Secondary Infertility - how far did you go with it?

[Anonymous]

TW: miscarriage and other children mentioned

I am pretty sure I am going through my 3rd miscarriage. I am 6w4d and have been brown spotting since Monday. I pushed for a repeat beta at 28dpo and it had only risen to 2101 from 447 (18dpo). I have no idea what happened since my first betas rose appropriately from 108 to 447 with a doubling time of 32 hours. I have a scan tomorrow to see what is going on but I am not holding out very much hope for this.

I am 35 and we have been trying for 10 months. Of those 10 months this is my 3rd pregnancy. I had a chemical in July and again August. I finally got a good positive in April with dark pregnancy tests and appropriately rising betas all for it to fall apart a few weeks into it. I am devastated to say the least. I seriously thought that after the good first initial betas we were out of the woods. I had two successful and uneventful pregnancies in the past (4 and 2 years ago) so I was not prepared for all of this when we decided to have our third.

With that being said, for those of you who have experienced secondary infertility, how far did you go with a RE or when did you know you were just done and to accept what has been dealt to you? We actually had our first consultant with Shady Grove and then I found out I was pregnant a week later. Right now I am not sure if we should reach back out to them or not. They suggested that I have an HSG done but I am not sure that would be necessary given that we know the egg can at least get to my uterus okay.

I feel bad for feeling so bad about this. I know I am beyond blessed for having two healthy children already. I don't want this to consume my life and take away from enjoying my children in the present now. I also don't know if infertility treatments are covered with my insurance or not (have to look into that). If it isn't covered or only partially covered I don't know how far we would take this since it is basically taking money away from my existing children for the possibility of having more children. Not sure if I should look at it like that or not.

Thank you for letting me express myself. I just feel so down about everything right now and am not sure how to proceed or process this.

[Anonymous]

A couple things come to mind. You are right, you COULD be miscarrying. But, doubling times do slow. Also, I’ve had hematomas with two of my pregnancies that caused me to spot. Maybe that’s it- and they would be able to see it on ultrasound (it resembles another sac in my opinion!).

If you are losing this pregnancy, an HSG could confirm if there’s anything in the uterine cavity that might be causing problems once implanted. Having just gone through finding a fibroid, the doctor said that if they are in the uterine cavity, they can sometimes cause miscarriage.

As for how far to go, only you know the answer. But fertility treatments are an emotional rollercoaster. Some personalities handle it better than others, but if you really feel like you’re supposed to go for it, make sure you build in personal time, restorative practices etc.

[Anonymous]

this is not secondary infertility it’s tertiary one. I went through 3 IVFs for #2 but did nothing for #3 (which has happened after one MC).

[Anonymous]

I had a successful IUI after a miscarriage at SGF and then 10 mo without any subsequent pregnancies. I have a healthy older child that was conceived by accident.

I think I’ve seen your posts before on these boards. Maybe progesterone will help prevent future miscarriages and maybe an RE will give it to you finally. You don’t seem to have trouble getting pregnant so you wouldn’t be diagnosed as infertile. A good friend of mine had 3 miscarriages (without any history of difficulty with her first) before having her second child at 38 - it happens!

But the possibility of this all being normal doesn’t make it less stressful. Are you getting help for the anxiety and stress of TTC and going through losses? It may be worth focusing time and energy on that beyond posting to message boards.

[Anonymous]

Sending you hugs and good wishes, OP. I hope this pregnancy turns out to be a healthy full-term one in spite of the spotting - as PP said, that can absolutely happen.

My own infertility journey was different than yours but I have a close friend from college who experienced something very similar. Two healthy pregnancies and births and then in her mid-30s she had a series of four miscarriages, all between 15-19 weeks. It was awful and the doctors were useless and never did figure out why it was happening. She stuck with it and did successfully have her third baby after four years of trying. I know she used Clomid at some point but don't believe she did anything else since, as you say, she felt she was having no trouble getting pregnant.

It's a really tough thing to decide and I sympathize. We're considering trying for a second right now and I am really on the fence after all we went through to get the first which involved several IVF cycles. I don't at ALL think you should feel bad for considering it. There's absolutely nothing wrong with having your dream family size in mind and it's not a zero-sum game or anything (I don't have patience with all those who bore on about how people "should feel lucky" to have one, they need to just shut up already). But it's definitely fair and reasonable to consider the potential financial and emotional impact on you and your family. Another child would of course be priceless...but playing blind and not knowing if that will ever come about makes it such a hard calculation. However, if what's happening in your case is that your miscarriages are being caused by chromosomal abnormalities that *is* something that could possibly be worked around via IVF, so if this pregnancy isn't successful (though I hope it is) you might consider testing the embryo for that as a potential cause. That could at least give you some more information to work with.

[Anonymous]

After 3 mc's, I would get a recurrent miscarriage panel done. This could be something as resolvable as a thyroid issue. Shady Grove should be able to help you with that. You can gather information without going all the way to IVF.

[Anonymous]

OP here - thank you very much for all of your thoughtful responses. I appreciate it. We have done some minimal testing.

All of my blood work came back great. I am 35 and my AMH is still 3.81 so I guess that is good? My husband did a SA and that came out okay. Morphology was a little bit on the low side but everything else looked okay per Shady Grove.

I guess if this doesn't work out we have a lot to talk about if we still want to go ahead and try for a third.

For the person who suggested therapy - thank you I am definitely going to think about this. This whole journey has riddled me with anxiety I didn't even know I had.

[Anonymous]

I'm sorry for your losses OP.

Did the RE run an RPL panel on you? If not you should have one at this point. It could give you some clues as to what might be going on.

[Anonymous]

On the thyroid issue, get your tsh number. You want it to be 2.5 or below. Most labs use a much higher number at the top of the normal range.

[Anonymous]

Anonymous wrote:On the thyroid issue, get your tsh number. You want it to be 2.5 or below. Most labs use a much higher number at the top of the normal range.

OP here -yes my tsh was 1.98 so I guess that would be considered within normal.

[Anonymous]

Anonymous wrote:I'm sorry for your losses OP.

Did the RE run an RPL panel on you? If not you should have one at this point. It could give you some clues as to what might be going on.

Thanks - I will probably ask them to do that. What does that entail? Just more blood work?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I'm sorry for your losses OP.

Did the RE run an RPL panel on you? If not you should have one at this point. It could give you some clues as to what might be going on.

Thanks - I will probably ask them to do that. What does that entail? Just more blood work?

NP here. Yes, it's just blood work. They may want to do an advanced ultrasound procedure (HSG or SIS) to check there's no scar tissue or other physical problems with your uterus. Three miscarriages is repeat pregnancy loss (RPL), counts as infertility. It's not getting pregnant, it's getting successfully pregnant, which you are not, unfortunately.

To answer your main question, we're doing IVF with PGT-A/PGS for secondary infertility and RPL. Infertility and IVF is very difficult emotionally, so aside from the time and money, I would think very hard about whether you want to put yourself AND your family through that stress and hardship. If you really truly want another child, then it's worth it. But it's impossible to go through the process without it affecting you. Good luck to you.

[Anonymous]

Hope it turns out you’re wrong about a miscarriage.
I did many rounds of ivf and finally DE for #2. Not sure I’d do the same for a third, but I also never imagined myself having a big family. It’s a very personal decision.

[Anonymous]

Had an ultrasound and they couldn’t see anything. Nurse practitioner said it could just be too early but I am pretty sure I am right about my dates within a few days. Also I am red bleeding now and cramping. They are doing follow up betas and another ultrasound next week. Beta was 2101 on Monday so they should have seen something right?

[Anonymous]

Anonymous wrote:Had an ultrasound and they couldn’t see anything. Nurse practitioner said it could just be too early but I am pretty sure I am right about my dates within a few days. Also I am red bleeding now and cramping. They are doing follow up betas and another ultrasound next week. Beta was 2101 on Monday so they should have seen something right?

If you are absolutely positive about your dates, and the person doing the ultrasound was competent (I’m assuming it was a translational ultrasound at this point), then yes.