QuestionHi! I live in Windsor, CO. I am 39 and have 3 healthy children. I'm recently remarried, my husband is 29 and we are trying for a baby. Sadly I have had 2 recent miscarriages; one in July and one in October both at about 5- 51/2 weeks gestation. Both ultrasounds looked normal; I have small fibroids not interfering with the endometrium. My progesterone level with my 2nd miscarriage was 38 at 4 weeks, before the miscarriage. I would like to know what lab tests are a good idea to rule out blood disorders; my Dr. has ordered a series of tests I will do this week including factor 5, and antithrombin 111, lupus, etc. I was wondering if it is possible to have such blood disorders after successful pregancies. My children are 9,7,& 5. They were all very large babies 9 1bs 11oz, 10bls 4 oz, and 9lbs 6 oz (2 weeks early!). I did have significant tearing but no c-section or other complications. Just wondered what your advice would be regarding blood tests, and any other advice before trying again! Thanks so much!
blessings,
Debbie
AnswerHello Deborah,
You doctor is being overly cautious and checking for the rarer causes of miscarriage. In medicine, we often do things to "rule out" major problems. The blood tests won't hurt, but I doubt that they will return abnormal.
The primary cause of 90% of miscarriages is spontaneous aneuploidy. What that means, is that when the egg is dividing an forming into an embryo, the chromosome breaks and becomes abnormal. Consequently the cells that continue to divide are abnormal leading to a multiple genetic abnormality. This leads to an abnormal fetus, which the body detects, and stops the pregnancy. Sometimes, only one chromosome breaks leading to a small abnormality and so the pregnancy continues like Down's syndrome (chromosome 21 abnormality). The most common reason for this spontaneous abnormality is age. A woman is born with all the eggs she is going to have in her lifetime. These eggs age, and as they age, they deteriorate in quality. So that at the age of 37, only 20% of embryos formed are genetically normal. That number decreases with ages greater than 37. That is the most likely cause of your miscarriages.
At this point, you only have two solutions: (1) Continue trying by a natural means such as natural intercourse, fertility drug assisted intercourse or insemination, which means that you need to be prepared for more miscarriages and more tries. Hopefully, eventually you will be successful. . . or not. (2) Proceed with IVF (in vitro fertilization), which is where very strong fertility drugs are used to stimulate the production of lots of eggs (10-20) which are then aspirated from the ovary. This leads to the fertilization and production of many embryos. This increases the chance that a normal embryo will be present in that batch (although not for sure), which increases the chances of a successful pregnancy. In your case, your chances for success would be very good because you have been pregnant before. The only thing you need is a good embryo.
Finally, if you are not seeing an infertility specialist, you should seek one out since you have had two miscarriages. Technically, you are now a "Habitual aborter".
I hope this makes sense to you and answers your questions.
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.
