I Told You So

For the uninitiated, hcg is a hormone created in early pregnancy. While the starting number isn’t too important (although there’s some solid research suggesting that the value at 14 DPO is predictive of outcomes), the speed with which the number goes up is critical. A viable pregnancy will see hcg double roughly every 24-60 hours, with a 48 hour doubling time being expected. My 12 DPO beta was 14. My 14 DPO hcg was 14. Saying ‘I told you so’ is rarely as rewarding as you hope. This time is no exception.

So, we’re on to miscarriage #3.  During the call with the office, I did a few things: asked to find out which doctor would be a better fit for me (answer: Dr. J), paid the bill from my d&c (high deductible health plan deductible met for the year now), and booked my saline sonohysterogram for May 6. I should know at that time if there’s anything structural causing these losses. I had a hysteroscopy years ago to remove a traveling IUD, so I know there’s no septum or other permanent structural issues. I could have a polyp or other adhesion that’s grown since Jan ’13, though, which might explain the issues. The sonohysterogram will determine if that’s the case.

To give a  quick summary of how a saline sonohysterogram works, the goal is to get a good picture of the inside of the uterus. Despite all the medical diagrams that you see in school growing up, the uterus doesn’t actually have an open space in the middle during normal life. While there is space there, the tissue presses up against itself. Thus, to be able to see clearly, a small catheter is threaded through the cervix and the uterus is filled with sterile saline. Following that, an ultrasound is conducted. At my clinic I’ve been told that the sonographer will do about 30 minutes of prep work, then the doctor will come in to perform the ultrasound and remove anything she sees. I’m to take 800 mg of ibuprofen before the procedure and arrive with a full bladder. Sounds like fun, right?

The other thing I plan to cover during that appointment is a question about my luteal phase. Research indicates that most blastocysts implant between 7 and 9 DPO. Once implantation happens, hcg begins to be produced in detectible qualities, and that hcg helps to prevent your period from starting. Thus, it’s important that your period not start early (14 DPO is the norm). In my case, the few periods I’ve had recently have started on 10 DPO. My progesterone this cycle was 14 at 12 DPO, so perhaps it isn’t a problem, but I want to delve into it further after 3 losses, so I understand better what’s happening.

Doing what PhD's do: Researching shit

As noted earlier, I’m a pretty logical person. I have a PhD, and I know my way around a good journal article. I can differentiate between a well run study and the crap that is produced by people with vested interests. Further, I genuinely enjoy reading research articles (horrifying confession, I know!). Thus, it was a no-brainer for me to start doing reading on the topic of repeat pregnancy loss. I have full access to MedLine through my job, so I did quite a bit of digging. I found many good peer-reviewed research studies on related topics. As a result, I decided to make several changes: I started taking 1000 mg of DHA, 200 mg of Ubiquinol, and 3mg of Melatonin each day. That was in addition to my normal prenatal.

As always, I used opks again in late March and early April, and although I had some mid-cycle spotting around CD12, I the opks started to darken at CD16. We had good timing again. I told myself that no one gets pregnant three cycles in a row. Normal chances are around 25% per cycle. I told myself not to get my hopes up, and to remember that an April pregnancy would mean a December birth, which would be suboptimal here in the frozen tundra of MN.

I told myself a lot of things, but I guess it didn’t matter because my period didn’t show up on day 10. Or 11, or 12. A faint line DID show up on day 11, and it stayed faint on day 12, so I went in for hcg and progesterone. Values – hcg: 14, progesterone: 14. Verdict, return in two days for repeat testing. Meanwhile the home tests are staying uber-light, so I can already tell what the call will be when it comes: “I’m sorry. . . “

If nothing else, at least I’m consistent, right?

What Comes Next?

Let me preface this by saying that I’m a highly logical person. When confronted with a problem, I focus on finding a rational solution, not addressing the emotional aspects. In fact, my reaction to stress is to start making lists of what needs to be accomplished and getting hyper-focused on resolving the issues that are creating the stress.

In light of that, it’s not surprising that I pushed my doctor to start with RPL testing. I should note here that “my doctor” is a bit inaccurate. My original OB, Dr. P, was perfect for me. She was also logical, research-focused, and pretty aggressive in her treatment approach. When we met, she gave me statistics, treatment options, and addressed my concerns about being AMA. Unfortunately she left the practice group between miscarriage #1 and miscarriage #2. She hadn’t been available the day of the d&c, so another doctor, Dr. A, had performed it. I was therefore, by default, assigned to be Dr. A’s patient. Dr. A is a nice, caring, emotionally focused person. He’s also a wait-and-see person. I am not. I am a “test the shit out of this and treat it ASAP!” type of person. Thus, I had to push him for the RPL testing. After reminding him I was 36, had a history of irregular menstruation and thyroid problems, and had now suffered back to back losses, he agreed to order a blood panel and saline sonogram to look for structural issues.

When I went for the bloodwork, I discovered he hadn’t ordered the TSH (thyroid) test, even though I’d had radiation treatment for my thyroid years ago. When I asked, the nurse informed me that thyroid function is unrelated to miscarriage, which is completely untrue. I pressed for the test anyhow, and she agreed. I couldn’t schedule the sonogram right away because it needed to occur between days 6 and 12 of my cycle, and I wasn’t entirely sure when that would be.

To my surprise, the blood work all came back within normal parameters. My TSH was 2.43, which just missed the treatment cutoff of below 2.5, but was reasonable. Dr. A told me I could take low dose aspirin just in case I had a clotting disorder they’d missed, and also told me to come in to have hcg and progesterone tested as soon as I got another bfp at home. With my short luteal phase, progesterone seemed to be a reasonable explanation for my issues. Next up was to be the sonogram, scheduled after a business trip I had to take out of state.

Well, Hello There!

Hi there. My journey started in October ’15, when I had my IUD removed, just days after my 36th birthday. I remember my OB’s words: “Congratulations, you’re fertile!” Having been on birth control that prevented menstruation for nearly 15 years, I wasn’t sure what would happen next, but I knew my periods during high school and college were infrequent and light. I figured “fertile” might have been a bit of an overstatement, but we agreed that I’d wait 6 weeks for a period and call in for Provera if none arrived. I truly expected that the husband and I would spend 6 months trying to conceive through irregular cycles before starting fertility treatments in April 2016. I was the girl who’d gone 12 months without a period as a healthy 18 year old, so there was no expectation in my mind that 36 year old me could get pregnant, or probably even menstruate, without help.

To my utter shock, two weeks later I had a super light period, and 13 days after that, the opks I’d bought from Amazon showed an LH surge was approaching. Of course, life interrupted when my job was eliminated that day due to corporate restructuring. Nothing puts you in the mood to get pregnant quite as much as suddenly being unemployed, so that month our timing wasn’t great. Ten days after I ovulated, AF arrived, and by that time I had secured a new job and we were ready to try again.

Month two worked out better. Once again, the opks showed a surge starting on day 13 and peaking on day 15. Our timing was perfect. My online tracking software gave us a ‘high’ score, but hey, I’m 36, so I wasn’t expecting much. Still, day 10 post ovulation (DPO) came and no period arrived. Day 11 came, still no period. Since DH had to leave town for a week at 5 am on day 12, I decided to get a FRER and test that night. Within the 3 minutes, a second line showed up. Cue a straight-out-of-the-movies scene of DH picking me up and hugging me. We were ecstatic. The due date was our 10th wedding anniversary. It seemed like a sign and couldn’t have been more perfect.

Days passed and the lines got darker on the home pregnancy tests. I scheduled a first ultrasound, but due to DH’s travel schedule, it wasn’t until 9.5 weeks. I spent the time with mild nausea, the worst cramps of my life, and a few other nasty side effects, but otherwise all was well. Except that it wasn’t, because the ultrasound revealed a blighted ovum. Development had stopped weeks ago and my body hadn’t figured it out. I opted to have a d&c at 10 weeks in January. It was one of the roughest experiences, emotionally, I’ve ever had.

My doctor told me as long as we were emotionally ready, we were cleared to try again as soon as I’d had a period. It took a full 6 weeks for my hcg to hit zero and AF to start, but it did in late February. While March’s cycle had a longer follicular phase than normal, I got a strong positive on an opk roughly day 17, and our timing was once again good. Twelve days later, when my period still hadn’t arrived, I tested and got a faint line. The lines stayed faint, and when I went to the doctor for a beta around 17 DPO, it was 8. “Chemical pregnancy” they told me. I had therefore joined the 1%. That is, the 1% of women who experience repeat pregnancy loss.