QuestionQUESTION: Hi, 5 years ago I got pregnant on my first try and carried my pregnancy to term without any problems. I have a healthy 5 yr old son. I tried to get pregnant 3 years ago and since then have had 5 miscarriages all between 5-7 weeks. I have not been able to receive any answers from any dr's and have had hysterosonograms, clomid cycles, shots cycles etc. Nobody has even mentioned a hysterscopy. Could I possibly have adhesions from my first delivery that they are not noticing on the hystosonograms? Please advise. Thank you!
ANSWER: Hello Lauren from the U.S.,
If you have had more than three miscarriages, you are in the category of habitual or recurrent abortion. You need to undergo an evaluation to try to find the reason, and then get treated appropriately. I think that maybe you have not seen the correct doctors thus far. A hysteroscopy is an essential part of the evaluation
Recurrent miscarriages occur for many reasons:
1. Spontaneous chromosomal anomalies (chromosomal breakage during cell division in the early embryo)
2. Parental chromosomal abnormalities
3. Anatomical causes such as uterine abnormalities.
4. Infectious disease causes.
5. Hormonal causes.
6. Immunological causes.
These require specific testing. I would advise that you see a reproductive endocrinologist if you have not already seen one. They would be the specialists in this field and for this problem.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: Thank you for your response. I have had an evaluation done except nobody has even mentioned a hysteroscopy. They haven't found anything abnormal except i tested positive for ureaplasma 2 years ago which they gave me antibiotics for and also told me that the ureaplasma has nothing to do with my miscarriages. I have had chromosome testing along with all of the others you mentioned. I have gone to two reproductive endocrinologists and neither of them have mentioned the hystoscopy. Should I go back and ask to have one done? My most recent miscarriage was in July and they were able to do karotype and it came back normal. I also have been told I have excellent ovarian reserve. Just so confused on how I had my son with no problems 5 years ago and now 5 miscarriages and no answers. Thank you for your advice.
ANSWER: Hello Again,
One thing that is very significant that you have not told me your age. Age has a very significant impact on the quality of eggs.
Also, if you have already seen two RE's, what did they tell you is the problem and what treatment did they recommend? They would have all the information in front of them so should be able to give you more specific answers to your question.
If it were me, I would do a hysteroscopy just to make sure, but this may not yield the answer. As I told another questioner, in order for me to give you specific advice, I would have to review your medical records, and that is not possible in this venue.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf
---------- FOLLOW-UP ----------
QUESTION: Thank you again for your response. I am 34 years old and had my first child at 29 and my first miscarriage at 31. The dr's both recommend as treatment, high doses of follistim shots, with hcg trigger, progesterone supplements etc. I did two months of it last year with inseminations and didnt fall pregnant either time. I am just very frustrated and searching for answers. They did an antimullerian bloodtest and found my egg level at 0.9. Not sure if that's considered very low or normal. I am considering trying another round or two of shot cycles but i feel like maybe I should have a hysteroscopy first to rule out any abnormailites. I have had about 4 hystosonograms, I take it the hysteoscopy will show more?
AnswerHello Again,
Well age is certainly not an issue for you, and I don't know why they would even order the AMH since that is not an issue for you either. The most common reason for recurrent miscarriages would be spontaneous breakages of the chromosomes at the time of division of the embryo.
If you were here, I would recommend that you consider moving to IVF solely because IVF allows us to retrieve multiple eggs and form multiple embryos with a higher likelihood of finding a normal healthy embryo, thereby reducing your miscarriage rate. Also, I would recommend my miscarriage cocktail, which is low dose aspiring (81 mg#, Medrol 16mg, Heparin 2000U twice per day, Estrogen supplementation with patches and high dose progesterone #injection and suppositories). This is worked for me in the past for recurrent miscarriage patients, although I cannot give a scientific reason to justify it. Studies have been inconclusive. These treat for subclinical immunologic factors and increase the blood flow to the implantation site at the micro vessel level.
The only additional treatment to consider is IVIG or Intralipid infusion, as recommended by immunologists for recurrent miscarriage. You might want to look up the site www.rialabs.com which is a practice that specializes in reproductive immunology.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf
