Your advice: Is it worth seeing a fertility specialist?

[Anonymous]

DH and I are fortunate in that we can get pregnant easily -- but we are unfortunate in that we haven't been able to make one stick. We had three miscarriages in 2012, including one in the second trimester. We've seen a perinatal specialist and have been tested for everything under the sun -- genetics, hormone levels, autoimmune issues, uterine abnormalities -- and every single test has come back negative. Our doctors are mystified, particularly with regard to the second-tri loss, which we know was genetically normal.

Now, our regular OB at GW wants us to go see Dr. Frankfurter because she thinks he might have "something in his bag of tricks" that could help us. I'm on the fence about that, for three reasons:

1. I'm not sure what he could possibly do to help, given that all our other testing has come back normal. Am I missing something?
2. Our insurance doesn't cover fertility, so we'd be paying out of pocket for the consult and anything else he wanted to do.
3. We would like to try again to get pregnant this month (first opportunity after the most recent m/c in the fall) but Frankfurter can't see us until the end of January -- so it would mean waiting yet another month to try, and I'll be 40 in June -- I'm feeling like every month matters here, both physically and emotionally.

If you were in our shoes, what would you do? Thanks in advance for your advice.

[Anonymous]

No reason to wait to try again. REs can help get you pregnant, but they're not magicians and can't save a pregnancy that's miscarrying. I think it would be worth seeing him and seeing what he says. My gut is that if you've had thorough testing, you'll just have to keep trying.

[Anonymous]

Don't waste time with anyone down here. I know you said you were tested for autoimmune issues but go see Dr. Braverman in NYC. He is a reproductive immunologist. The doctors down here aren't trained in immunology with respect to pregnancy. Dr. Braverman can do even more extensive testing and has a lot more in his arsenal.

[Anonymous]

You have a big problem. See a specialist. PP is right, you may have to go elsewhere to find someone who will treat the causes of your miscarriages, but any reputable RE here can give you a diagnosis (probably auto immune). Sorry for your loss.

[Anonymous]

I've had 8 first trimester losses and only ended up being successful with immune treatments. There are few doctors who believe in immune treatments and don't recommend them, but my 5 month old DD would not be here otherwise. We were the same way, no trouble getting pregnant but could not stay pregnant. I'm in my early 30s BTW.

To me a 2nd trimester loss of a normal karyotype fetus is a classic sign that something is wrong immunologically. This is of course if your uterus is free of any anomaly. A good friend of mine had 2 second trimester losses before going to immune treatments and her little boy is now 2 months old. Those of us who have been through this hell will tell you getting tested is worth it.

Go see Dr. Abbasi at CFA she will get you the additional testing you need. I was ultimately successful with her and Dr. Braverman in NYC. Dr. Hamersley was my MFM and she also sees a lot of RPL patients so she might be one to consult with as well since you will probably be monitored closely in your next pregnancy. Tests you will have done include NK cells, TNF, LAD, full APS panel plus others looking at specific subsets of leukocytes. The world of reproductive immunology is one that is newly emerging, but very promising.

It's really not a good idea to keep trying until you've had the testing done.

[Anonymous]

Anonymous wrote:3. We would like to try again to get pregnant this month (first opportunity after the most recent m/c in the fall) but Frankfurter can't see us until the end of January -- so it would mean waiting yet another month to try, and I'll be 40 in June -- I'm feeling like every month matters here, both physically and emotionally.

If you were in our shoes, what would you do? Thanks in advance for your advice.

I would be making multiple appointments -- with the best fertility specialist you can find in this area AND someone out-of-area that specializes in recurrent pregnancy loss.

I am sorry for your prior losses and hope you can find a doctor to help you very, very soon.

[Anonymous]

A friend of mine had 13 miscarriages, despite being treated by the very expensive Dr. Braverman. She wound up getting pregnant spontaneously after an unsuccessful IVF and this one stuck. I really think it's just a matter of finding the right egg.

[Anonymous]

I just called CFA this week for an initial consult and was able to make an appointment for next week. If you are interested in getting in to see Abassi at CFA, I don't think it will take very long.

[Anonymous]

I am assuming by saying you had your genetics tested you had a karotype test on your blood but just wanted to double check. My DH has a translocation of his chromosomes which causes miscarriages. We had no idea until we both had karotype tests done on our blood. Good luck and I'm sorry for your struggle and losses.

[Anonymous]

This is the OP -- thanks so much for the input and good wishes, everyone.

13:41, yep, we had karyotype testing -- all normal.

We've read a lot about autoimmune issues. Clearly there are those who feel very strongly that it is a real and treatable condition, and others (including one nationally renowned specialist in RPL who I had a phone consult with) who feel that the evidence just isn't there yet. I know there are multiple threads about this on DCUM, and I'd rather not re-open that dialogue again here. I'm not yet sure where I stand on it -- I've heard powerful arguments both ways.

What I think we may do is see Dr. Abbasi instead of Dr. Frankfurter -- that way, we can discuss the more "traditional" RE strategies (which we would've covered with Frankfurter anyway) and we can also talk about the autoimmune stuff with someone we know won't dismiss it out of hand.

Any other advice/experience/ideas welcome! Thanks again.

[Anonymous]

Dr. B is expensive yes and you also have to remember that there are autoimmune conditions that can negatively impact egg quality. Once those things are addressed I think it is entirely possible that a person would not necessarily need IVF to get pregnant (who needed it prior). That's not the case for all of us with autoimmune issues. New research in this area is pointing to complex processes during trophoblast invasion as being one cause for repeated losses.

[Anonymous]

My heart aches for you, OP. My DH and I also got pregnant easily and have two children from previous uneventful, normal pregnancies, but still had 3 losses in the last year at age 41-42 (DH is 38). All losses were between 9-12 weeks. The last two were trisomy related but the first came back no issues/female (though my OB wasn't completely convinced this was accurate b/c the practice lacked confidence in the lab they used at the time and subsequently switched).

It was recommended that we try IVF with PGD. Fortunately my insurance covered it though I paid out of pocket for some of the meds (my long stim cycle required meds that exceeded my insurance cap). We went with Dr. Osbourne at Shady Grove and agreed to give it ONE shot and then move on.

Prior to cycling, my DH and I went through a full array of tests, including genetic, but everything came back normal. Long story short, the PGD testing at 3 days revealed that out of 9 embryos, only 2 were genetically "normal." We put back those 2 and have 2 beautiful beans at 7 weeks with heartbeats. We are obviously not out of the woods yet, but for me, the PGD results were enough to justify our going the IVF/PGD route. While we surely could have gotten pregnant again on our own, the odds clearly were not in our favor.

Best of luck to you.

[Anonymous]

I have a good friend who had similar issues-no trouble getting pregnant but multiple miscarriages. Her OB/Gyn wasn't helpful so she ended up doing research on her own and requested a hysterosalpingogram. She was diagnosed with a septate uterus and subsequently had surgey to correct it...she now has a 2 year old and is 7 months pregnant with baby # 2.

Not sure if this is something you've been worked up for but if not it's worth a shot.

[Anonymous]

PP who posted at 20:27 here-I apologize for being redundant-I just re-read OP's post and saw that you had already been tested for uterine abnormalities.

Good luck with everything.

[Anonymous]

OP, have you been tested for blood disorders? I don't know your racial background but I had the same problem as you - mutliple miscarriages. I was tested for thrombophilia based on my racial profile (I wondered why they always asked!) since I am Mediterranean. Certain races are not prone to this. It was determined that I have a genetic disorder which causes me to over clot. I was placed on meds and was pregnant in two months....and finally stayed pregnant. FWIW, I agree with poster 9:58...