wouldn't be able to give a diagnosis of the situation with 100% certainty. Miscarriage has many gray areas.
Basically, he says that with miscarriage lost so early in a pregnancy, it is most times due to a genetic abnormality from either the egg or the sperm. Progesterone deficiency also happens to be a cause of early miscarriage, but since I was taking Prometrium during my luteal phase and during the pregnancy and levels measured fine, this is ruled out as a cause for the miscarriage. So chances are it was a genetic abnormality. Finding out which person the abnormality came from is somewhat impossible at this point, because the sperm and egg have already come and gone. The only real way someone can make sure they are getting pregnant (before even getting pregnant) with a sperm and egg that have NO genetic defects whatsoever, is to do IVF along with something called PGD or Preimplantation Genetic Diagnosing. This is where they test the genetic make-up of the embryo before inserting it back into the woman's uterus.
For most people who have gotten pregnant and miscarried even more than once, IVF with PGD still isn't the next step, because it's just so crazy expensive and invasive, and the chances are favorable that miscarriage won't happen again. Yeah, tell that to people who have miscarried 3 or more times! Nevertheless, we are definitely not considering IVF with PGD yet, especially considering it costs $18,000 to go that route. Dr. Vaughn certainly wasn't suggesting we do that, but was just explaining how genetic abnormalities happen and the ways in which they can be avoided.
So, what are the odds that this happened 2 out of 2 pregnancies with me? Well it isn't shocking due to the fact that my age is creeping up, my eggs are getting older, and the amount of eggs I have left is falling as well. I mean, I'm still just under the 35 year old mark for Advanced Maternal Age, but I'm not a 24 year old either. AMH or Anti-Mullerian Hormone is the hormone used to test for ovarian reserve, and although I knew mine was low (0.88) I never knew that I actually had the diagnosis of DOR or Diminished Ovarian Reserve. However, apparently I am considered DOR. You've got to be kidding me! Hmmm, that's a pretty important piece of information for my previous RE to leave out ya think?!
I'm not a huge expert on DOR. It is a fairly complex diagnosis, but from what I do know, it basically means that I have a lower than normal number of eggs left in my basket. Lowered egg quantity sometimes (not always) lends to a lowered egg quality, and thus another reason why it's more likely for older women with less ovarian reserve to produce eggs with genetic abnormalities. You following me here? Bear with me! The only real way to assess the quality of each individual egg is by retrieving the eggs from your body, as is done in IVF. And again, we are not there yet.
There are plenty of other reasons for miscarriage including chromosomal abnormalities in the parents themselves, autoimmune issues, clotting disorders, etc. Even still, my RE thinks it is unlikely that these would cause such early miscarriage, and still thinks that mine are due to genetic issues. However, just to be on the safe side, both hubby and I are having a complete chromosomal blood panel done. I will do an extra "recurring miscarriage panel" which will test for the autoimmune issues and clotting disorders. Should be interesting to see if our insurance covers this, as it is VERY expensive. I made sure it was coded for "recurring miscarriage" and nothing fertility related, but insurance companies like to fight people on getting these tests done, so we shall see! No matter what, it is worth it to us to have a definitive answer whether any of these things could be causing our issues, and we are happy to have it done.
As long as the blood tests come back normal and I'm able to have this miscarriage naturally with my hCG dropping to zero sometime soon, we should be on track to TTC again. We will be testing down my hCG to make sure it goes to zero, making sure there is no chance it was an ectopic pregnancy before proceeding with any further treatments. We will be able to begin again with Femara/IUI once the miscarriage actually happens, hCG returns to zero, and a new cycle starts...hopefully in January. The chromosomal testing and recurrent miscarriage workup takes about 3 weeks to get results anyways, so I feel we have a really good timeline in place to follow.
All in all we are happy that we are having further testing done to check for possible causes, but also happy to know that we still have a shot continuing with Femara and IUI. I do think it could just be a matter of a better egg and sperm hooking up. If at first you don't succeed try and try again! If only I could host a little party with free cocktails to coerce all the studly sperms and miss priss eggs to finally unite with their perfect healthy mates!![]()
Basically, he says that with miscarriage lost so early in a pregnancy, it is most times due to a genetic abnormality from either the egg or the sperm. Progesterone deficiency also happens to be a cause of early miscarriage, but since I was taking Prometrium during my luteal phase and during the pregnancy and levels measured fine, this is ruled out as a cause for the miscarriage. So chances are it was a genetic abnormality. Finding out which person the abnormality came from is somewhat impossible at this point, because the sperm and egg have already come and gone. The only real way someone can make sure they are getting pregnant (before even getting pregnant) with a sperm and egg that have NO genetic defects whatsoever, is to do IVF along with something called PGD or Preimplantation Genetic Diagnosing. This is where they test the genetic make-up of the embryo before inserting it back into the woman's uterus.
For most people who have gotten pregnant and miscarried even more than once, IVF with PGD still isn't the next step, because it's just so crazy expensive and invasive, and the chances are favorable that miscarriage won't happen again. Yeah, tell that to people who have miscarried 3 or more times! Nevertheless, we are definitely not considering IVF with PGD yet, especially considering it costs $18,000 to go that route. Dr. Vaughn certainly wasn't suggesting we do that, but was just explaining how genetic abnormalities happen and the ways in which they can be avoided.
So, what are the odds that this happened 2 out of 2 pregnancies with me? Well it isn't shocking due to the fact that my age is creeping up, my eggs are getting older, and the amount of eggs I have left is falling as well. I mean, I'm still just under the 35 year old mark for Advanced Maternal Age, but I'm not a 24 year old either. AMH or Anti-Mullerian Hormone is the hormone used to test for ovarian reserve, and although I knew mine was low (0.88) I never knew that I actually had the diagnosis of DOR or Diminished Ovarian Reserve. However, apparently I am considered DOR. You've got to be kidding me! Hmmm, that's a pretty important piece of information for my previous RE to leave out ya think?!
I'm not a huge expert on DOR. It is a fairly complex diagnosis, but from what I do know, it basically means that I have a lower than normal number of eggs left in my basket. Lowered egg quantity sometimes (not always) lends to a lowered egg quality, and thus another reason why it's more likely for older women with less ovarian reserve to produce eggs with genetic abnormalities. You following me here? Bear with me! The only real way to assess the quality of each individual egg is by retrieving the eggs from your body, as is done in IVF. And again, we are not there yet.
There are plenty of other reasons for miscarriage including chromosomal abnormalities in the parents themselves, autoimmune issues, clotting disorders, etc. Even still, my RE thinks it is unlikely that these would cause such early miscarriage, and still thinks that mine are due to genetic issues. However, just to be on the safe side, both hubby and I are having a complete chromosomal blood panel done. I will do an extra "recurring miscarriage panel" which will test for the autoimmune issues and clotting disorders. Should be interesting to see if our insurance covers this, as it is VERY expensive. I made sure it was coded for "recurring miscarriage" and nothing fertility related, but insurance companies like to fight people on getting these tests done, so we shall see! No matter what, it is worth it to us to have a definitive answer whether any of these things could be causing our issues, and we are happy to have it done.
As long as the blood tests come back normal and I'm able to have this miscarriage naturally with my hCG dropping to zero sometime soon, we should be on track to TTC again. We will be testing down my hCG to make sure it goes to zero, making sure there is no chance it was an ectopic pregnancy before proceeding with any further treatments. We will be able to begin again with Femara/IUI once the miscarriage actually happens, hCG returns to zero, and a new cycle starts...hopefully in January. The chromosomal testing and recurrent miscarriage workup takes about 3 weeks to get results anyways, so I feel we have a really good timeline in place to follow.
All in all we are happy that we are having further testing done to check for possible causes, but also happy to know that we still have a shot continuing with Femara and IUI. I do think it could just be a matter of a better egg and sperm hooking up. If at first you don't succeed try and try again! If only I could host a little party with free cocktails to coerce all the studly sperms and miss priss eggs to finally unite with their perfect healthy mates!
