Anonymous wrote:13:50 -- that sounds awful. I'm a little surprised that the midwife waited until three miscarriages to suggest testing progesterone. How awful that your marriage has ended. I hope you're doing okay.

To answer your questions, I do not have a history of fertility issues. This marks 7 months off birth control and 4 TTC. As far as I know, I've never had a miscarriage. I have been tracking my cycles -- the first three months using OPK's and most recently temping and observing CM (although I'm not very good at that part yet). A generous DC Urban Mom user gave me her fertility monitor, so going to start using that this month. Based on both OPK's and temping, my luteal phases have only been 9 days for all of the last four cycles, assuming AF comes today. That gives me concern. And although I know that four months isn't that long, some other posters have said that it might take 2-3 months to get an appointment with an RE, so I thought maybe I should go ahead and start that process if it seemed like that's where I should go.

Thanks for all your responses. Haven't really decided what I should do now.

Hi, it's me, the PP. I apologize for checking out. Busy few days!

Re: GW midwives' management of miscarriage and their personalities, people do not say this often, but I actually REALLY liked Marsha. She helped me through the second miscarriage, which was pretty scary. Many on here do not like her as much as the others, but I thought she was great. Whitney was actually fairly cold and I didn't get a great vibe from her. I spoke with Nora on the phone a bunch during #3 and that was okay too. The first spontaneous miscarriage was frightening, but it was pretty clear that there wasn't much they could "do" for me other than see me when the process was complete, check my hormone levels and make sure I was doing okay psychologically, which they did. The second one was a little more confusing and I came in for an ultrasound to confirm that the pregnancy was actually ending. I was given misoprostol to complete it at home, which was awful and I do not recommend. #3 was more like #1 and didn't require management. Nora and Marsha were both really great about responding to my phone calls or messages in the online system. Marsha in particular was also great at INITIATING contact, which I found unusual and super reassuring.

We were sort of taking the approach that 3 miscarriages (at 7 weeks, 9 weeks and 6 weeks, respectively) is not outside the range of "bad luck". They didn't suggest testing anything until the second one. I asked for the autoimmune stuff because I was concerned that maybe I had the same illness my mother does. Everything came back normal. After the second miscarriage, my husband and I put the brakes on and the third pregnancy was not really "planned" - I wasn't on BC but we also were not having sex regularly and literally only one time during my fertile window. When that pregnancy ended, we both realized that we were kind of relieved and separated. We (and our older child) are all doing great in our new lives.

I am a little concerned about how to approach TTC if I have another child. I am remarried and we have talked about having another child, but not for a couple of years. I am young enough that by that point, I will only just be bumping up against the AMA line, but given my history of miscarriages, my inclination is actually to go straight to a RE and then transfer back to the midwives once I'm actually pregnant.

In your case, OP, I think it would make sense to schedule appointments with the RE, provided that you can afford it or it's covered by your insurance, while you continue to try the way you have been. If you get pregnant, you can always cancel the appointment.

Anonymous wrote:

If can take some time to get an appointment. I would schedule one and then cancel if you change your mind. The first appointment is just an introduction. You meet with a doctor, one of the nurses and someone from financial. They will give you a list of tests you will need to get done (bloodwork and what not). Your insurance should cover the visit and they will be able to tell you (if you don't already know) what else would be covered - which is good to know in case you need something like invitro in the the future. I'm at Shady Grove Fertility, which is fine. It's very close to my work so that helps make my life easier while going through all of this.

+1. Great advice. Go ahead and make the appointment. You can always cancel it later, and it will likely be covered or partially covered. It doesn't mean you're going to have IVF. They may be able to diagnose and treat a simpler problem based on labs and an exam.

Anonymous wrote:13:50 -- that sounds awful. I'm a little surprised that the midwife waited until three miscarriages to suggest testing progesterone. How awful that your marriage has ended. I hope you're doing okay.

To answer your questions, I do not have a history of fertility issues. This marks 7 months off birth control and 4 TTC. As far as I know, I've never had a miscarriage. I have been tracking my cycles -- the first three months using OPK's and most recently temping and observing CM (although I'm not very good at that part yet). A generous DC Urban Mom user gave me her fertility monitor, so going to start using that this month. Based on both OPK's and temping, my luteal phases have only been 9 days for all of the last four cycles, assuming AF comes today. That gives me concern. And although I know that four months isn't that long, some other posters have said that it might take 2-3 months to get an appointment with an RE, so I thought maybe I should go ahead and start that process if it seemed like that's where I should go.

Thanks for all your responses. Haven't really decided what I should do now.

If can take some time to get an appointment. I would schedule one and then cancel if you change your mind. The first appointment is just an introduction. You meet with a doctor, one of the nurses and someone from financial. They will give you a list of tests you will need to get done (bloodwork and what not). Your insurance should cover the visit and they will be able to tell you (if you don't already know) what else would be covered - which is good to know in case you need something like invitro in the the future. I'm at Shady Grove Fertility, which is fine. It's very close to my work so that helps make my life easier while going through all of this.

13:50 -- that sounds awful. I'm a little surprised that the midwife waited until three miscarriages to suggest testing progesterone. How awful that your marriage has ended. I hope you're doing okay.

To answer your questions, I do not have a history of fertility issues. This marks 7 months off birth control and 4 TTC. As far as I know, I've never had a miscarriage. I have been tracking my cycles -- the first three months using OPK's and most recently temping and observing CM (although I'm not very good at that part yet). A generous DC Urban Mom user gave me her fertility monitor, so going to start using that this month. Based on both OPK's and temping, my luteal phases have only been 9 days for all of the last four cycles, assuming AF comes today. That gives me concern. And although I know that four months isn't that long, some other posters have said that it might take 2-3 months to get an appointment with an RE, so I thought maybe I should go ahead and start that process if it seemed like that's where I should go.

Thanks for all your responses. Haven't really decided what I should do now.

Anonymous wrote:I am confused, OP. Do you have a history fertility issues? How long have you been TTC? Are you tracking your cycles?

When I got pregnant with my first child, I stopped taking birth control, spoke to my gyn, who suggested I start taking vitamins and tracking my cycles, and see where we are in a few months. I got pregnant right away, so where we were was "prenatal appointments."

My second, third and fourth pregnancies ended in miscarriage, which in turn ended my marriage. I received great medical care from the GW midwives during that time, including various autoimmune tests. After pregnancy #4 ended, midwife said that next time, we would test progesterone levels and track things more carefully, but since I am now not TTC, we're not doing that.

I would not jump immediately to RE unless you have reason to believe you will have difficulty conceiving.

Really sorry to hear about your losses and your marriage... I am with the GW midwives as well and have had two miscarriages after my first child. I'm not sure if I have a medical problem or just bad luck. Can you tell me more about what they did for you? Who is your favorite midwife?

midwife is not a doctor

I conceived my first at 33 after about 9 months of trying. Up to a year of trying when you're under 35 is normal. I drove myself crazy and got tested (and had DH tested) but we were completely normal (I have PCOS but I'm fertile and ovulate, just sort of irregularly).

You should use a tracker like Fertility Friend and invest in a basal body temp thermometer or bite the bullet and get a Clearblue Easy fertility monitor. (That's what I did and I got pregnant the first month with it.) I was tracking with FF's website for all 9 of those months, using a BBT thermometer, but it looks like I was off and my luteal phase is just insanely long (18 days) and temping didn't work for me -- but the monitor was awesome. I'd try that at least a few months before going to an RE, honestly. Unless you think you have an issue, just not getting pregnant in 6 months could be a matter of bad timing. And good tracking and the monitor/BBT will tell you for sure that you do/don't have a luteal phase defect, which is better than not knowing!

I am confused, OP. Do you have a history fertility issues? How long have you been TTC? Are you tracking your cycles?

When I got pregnant with my first child, I stopped taking birth control, spoke to my gyn, who suggested I start taking vitamins and tracking my cycles, and see where we are in a few months. I got pregnant right away, so where we were was "prenatal appointments."

My second, third and fourth pregnancies ended in miscarriage, which in turn ended my marriage. I received great medical care from the GW midwives during that time, including various autoimmune tests. After pregnancy #4 ended, midwife said that next time, we would test progesterone levels and track things more carefully, but since I am now not TTC, we're not doing that.

I would not jump immediately to RE unless you have reason to believe you will have difficulty conceiving.

RE. Midwives are all about pregnancy care and deliveries. They don't have as much experience and training with fertility problems. Unless your midwife is really great with getting pregnant, do the RE. It can't hurt to do the first consultation and labs.

I guess you like your RE? What's his or her name?

Anonymous wrote:I'd go to the RE. You'll just waste time with the midwife.

I'm the PP and just thought I'd share that this comes from personal experience. I wasted months making appointment with the OB and getting bloodwork that just had to be repeated once I got to the RE. Was pregnant 2.5 months after just biting the bullet and going to the RE.

I'd go to the RE. You'll just waste time with the midwife.

OP here. I'm 33. Also pretty certain I have luteal phase defect.

Depends how old you are. Personally I would go straight to an RE. Even an OB/Gyn will waste your time if you are having a true fertility issue.

At pre-conception appointment, midwife told me to come back if I tracked my cycles and still wasn't pregnant after 6 months. Should I go back to her or go straight to an RE? Anyone have RE recommendations?