Evaluation of RPL

Taken from ivfauthority.com

Diagnosing the Cause of RPLEstablishing the correct diagnosis is the first step in determining effective treatment for couples with recurrent pregnancy loss. RPL results from a problem within the pregnancy itself or within the uterine environment where the pregnancy implants and grows. Diagnostic tests useful in identifying individuals at greater risk for a problem within the pregnancy itself include:

1. Chromosome analysis done on both prospective parents
2. Chromosome analysis results from previous pregnancy losses and from both parents
3. Ultrasound examination of the uterine cavity after sterile water is injected or hysterosonography (saline ultrasound, sonohysterogram, fluid ultrasound, ultrasound)
4. Dye X-ray test of the uterus and fallopian tubes or hysterosalpingography
5. Hysteroscopic evaluation of the uterine cavity
6. Evaluation of hormonal response of the uterine lining
7. Immunologic testing useful in the diagnosis and management of recurrent pregnancy loss in affected couples. Such tests include: a)Antiphospholipid antibody (APA) panel; b) antinuclear antibody (ANA) panel; c)Antithyroid antibody panel (i.e. antithyroglobulin and antimicrosomal antibodies); d) Reproductive immunophenotype; e) Natural killer cell activity (NKa) using the the K562 target cell test.
8. Alloimmune testing of both the male and female partners (DQ alpha and HLA)
9. Thrombophila Panel

Ignorance???

People can say the dumbest things.  I told one of my good GFs about my recent m/c.  Her initial comment was "its just not your time".  Really??? What does that mean?  Was it your time when you were pregnant and had an abortion? Or maybe it was your time when you decided to have your unplanned children because you did not want to have any more abortions.  It's easy for those that can "choose" their time to say stuff like that.  Or even with ART, and ppl say...well it wasn't meant to be, and the process is unnatural.  Was it meant for Jeffrey Dommer to be born so he can be a psychopath?  What about the children who are abused and raped, and cut up, and placed in the freezer, or the crack heads that repeatedly have babies, or the overcrowded foster care/jail system...What was their purpose?  Was  that destined by God?  Get the phuck outta here with that bull-ish....

OB/RE phone call

So got a call from my OB yesterday to review my recent lab results.  I asked her about the mofo but she wasn't too concerned. She said research is inconclusive...

Then spoke to the RE RN, who asked the RE who also said he wasn't too concerned, but would rather look at my homocysteine levels. 

To me inconclusive means..no yay or nay...so why not err on the yay (cautious side) vs the nay.  I have been doing tons of online research (what else is there to do) and have found that erring on the yay side is better than not.  Primarily because even if my homocysteine is normal and I still can't break down folic acid, I would hate to carry and have a late term loss or a child with spina bifida.  The goal is not only to get pregnant but to stay pregnant and then have a healthy child.

Based on my research, i'll be adding neevo to my regimen.  I had my OB call it it, its $50 fricking dollars, OMG..but I waste that monthly and this is for a good cause...so i'll do what I have to do.  I'm still researching how much folate I should take, I"ve seen 400mcg to 5gm...The neevo only has 400mcg which is about 4mg. I think i'll shoot for about 1-2mg starting in january.  Since its water soluble, the excess will excrete in the urine.

I'm still on the fence about the baby aspirin.  It is a category D (YIKES) meaning documented human fetal risk...especially in 3rd trimester.  Low dose ASA is relatively safe...hmmm

Girls POW WOW!!!

I had dinner with two of my "journey to motherhood" friends last night.  Its "funny" because we started getting together about one year ago just to get out and have a girls night about once a month or so just to rant and rave about life.  We soon started talking about having children, each of us with our own individual timeline. Gigi started out her process first. She has a history of endometriosis, so that has its own ups and downs, then Kiki started on her own journey, then me.  Sometimes I wonder if we all waited too long.  I mean, we did what we were 'suppose' to do, finish school, get a career and then a stable home, and THEN the kids...So why are we here?

I pray, actually I know that 2012 is "OUR" year.  That is the vibe that I am putting out into the universe.  But in the meantime, at least we have someone to support, who understands, as we go through this process.

Ain't this a...

Motherfucker....yup...I have the MTHFR A1268C mutation.  Not really sure how to feel about this. Meaning I guess its better than having unexplained (in)fertility or it being caused my something else that would be more difficult to control. I must say that, out of all the tests that the OB had me take, this was not the test I expected to come up positive. I thought this was a white person's disease, after all black people only get sickle cell.... right???.

 The good news is that I have only one copy of it, and it's the least serious kind.  The soso news is that the mutation is fairly common, and the research is inconclusive as to its effects on m/c but the indication is that if it does cause m/c, its due to the inability of the body to metabolize folate into its useable form which can cause spina bifida etc, but in early pregnany, more with clotting issues.  The better news is that if this is the cause, then its easily fixable with increased folate, B6, B12, and a baby ASA (or lovenox/heparin). 

SO....one possible cause identified...still have the rest of my rpl w/u next month when AF comes..so we'll see..

SOME FACTS per http://www.pregnancy-info.net/mthfr.html

What is MTHFR?
Methylenetetrahydrofolate reductase (MTHFR) is the name of a gene that produces an enzyme, also called methylenetetrahydrofolate reductase. If a person carries the genetic mutation that inhibits production of this enzyme, it can result in hyperhomocytenemia, which is an elevated level of an enzyme called homocysteine found in blood plasma.
When the body is deficient in methylenetetrahydrofolate reductase, its ability to absorb folate (also known as vitamin B9), such as folic acid, is inhibited. Folic acid and B9 are both essential to the development and health of the fetus.

MTHFR and Pregnancy
Because of a mother with MTHFR’s inability to efficiently metabolize folic acid and vitamin B9, the disorder has been linked to a variety of pregnancy complications such as chromosomal abnormalities, such as Down syndrome, and congenital malformations.
Elevated levels of homocysteine have been associated with placental disease, preeclampsia and recurrent pregnancy loss. 21% of women with high levels of homocysteine experience recurrent pregnancy loss.

Cytotec take 2!

so I have to accept that I am having another miscarriage, fricking GREAT. Not only can't I carry a child, I can't even miscarry properly. Again, I either wait to expel naturally, take meds, or d & c. D&C was out of the question, and we know this nugget is comfy, so cytotec it is. I waited until my RE appt (more on this later) before taking the pill. I was hoping he would give me some other news, maybe to say, oh your baby is just lazy, but s/he'll come around but nope, miscarriage it was.

I so did not want to do this again...after last time, I just couldn't imagine having to go through this pain again. On December 6th, I decided to go for it. This time I was prepared. I was prepared for war. I had my Motrin and percocets ready. I took them about 30min in advance and took the pills about 12:30. DH and I were ready for war. 2 hours later, NOTHINg...I even fell asleep. I had some cramping and chills during the night but I was able to sleep through it. I woke up at 6am to go to the bathroom and had a gush of "blood/clots"' then went back to sleep. The next day wasn't too bad, some mild cramping, 2 days later more cramping, but tolerable, and I think I passed the sac today. Thank you Jesus. This means I don't have to take the pills again AND no d&c..yessss!!!

High betas, but not quite..

First beta value was 31,080 on 11/21/11, 2nd was 30,719 on 11/23/11,  one week later 38,798 on 11/29/11, then 41,720 on 12/2/2011....WTF???....Slowly rising but no where near doubling.

Why are these numbers playing with my emotions? After my 2nd beta, I cried like never before. How cruel can life be? This week I celebrate 2 losses, the loss of my first child since I am suppose to deliver this week, and now an impending miscarriage. I went home on thanksgiving and had to break the news to my mother. She tried to be hopeful and even prayed over my belly. I hoped that she had a better connection to God because it was clear that we weren't that cool. I came home and also prayed over my belly, every night and every morning.

Had another US on december 2nd, and nothing but an irregularly shaped yolk sac and fetal pole at 8 weeks, measuring 6.4weeks with no heartbeat. DAMN!!!!!!

BFN after BFN

After my mmc, I was determined to get pregnant again. I read , I temped, I timed, took mucinex, epo, whatever I read that worked. After 4 months of that, I was tired, frustrated, sex became a chore. Decided to get rid of my thermometer, but I couldn't get rid of my opks. I was just tired and wanted a quick fix. After all, how hard can this baby making be, people do it all the time. I resolved to going to see an RE, get IVF and voila, come out with twins. So I planned, something I was very good at. I made a PCP appt to get a referral. I wanted to be on my way by January.

October 2011 was a really stressful month. DH and I were at a crossroads, I had to re-take a board exam to continue being certified, ie...keep employment. TTC was almost the last thing on my mind. By God's grace, I made it through October.

On October 31st I found out that I passed my test...yippeeee!

On november 1st I got a BFP, how could this be? There was no timed sex, there was no preseed, there was nothing. I was happy and grateful for another opportunity. I decided not to stress about it this time. I will enjoy it. I didn't even want to see an OB until at least 8 weeks.

This time had to be it...right?? It was November, I should have been 36 weeks with my first nugget, but instead I'm blessed with a second opportunity. Who said God wasn't good.

I went to the Bahamas for about a week. One night I saw some blood on toilet paper. I prayed and prayed like I never have before, for this not to be happening again. No blood seen after 24 hours, and from then, I decided to leave it to God.

I came home, made an appt for 7 weeks on November 21st. It was going to be a really wonderful
Thanksgiving or a really sad one.

We set up for an US, and there was only a yolk sac. How could this be? I was not bleeding. How can this be happening to me AGAIN. DH and the OB were trying to be hopeful, and although I also tried, I knew deep in my heart that it was over.

But I decided to hold onto faith instead.

The beginning?

I decided to start this blog to journal my journey into motherhood. I am not claiming infertility but more awaiting a time to perfection. I named this blog based on a claim to victory. I am claiming victory to "this". And I plan to be a success story for others to follow.

So here is my story:
I have always wanted to be a mother. I wanted it all. The white picket fence, home, 2.5 kids, a good career, all of it. And although I almost had it all, life just cannot be that perfect. I found out I was pregnant in march 2011, and although I was nervous as hell, I was soo happy. About one week later, I started spotting. Went to see my OB but I just couldn't help feeling that this wasn't going to make it. I even saw a heartbeat at 6.2 weeks, but a week later, the weekend after Easter, there was no heartbeat. Just like that, my baby was gone. I cried, boy did I cry. I later learned that an old college housemate had lost her 7 year old son. Wow..to lose a child after 7 years was just unimaginable. It helped me to pull myself from my bootstraps and get it together. 7 weeks was nothing compared to 7 years. I thank God it wasn't at 7months.

I went through the painstaking choice of taking cytotec. A part of me felt that I was aborting my child although my mind knew that it was already gone. I took the pill, more so because I didn't want to risk losing my womb over my already lost child. I took the 4pills vaginally on April 4th 2011 @11:30 pm and oh boy. I felt like death 2 hours later. I had chills, excruciating cramps, diarrhea and vomiting and Motrin WAS not helping. I finally slept my way through the pain. Next morning, no baby, so had to take it again. Monday morning nothing but I was in soo much pain.

Saw my ob on Monday, and discusses a d & c, something I didn't want but the pain was so bad that I wanted to get this thing out of me. I got some narcotics and decided to give it another day. I slept like a baby, that stuff works. Next morning, plopp just like that, fetus was out. I felt such a sense of relief that I could no longer grieve.