4th Miscarriage- Normal fetal karyotype...(loss mentioned)

(13 posts)(4 voices)
  1. Hi All,

    I have been thru my 4th miscarriage in a row. Im 29yrs old and this journey to have our own baby has been truly brutal.
    The first 2 m/cs were not tested and we did not have a proper embryo. They were sort of blighted ovum pregnancies. Then we started seeing a RE and she ran prelimanary tests and nuthing came up. So she started me on prometrium 100mg BID(total of 200mg/day) from 7dpo(CD-27 in my case as I ovulate late) and baby aspirin. I got pregnant naturally on the first try and we saw the heartbeat at 6.5 weeks and lost it when we went for our follow-up sonogram at 7.5 weeks. Had a D&C and got the fetal tissue karyotyped. We found that we actually would have had a normal boy( 46XY) chromosomes.
    Fast forward to after the 3rd miscarriage, we saw another RE at shadygrove, MD for further evaluation and he recomended that we up the promterium to 200mg X 2 times a day and start the promterium 3dpo instead of 7dpo and stay on the baby aspirin. Also we met with a leading perinatologist and he recomended that we add lovenox-80mg once per day to the mix of meds. So we once again got pregnant on our own and the peri started the lovenox about 18dpo but had me take 40mg untill 7.5 weeks when we saw 2 very strong heartbeats of identical twins. We knew very early on that we are having identical twins coz we were being closely monitored by the RE right from 13dpo when we got a positive HPT. So from 7.5 week onwards I was on 80mg of lovenox once a day. I had severe nausea and was vommiting like crazy so I was also on zofram from the 7th week onwards. Once again at our 9 week sonogram we saw 2 very strong beating hearts( 167bpm & 170 bpm) and we found out that we are having monochorionic-diamniotic identicals(coz we found the diving membrane) and we were relieved. Then at our NT scan apt at 12w2d we were devasted beyond belief to find that we lost both our twins ( They stopped growing on the very same day(i.e., 11w) so we were once again scheduled for a D&C. Our peri gave us the same **** that it would most likely be a chromosomal issue , lets wait for the fetal karyotyping result and go from there. Just yesterday we recieved the result and as I had predicted to my peri they turned out to be very healthy & normal babies. We found out they were boys(46XY) ...It was so so sad to know that 2 more normal babies got wasted for no reason whatsoever inspite of us doing whatever was in our hands and being compliant.
    I have been thru the thrombophillic panel tests which included all the factor leidens, protein S & C , anti-thyroid , ANA and anti cardiolipin antibodies. Every single thing has come back to be normal including DH & my own karyotyping result. My peri had put me on the lovenox coz he said it does not hurt/maybe I have some clotting disorder that has not yet been studied. But all of this did not work. Now the only thing I have not delved into is Immune testing. I have not had my APA or the other immune related stuff tested yet and was wondering if that would help. I recently had my ANA tested and I was on baby aspirin and fish oil at the time. The ANA came borderline like th upper normal limit was 99 and mine was 100 so my RE said lets just ignore that coz 100 is most likely normal. I mean im beginning to wonder would my ANA be higher if i was NOT on the BABY ASPIRIN at the time and so should I repeat it. Should I seek the immune testing or what should I do. I really do not mind trying the immune testing but is it worth it? Has anybody had a success story after going thru something like this?
    All of this is absolutely soul destroying and frustrating not knowing what is going on when all of my test results are normal as well all my angels lost in the process have also been normal.
    Any information or personal experience is more than welcome and I'll be grateful for all the info shared.

  2. Hello Waiting,

    I am so sorry you are going through all this. I can really understand your pain- I had 3 miscarriages in succession- first one at 6.5 weeks, second at 10.5 weeks (after nice strong heartbeat-twice) and third one at 12 weeks (after multiple u/s with strong heartbeats). There was a chromosomal issue for #2 and #3, but not #1.

    I just want to make SURE that you have had your prolactin level checked. I had a ton of miscarriage bloodwork done, but they never checked my prolactin...and then finally when they did, it turned out to be sky-high, and we found out that I had a small, non-cancerous tumor (called a prolactinoma) on my pituitary gland. I was put on medication to stop the growth and the secretion of the hormone. My neuro-endrocrinologist believes that it definitely was messing with my ovulation (which was always late around day 21 or 22) and with my egg quality. I was doing prometrium after ovulating, too, but since the egg quality was compromised, the prometrium was not really addressing the problem. Is your luteal phase short, or even borderline (around 10-11 days or less)? This can also be a sign of a prolactin imbalance.

    Just so you know, my husband and I ended up going straight to IVF, even though we had conceived #1 and #2 naturally. We just felt that if all my hormone levels could be monitored and controlled precisely, it might make a difference. I did miscarry on my first IVF cycle, which was incredibly tough. But, we went for one more round, and chose to put back three embryos, even though I am only 33, and they don't usually do more than 2 for women under 35. We just figured that with our miscarriage history, we wanted to be more aggressive. After three years of recurrent miscarriage hell, I am now 23 weeks along with boy/girl twins...and I really think that controlling the prolactin level made the difference!

    Recurrent miscarriage is the cruelest, most painful thing I have ever experienced, and it breaks my heart to know that someone else is going through it. Please try to keep the faith- I really hope that you will get some answers as you heal from your most recent loss.


  3. Hi Tabet,

    Thanks so much for understanding the m/c hell. Its truly crazy and Im so frustrated coz everything comes back normal. My prolactin has been checked on 2-3 ocassions coz only once - the month I got pregnant during ovulation I had some breast discharge for 2 days around ovulation so again my PRL was checked around ovulation and it came back in the normal range. So they did the entire thyroid and all those bloods related to it and it was normal.
    So Im at a loss whats wrong and we are back to square one.

  4. I am so sorry for all of your losses, how awful! Did you ever have a hysteroscopy done, sometimes things are missed with the hysterosalpingograms/saline sonos...
    Good luck!

    No I have not yet got a hysteroscopy done but Im going to talk to my doctor about it. I have an upcoming phone consult with Dr.Sher from SIRM so I'l ask him about it.
    Have you been thru m/cs too?

  6. Hi KALLIOPI,No I have not yet got a hysteroscopy done but Im going to talk to my doctor about it. I have an upcoming phone consult with Dr.Sher from SIRM so I'l ask him about it.Have you been thru m/cs too?

    Yes, I have been through several pg losses, all the result of IVF. IVF#1 resulted in a blighted ovum (D&C done, karyotype showed 46 XY, no real reason why the embryo didn't develp properly). IVF#3 resulted in a pg that was lost at 20 weeks, karyotype was normal as per amniocentesis (the baby had a major abnormality). IVF#4 & 5 were biochemicals. IVF#6 was, thankfully, succesful (I did lose one the babies, after heart beat was detected). In my case no real reason was found as to why this was happening....
    For IVF#5 & 6 I did use Lovenox (blood thinner) even though I only came up positive for one gene of the PAI-1 (according to most specialists its not reason enough to be on blood thinners), though, at that point I didn't care and I pushed for it--not sure if it really made a differance, but at least I felt that I was doing everythign I could do. I also read that some people have clotting disorders but there is no test currently to detect it.

    As for immune testing, I never did it-I was afraid of being told that I need IVIG. I didn't like the idea of pouring in a blood product into me for something that by most specialists is considered a "grey area," as well as, the cost was very steep (and I heard that most people need severl infusions at several thousand dollars each time)!

    I also had a hysteroscopy done prior to IVF#4 and a large polyp was removed--I think that having something in the uterus definately reduces the chances of implantation and/or increases the risk of a pg loss. Yeah, I am glad that you will ask about the hysterscopy, IMO, get it done-no harm if all looks well in there!

    Sorry, I hope I didn't depress you or overwhelm you (thats why I hesistated posting all this originally, but since you asked about my history....). I want to wish you lots of good luck! Hang in there, I hope things will work out for you.


  7. Hi Lotus,

    You did not depress me in any way. I guess Im past that stage and willing to try anything that would work and help me succeed.I really appreciate you sharing your history, diagnosis and treatment with me. Were you also on baby aspirin? My peri gave me the same argument abt being in lovenox, he said maybe they havent discovered the clotting factor you have so far and it wont hurt. What was your dosage of lovenox during the 5th & 6th pregnancy and how often did you take the shots - once or twice a day?
    Also who was your ob-gyn & RE during the entire process?

  8. No, I was not on aspirin. I felt that Lovenox was enough. I was on 40mg once a day--preventative dose (some people with full blown or multiple clotting disorders take that dose TWICE a day, in addition to aspirin). I also liked that Lovenox doesn't cross the placenta (like aspirin does).
    Where are you? I saw two hematologists, one in NJ and one in NYC. The first drew ninetieen vials of blood, so be prepared for that! My perinatalogist was Dr. Kallish in NY Presbyterian hospital. If you are near me, I can give you more info about these doctors.

    I live in Northrn Virginia and have been tested for the thrombophillia panel and protein C & S- all came back normal so my peri put me on a preventative dose of 40mg. But when we found out it is identical twins they upped my dose to 80mg with the baby aspirin.
    It was my first try with the lovenox during the 4th pregnancy. When did you start your lovenox with the unsuccessfull & successfull pregnancy? I started it after a +ve pregnancy test. My perinatologist here in northern VA feels I still have a good chance of a successfull pregnancy with a slightly higher dose of lovenox. Ive tested -ve for the entire thrombophillia panel, mthfr,etc. But this 4th pregnancy went so far along and was perfectly healthy in terms of growth of the babies and cardiac activity so Im guessing the lovenox was definately helping me in someway. During my 3rd pregnancy I was only on baby asprin and even that pregnancy went as far as 7.5 weeks with a proper fetus with a heartbeat. The 1st & 2nd pregnancy we did not even see a proper embryo or heartbeat so the aspirin helped a bit and lovenox helped much more. My peri thinks we were already high risk and the identical twins made our case even riskier with the higher mortality in Identical twins.

  10. I have started the lovenox, both times, the day after retrieval (so as not to worsen post-op bleeding). I did hear too that identicals are a higher risk category, being that there can be twin to twin transfusions early on... Ugh, I am so sorry for what you are going through! I do remember reading, or hearing somewhere, that most women with recurrent pg losses (even unexplained) eventually do end up with a live birth-I hope that will be the case for you. Hang in there...

  11. Hi Waiting,

    I just wanted to second Lotus about the hysteroscopy. I actually had two done (after my 2nd and 3rd m/c's)...RE did not want to do IVF until they had checked my uterus, especially since I had D&C's for the m/cs. All was fine both times, but RE said that sometimes when there are multiple m/c's, scar tissue could be a factor in subsequent m/cs. Also, there could be a uterine anomaly like a septum that is affecting things, and they can't always tell that from u/s...they need to get in there with a camera. A friend of mine had six miscarriages before having a hysteroscopy, where they found that she had a septate uterus. Once the septum was removed, she was able to carry a baby to term.

    Also, have you read Coming to Term by Jon Cohen? I found it really helpful in dealing with multiple losses...

    Hang in there!

  12. Hi Paula,

    I will definately ask about the hysteroscopy in my upcoming consult. Also at what stages did your friend miscarry due to the septum coz Ive heard of 2nd trimester m/c's due to a septate uterus but I might be wrong. Once I had asked me RE about a hysteroscopy when me & DH were on the verge of going straight to IVF but my RE said with a absolute normal HSG we generally do not do a hysteroscopy as it carries its own risk of scarring due to instruments in the uterus. But I have noticed that after so many D&Cs I have a much lighter AF every month even thought I have all the same cramps,etc so Im not sure if it means anything.
    I am currently reading the book called Preventing Miscarriage bu Dr.Scher.So what kind of medications were you on for this pregnancy? Goodluck and God bless this pregnancy.

  13. I am so sorry for your losses. I can imagine your pain. I'm 9w pg at the age of 42 and was told last week by my peri that this was not a good pg, I will most likley be losing this one.

    You have age on your side. I don't. So I'm not sure if you would be willing to consider this but if this pg fails, I plan to fly out to CCRM in Colorado because I hear they are the best in the country for getting women pg who have had mulitple miscarriages before. You send in your paperwork, schedule a 30 min phone consult if you are out of state, fly out for your one day of complete testing. Then you stay on meds while right here in VA (I live in northern VA also). Then you fly out for a week for ER and ET.

    Dr. Schoolcraft is apparently the best in figuring out why certain women miscarry.

    I wish you the best of luck. You seem to be able to get pg easily but have trouble keeping them past first trimester. Hang in there and don't give up. I am sure you will one day be able to have a successful pg as soon as you can find someone knowledgetable enough to evaluate your case well. It doesn't sound like anyone in the past has been able to figure out what's causing the fetuses to miscarry, but once this is figured out you should be well able to have a baby I should think.

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