QuestionHi, I'm 33 years old my husband is 39. We are a healthy couple. Twice this year we got pregant. First pregancy, very early, I began to have spotting and eventually was diagnosed wiyh an ectopic pregancy, I was given Methotrexate. This past December pregnant again, and during my first evaluation at 6 weeks everything was fine, expect my progesterone level was low (12.17) and I began using shots anf pills daily. After one week my levels reach 96.14. At 8 weeks my evaluation showed no heartbeat, I was diagnosed with fetal demise. I' concern bacause my husband and I have different Rh and blood group (B- and O+) is this a problem? What should we do next? infertility evaluation?
Thank you,
Maria, writting from Puerto Rico
AnswerHello Maria from Puerto Rico,
First of all, in regards to your blood type differences, if you have a negative Rh factor (B-) and your husband is positive (O+) then you will need to receive an immunization called Rhogam, which should be given with this miscarriage, and should have been given with the ectopic. This is because in a future pregnancy, the fetus can be affected by an immune response and develop a disorder called erythroblastosis fetalis. This difference does not lead to miscarriages, however.
Second, you have to separate your two pregnancies because they are completely different. An ectopic is a pregnancy that implants in the tube. This is different from a miscarriage, which is in the uterus. They are not related. The only conclusion you could make is that because of a previous ectopic, you are at risk for another. However, you have already shown that you can get pregnant within the uterus despite this risk. Miscarriages are a natural occurrence. They occur in up to 40% of pregnancies, and the most common cause is a chromosomal abnormality in the developing fetus. The body (nature) realizes that the fetus is abnormal and stops the pregnancy or severe defects in the fetus causes it to die off. The good news is that most women that have miscarriages are eventually successful. You just need to keep trying and I don't think that you need to do anything different, necessarily.
Because of the progesterone issue, you might want to add supplemental progesterone after ovulation, just as a precaution. This can be given as injections or vaginal suppositories. I am confident that you will be successful.
Sincerely,
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 facebook and twitter with me at @montereybayivf
