RPL...RE appt coming up...questions

[kellyowens]

I hope this is fine to post this here...you ladies have more experience with REs though and I have some questions before my appt on Thursday

I've had 9 pg losses. My ob has prescribed prometrium and ld aspirin with my successful pgs in the last 6.5yrs (my last two m/cs were a little over 4yrs ago).

We recently moved and I have new care providers. I went to a cnm for a pre-pg consultation and she gave me a referral to a RE since she's not "qualified to dose and monitor" the meds. She was willing to follow my former dr's protocol the last two cycles until my re appt but they haven't resulted in a pg.

So my questions...
What is usually included in the initial work-up?
Is it likely the re will want to repeat the labwork I've already had done (most of it was ~7yrs ago)?
I'm bfing (2x/day)...will that pose a problem?
Anyone with rpl? What did your testing involve?
Since I have no problems conceiving, only maintaining, will dh have to have testing?

My fear is that even though I know prometrium/aspirin works for me he won't be willing to prescribe it without the *full* gamut of testing. I want to avoid unnecessary diagnostics as much as possible (eg I know structurally my tubes, ovaries, cervix, and uterus are fine since I had a baby 13months ago). Then again I worry he won't be aggressive enough and he'll tell me to come back in 6months or after I have another loss (that actually terrifies me...it's one thing to lose a baby while doing everything you could do but another thing entirely to stand by helplessly doing nothing because your dr didn't feel it was necessary btdt).

I hate going into these things blind, lol. I've been reading online but you all know how that goes...

Thank you for any info

[GatorGRITS]

I'm a return patient to my RE so I'm not sure if the process was exactly the same as it was a few years ago, but my RE did an ultrasound on the day of the initial consult to look at my ovaries and uterus and then basically it was just us talking in her office about my treatment options. She did order the full lab work up though to check all my hormones, insulin resistance, etc. The other tests (HSG, saline sono, etc.) came later. She didn't order the HSG until two cycles in when I didn't get a BFP with 3 follies...wanted to make sure I didn't have blocked tubes. Also, DH had already had a SA before I ever went to the RE. My OB had ordered it months prior when I told her we were having trouble conceiving. She said testing the male is easier and cheaper and to start there first. Of course, DH has super sperm. It's me that is totally the problem

EDIT: She also repeated the u/s and lab work this time around at my initial consult.

[akhiker]

I was going to say pretty much the same thing that Jen said. Since it has been so long since your last work up, they will probably want to test everything again. Sometimes though, they will let you go a few cycles before running ALL of the tests. The most important thing is that you and your RE are on the same page, so ask lots of questions, and definitely communicate your history and plans for the future. Good luck!

[kellyowens]

Thank you ladies!

For now, I'd really like to stay the course with the progesterone/aspirin after O...it has been working well for me. I'm hoping we'll be on the same page .

[JJorn]

Since I had three losses in a row they recommended that we prevent while they did the testing. I had never had any sort of testing done so they wanted to do everything for me and DH (well, not an SA since we seemed to easily become pregnant). We actually got pregnant while preventing before all the testing was done so they had me come in for HCG and progesterone testing and recommended I take a baby aspirin a day (which I could not do since I am EXTREMELY allergic to it - would probably die without prompt medical attention). So, with your repeat losses they might recommend that you not get pregnant because it is very difficult to treat some things while you are pregnant as opposed to before you are pregnant. But, if you chose to try anyway they would probably be ok with you doing the regimen that you are currently on.

We had all the testing done that our insurance would cover and were just saving up for the rest of the testing when we got pregnant again.

[CeCe1975]

Ditto everything everyone has said. Only thing I wanted to add is in regards to b'fing. I just had an appt with a new RE on Fri (stupid insurance change). And while my old RE had no problems with me still nursing, the new RE said he wouldnt do any testing at all until my DD weaned. Said my prolactin levels would be too high to get pregnant and wouldnt do any b/w at all. While I understand all that, he wasn't willing to budge at all. Did not like him one bit.

So, hopefully you get an RE who won't give you a fuss if you're not willing to wean.

ETA: My appt was for achieving pregnancy, not staying pregnant. So maybe that wont have anything to do with your appt since its the rpl you're going for. Just a heads up and an experience in case it's brought up.

[kellyowens]

Thanks Jess! I'm not opposed to waiting through 1-2 cycles to have the hormone testing done if that's what he recommends. I'll be on cd14 for my appt and I O ~cd22 so the timing is good. We can prevent if we need to and I won't have to wait from the beginning of my 35day cycle before my next cycle starts .

I really have my hopes up that I'll get the green light to ttc this cycle and that he'll support my current regimen. Is that realistic or should I prepare myself for waiting?

I'm afraid he's going to want to do something differently and after all the time, energy, and financial resources it's going to result in more losses. For the first time in 15yrs I had two babies in a row without at least one miscarriage between them...did we just happen to catch two good eggs in a row and the rest stink, lol, or did the progesterone/aspirin really help ...I know it was the grace of God for sure but wondering what He has in store for us now...I have to believe it's going to be okay, lol, just wish I knew what it was .

[kellyowens]

Ditto everything everyone has said. Only thing I wanted to add is in regards to b'fing. I just had an appt with a new RE on Fri (stupid insurance change). And while my old RE had no problems with me still nursing, the new RE said he wouldnt do any testing at all until my DD weaned. Said my prolactin levels would be too high to get pregnant and wouldnt do any b/w at all. While I understand all that, he wasn't willing to budge at all. Did not like him one bit.

So, hopefully you get an RE who won't give you a fuss if you're not willing to wean.

ETA: My appt was for achieving pregnancy, not staying pregnant. So maybe that wont have anything to do with your appt since its the rpl you're going for. Just a heads up and an experience in case it's brought up.

Thanks Christina! I was wondering about that too. I'm not willing to wean yet but my fertility appears to have returned (or is right around the corner) since my cycles are regular and based on my chart I ovulated last month (got a +opk the month before but wasn't charting so not sure about O).

If he won't do testing while I'm bfing but I get pg (very likely based on my hx) then is it possible he won't prescribe the progesterone for me either...not sure but I'm really hoping it doesn't end up that way.

If he really feels I need to prevent pg or wean so I can stay pg then I can appreciate that but hopefully he'll support whatever decision we make.

Eta... (((hugs))) I noticed your siggy and the anniversary of your loss next month...thinking of you !

[JJorn]

The testing that they wanted us to do was genetic in basis mostly or for common causes of miscarriage (various auto immune issues, clotting issues, etc). The chromosomes took about 6 weeks to come back which is a normal wait time for that test. Since I had two healthy babies followed by three miscarriages he did say that a genetic issue could be it since I was right around the 50% viability mark. My DH never got that test done but I came back 100% normal (he doesn't see the doctor very often and it was a busy time for him) and that was the only test they wanted done on him.

[Lizamay]

I don't know about the visit for rpl since my promary problem seems to be not ovulating and getting pg but I just wanted to say GL. I hope the appt goes well!

[kellyowens]

I've had autoimmune and clotting panels done but not the chromosomal. I do have a rare genetic issue that may be the cause of some or maybe even all of my losses but it's impossible to know for sure I guess. The autoimmune thyroid issues may have contributed also.

I know my age could be a factor this time around (36) and having a family hx of early meno makes me feel like the clock is ticking even louder, lol, but I'm feeling optimistic for now .

[kellyowens]

I don't know about the visit for rpl since my promary problem seems to be not ovulating and getting pg but I just wanted to say GL. I hope the appt goes well!

...thank you Liz!

[kellyowens]

The testing that they wanted us to do was genetic in basis mostly or for common causes of miscarriage (various auto immune issues, clotting issues, etc). The chromosomes took about 6 weeks to come back which is a normal wait time for that test. Since I had two healthy babies followed by three miscarriages he did say that a genetic issue could be it since I was right around the 50% viability mark. My DH never got that test done but I came back 100% normal (he doesn't see the doctor very often and it was a busy time for him) and that was the only test they wanted done on him.

I'm assuming that percentage is losses/total pgs? Based on that I'm at 53% (down from 60% before my last two pgs)...does that increase the likelihood it's a genetic thing then?

[JJorn]

I was at less than 50% - 2/5 pregnancies resulted in healthy babies. So he really thought that genetics might be it. Now, if this one is ok, I'll be 3/6 so exactly 50%. Odds around 50% are generally thought to be genetic with one parent having a good choromosome and one bad chromosome.

However, it does seem the inflammation present in the body lowers the progesterone levels greatly and with my second and third loss they did check progesterone and I was very low. We started supplementation but it was too late. Since around all the times I was miscarrying I had a sinus infection requiring steroids due to inflammation, and then hives which again required but did not make the hives go away (hives = inflammation) and then asthma that came back which again required steroids. All of that was due to someone's laundry products in the building since everything went away when we moved out and I washed all of our clothes/bedding/towels/etc. I then accidently got pregnant and progesterone was immediately great. So, it seems my issue my just have been the allergic reaction. But, since I'm still at 50% odds we won't really know unless my DH gets his chromosomes finally tested.

[kellyowens]

(((Hugs)))...what an ordeal, oh my goodness! I remember reading some of your posts when you were going through it...I'm so glad it resolved and you're moving along perfectly through your pg !!

I calculated it backwards then...so my viability would be 47% (8/17). Either way, chromosomal issues are a possibility. Do you know of any websites off hand that go into more detail about which abnormalities are tested for?

Thank you for sharing this with me!