Dr. D Consult

We showed up to our consult with our 30 pages of homework filled out. She was every bit as nice and calming and comforting as I expected based on what I had read about her. She was also very positive - telling us that if all of our tests come back normal that we have a 75% of success with our next pregnancy. I don't know why, that part made me cry. Probably because I don't believe it.

We have lots of tests coming up. Okay, I have lots of tests coming up. My husband only has 1 test. I am not going to have any testing done until my period shows up again. While some tests like the genetics don't require homeostatic hormone levels, others do and I'd rather just go once. So here's what we have coming up:

1) A sonohysterogram. An ultrasound procedure where they will inflate my uterus with saline via a catheter and then do a detailed ultrasound to look for any uterine abnormalities such as a septate (heart shaped) uterus or any fibroids or polyps. The chance that I have a septate uterus that went unnoticed through my entire first pregnancy is slim, but possible. The chance of fibroids or polyps that may have developed since my first pregnancy is greater - given that my periods have changed since I had my son (they are extremely heavy) and that in this most recent pregnancy the baby was situated in a position where the ultrasound tech couldn't get good measurement. Treatment is relatively straightforward, but does require surgery.

2) Hormonal deficiencies / abnormalities. The list here is LONG. My lab work writeup calls for 15 different tests and most of them fall under this category. Everything from thyroid to prolactin to diabetes. We did talk about my thyroid results from July and I'll talk about that a little more below. Treatment with medication is relatively easy for all of these problems.

3) Clotting disorders. There are acquired types of clotting disorders and there are inherited forms. There are two things in my history that point to an unlikelihood that this is our problem - 1) an uncomplicated full term pregnancy with my son and 2) the previous use of hormonal birth control with no complications (birth control pills can cause clotting problems). However, there is 1 very alarming piece of my history - my dad died of a stroke when he was 49 years old and he was adopted, so we have no family history at all. Given such a young age for such a serious stroke she is testing me for all clotting disorders. Treatment with medication is relatively easy for this problem as well.

4) Chromosomal abnormalities. Now we get to the complicated stuff. She said she sees this in about 3-5% of RPL patients. It is possible that my husband or I could have genetic translocation. This is where an individual is completely normal because they have all of their required genetic material, but it can be located in the wrong place. It creates no problems for the person with the translocation, however when trying to create an embryo, the genetic material from the egg and the sperm do not match up. This is the most serious of all the problems we talked about. Depending on what chromosomes could potentially be translocated, the chance of miscarriage could range from 50% to 95%. It is absolutely possible for someone with genetic translocation to create a healthy embryo (like our son), it's just a lot more common for a genetically abnormal embryo to develop. Given our 2 chemical pregnancies (most very early pregnancies that terminate are due to chromosomal abnormalities) I am concerned about this one. Treatment is not easy or cheap - it requires in vitro fertilization with preimplantation genetic diagnosis (IVF w/ PGD).

So that's where we are. We will have all of these tests done and go back for a follow up consultation with her. She did warn us that more than 50% of all RPL patients get through this initial testing with an unexplained diagnosis. But we will cross that bridge later.

I do like her, and she's one of the best in our area - so I'm trying to stay positive. There are however, a couple of things that worry me:

1) No semen analysis. Because we get pregnant so easily she thinks it would be a waste to do a SA. Obviously my husband doesn't have a shortage of swimmers, but I would have been more comfortable if we were at least going to address the quality of his sperm. While we are talking about it, I wouldn't mind knowing about the quality of my eggs.

2) She doesn't have a problem with a TSH of up to 3.5 and she also doesn't treat thyroid antibodies. She is the expert, so I'm not going to get upset about this . . . YET. However, if everything else I listed above comes back normal and my TSH stays at this borderline level, I may be seeking a 2nd opinion.

So that's where we are. Now I just wait for my period to show up so we can start these tests.