Advice please

Hi Ladies,

I'm hoping you lovely ladies could help navigate some questions for me, as I feel like a complete newbie with no clue.

I conceived naturally and miscarried in December. It was my first pregnancy ever, and we had been trying for close to a year (probably really tried for 8-9 months as DH travels for work so sometimes his travels were completely against us). I'm 35 --- almost 36. I guess ultimately, that is my biggest issue/concern.

After testing the tissue/fetus, my Dr. said there was no chromosomal abnormality - which means, no explainable reason I miscarried (we had even seen a HB at our first sono and 2 weeks later, it was gone) - the miscarriage simply happened.

Here's my question--- I asked my doctor what next steps are. He said, simply to try again OR if I wanted, I could have a blood work up done (I guess an extensive one because he said he would need to send me out and would need a heads up to prepare the paperwork). However, he also said that if I go that route, we have to deal with the results (according to him, i.e. if i have clotting issues, I can't go on pill ever again etc.--- not terribly concerned about that though, lol).

The Dr. noted that most drs. don't order bloodwork until at least 2 miscarriages....but I guess because of my age, and given that we kNOW it wasn't chromosomal, he wouldn't say no.

So, my questions are this--- what kind of things would a first blood work up show (I am totally clueless as to this process - no idea)--

is this something that should be done by my OB or should I see somebody else. If somebody else, would somebody else even see me after 1 miscarriage?

Am I silly for worrying since its "only" been one miscarriage, or would you start the process just so I am not doing this months down the line in the event I miscarry again and then I'm even older and more time has passed (although I pray that doesn't happen-- once was devastating enough).

Any idea on what any downside to testing might be?

I just don't know where to start or if I should relax or be "proactive".

Really appreciate your help as those who have been there, done that. Best of luck to all of you!

Message edited 1/27/2015 1:08:46 PM.

Re: Advice please

Hi! First of all, I'm so sorry for your miscarriage. It's not an easy thing to deal with.

I think at this point, it's really a personal decision. 8-9 months is not an unreasonably long time to try at 35. However, if it were me, I would want to know more about why I miscarried and what other things might be influencing conceiving/ staying pregnant. I think an RE is the best person to help you figure out the answers to some of the questions you have. As someone once told me, OB's are great once you're pregnant but RE's are the experts in getting people pregnant. I hope that helps!

Re: Advice please

I'm so sorry for your loss.

It really is up to you, how you feel with pursuing it further. I personally would not waste my time with an OB. I would go to an RE or few to see who you maybe comfortable with. They can do all the necessary blood work and gave you more information to make a more informed decision.

Re: Advice please

I agree with the other ladies. After 35 years old, "they" say to see the RE after 6 months of trying. If you were able to conceive on your own - that's good news! The miscarriage could have been a fluke, or it could be something else easily treated. You won't know unless you see someone who can monitor you closely.

Personally, I wouldn't waste my time with your OB. His/her job is to deliver your baby. And RE's job is to help you get and stay pregnant. I'd go there at this point. I'm all about being proactive!

I'm sorry about your loss.

Advice please

Thank you everyone......I guess it really is just a personal decision at the end of the day, but I'm just not sure if I'm being too concerned after one miscarriage....but again, since I KNOW it wasn't chromosomal, maybe it makes some sense to start the ball rolling just in case....I can't imagine that having information would be a bad thing -- and if the only "risk" to knowing is that I cant be put on birth control in the future, that's not really a risk.....

Re: Advice please

One thing you should get tested for is the clotting . Also watch your next cycle and track your ovulation. After you ovulate get your progesterone level checked seven days later . If your progesterone is low that could be a reason and you could get supplements .

Re: Advice please

Re: Advice please

Interesting question.

First, sorry for your MC.

I have many family members & close friends who had a miscarriage with their first pregnancy (all like yours: after HB detected & without chromosomal abnormalities, so all at about 8 weeks). All went on to have totally easy, healthy subsequent pregnancies & healthy families.

The issue is that you are older than they were. Getting pregnant again may take longer for you.

What is the panel? Probably something like this:
http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_Recurrent_Miscarriage

5% of healthy people without MC have a clotting disorder (to me, this means that a clotting disorder may or may not effect pregnancy). It's higher in people who have multiple MC. You may need to go on blood thinners during pregnancy (but that is all risk vs benefit). If it is all negative, you learn something as well.

The benefit is that you can learn something. The risk is it may/may not have something to do with your MC. The other negative is that if your insurance doesn't cover it, it may be $$$.

As for WHO to do it: I'm not sure what your $ situation is. I know that to get covered for anything in IF, I had to answer a slew of questions: how long were you trying?, ever pregnant in past?, ever have a MC in past? A blood work panel like your OB is suggesting may cost a lot esp if insurance doesn't cover it (not sure if it is billed differently if your OB vs your RE sends it: it may be best to get your OB to send the panel & if you find anything and/or you end up going to an RE to have the RE send anything extra they may want).

That being said, I'd call an RE and ask if you would be covered. This may involve some talks with their financial staff. I'd potentially pay for a consult visit out of pocket & see what he or she suggests (and don't forget, they all have different theories about IF, clotting disorders, immune issues & work-up).

Good luck!

Advice please

Thank you so much! Very informative :)

Advice please

Whoever does your bloodwork, make sure they check your thyroid too. TSH should be below 2.5 when TTC. Clotting factors and progesterone are also good places to look.

Also, there's no such thing as "only" one miscarriage. Don't let anyone tell you differently. I'm so sorry for your loss.