Recurrent Pregnancy Loss - specialist?

[Anonymous]

Anyone have any recommendations on doctors in the area who specialize in Recurrent Pregnancy Loss? We have been to 2 differerent RE's, both highly recommended by many of you on this board, who have run the usual barrage of tests to see if there is an underlying cause for my recurring miscarriages. Both have come up with nothing and then proceeded to tell us to just keep trying and that eventually, we'll get one that will "stick". Additionally, I felt that after realizing that the initial "getting pregnant" part was not a big issue for us, they seemed to just write us off. I got the feeling that they just didn't think miscarriage was that big of a problem.

Any advice on which doctors might be more helpful would be greatly appreciated. Thanks!

[Anonymous]

So sorry for your losses. How many mcs have you had? Have you seen a perinatologist? How early were your losses?
Clotting issues are ok? How old are you?

[Anonymous]

OP: I have had 3 and no, did not even know what a perinatologist was - I had to look it up. Is this something that I should look into before even becoming pregnant again? The losses have ranged from 5 weeks to 8 weeks and so far I have not come up positive on any of the clotting tests both my OB and RE have done. I'm only 32, and in their definition, "not old".

[Anonymous]

15:17 here.
I've had two, and have an appt with a perinatologist in 2 weeks. I can't go through it again. I have not tested positive for anything in the clotting panel either, but I will request lovenox whenever I get pregnant again. I have talked to a hematologist (family member out of state) and he told me some doctors prescribe lovenox empirically in women who've had 2 or more losses even though there are no studies that show that it helps.
My cousin had 2 losses and didn't test positive for anything either and took lovenox for her 3rd and 4th pregnancy and had two kids.
Of course odds indicate eventually you will have a succesful pregnancy, so maybe it is the lovenox, maybe it isn't.
This hematologist told me that lovenox is as safe or safer than baby aspirin, and since I am already taking that, I might as well try the lovenox.
I would definetly recommend seeing a perinatologist.
Good luck.

[Anonymous]

Can you share the name of your perinatologist and how you found them? Did you go to him/her for an initial consult (or is this what your appt in 2 wks is)?

My RE has suggested monitoring for my next natural cycle, but I don't see how that's going to help my issue. Is your perinatologist essentially going to replace the RE?

[Anonymous]

I know someone who went to an expert on miscarriage in Chicago who was mentioned in the book "Coming to Term." She raved about the doctor.

[Anonymous]

After reading a lot online and talking to a couple women who had had 2 or more losses, I decided to ask my ob for a referral to a perinatologist. I have my pre-pregnancy consult on August 2nd, I haven't seen them yet. Going to the Brock Family Center at Inova Alexandria. I don't think the perinatologist will replace the RE, although I am not exactly sure I need the RE yet since I get pregnant on my own, but they have prescribed progesterone and they monitor me closely, even though that hasn't seemed to help.
I recommend the book Coming to Term: Uncovering the truth about miscarriage, if you haven't read it yet. The specialist mentioned there is Mary Stephenson. I believe there was someone posting here that was going to see her in Chicago.
If I do get pregnant again and end up miscarrying again I am definetly going to see her.

[Anonymous]

Another avenue to investigate is immune issues. This is a controversial field of reproductive medicine---with some doctors not believing in it at all. The late Dr. alan Beer was one of the pioneers in this field; however, I have heard very mixed things about his center now that he has passed. I have also heard that they were very aggressive about always finding some problem that needed to be addressed. A more middle of the road reproductive immunologist is Carolyn Coulam in Chicago. I have been to her and found her quite knowledgeable while being more conservative than Beer's.

There is a yahoo listserv re reproductive immunological issues. While I would suggest you take it all with a grain of salt---I do know of women with recurrent M/C who eventually sustained a pregnancy after getting their immune systems treated.

[Anonymous]

OP - I have had 2 m/cs myself in the past 8 months and hate that any of us have to suffer a m/c. Have to ask - Did you have karyotyping done for both of your m/cs and, if so, what were the results?

If they were chromosomally abnormal embryos, then I would say it is more of an odds game with trying than there being an underlying issue with you. Not to discourage you from pursuing RPL treatment further, but it is more likely that you had a couple of bum cycles and the testing is more likely not to turn up any other issues . Both of my m/cs were missed m/cs and one test came back inconclusive (chromosomally normal girl). When I learned that missed m/c occurs 85% of the time due to chromosomal abnormalities, I didn't pursue further testing as the odds are small that the issue is with me, but rather is most likely with my AMA eggs.

If they were chromosomally normal embryos, then I say to dig investigate the different areas - immune issues, etc - to make sure there is absolutely nothing going on with you that could be impacting those embryos. It may take some legwork, as PP stated some REs don't believe in immune issues at all and that has been the case with the 4-5 I have spoken with in this area. Good luck!

[Anonymous]

I have had 3 m/c (all in 2009, one after the other). I did an enormous amount of research after the third one, and it came down to 2 things - I did IVF with PGD (to make sure there was not a chromosomal issue), and I saw Dr. Jonathan Scher, a miscarriage specialist in NYC. He is expensive but I heard many rave reviews from people in our situation. I saw him right after my 3rd m/c and he took like 20 vials of blood from me, swabbed my vagina, and took a bunch of blood from my husband. From the results, he came up with a protocol for me. I am currently 5 1/2 weeks pg and I just came from my first pregnancy visit with him today.

I am taking/have taken:
baby aspirin
Lovenox
prednisone
progesterone
vitamin D
Folgard
intralipids

Most of these things were from Dr. Scher. I could not bear the thought of another pregnancy without knowing that I had done everything in my power to address any issues known to medicine.

I am, of course, feeling alternately excited to be pg and scared, since it is hard to move forward and not think about the past. But I do truly feel like I have done everything I can do.

I'd be happy to talk to anyone about it more . . . is there a way to pass on a personal email here without distributing it to the world?

[Anonymous]

PP I would love to talk to you, I am 15:17 poster.

Please email me at [e-mail] and we can give out real emails there.

Thanks!

[Anonymous]

And btw, congrats on your pregnancy!

[Anonymous]

Thank you so much! Emailing you now.

[Anonymous]

To 18:57 - I am OP. That's interesting about the missed m/c's - I hadn't heard that before about it being mostly due to chromsomal issues. My first 2 were indeed missed m/c's. We did karyotyping with m/c #2 and it was a chromosomal abnormality. With the first one, it is unknown, although they suspect chromosomal as well due to some things that came up during the ultrasounds. Could I really have bum eggs already at the ripe old age of 32? That's an incredibly depressing thought (not that the rest of this isn't already depressing).

To 21:44 - re: Dr. Scher being expensive, does he not take any insurance?

[Anonymous]

OP again - to 21:44, crossing my fingers for you that this one sticks!