Understanding Recurrent Miscarriage: Non-Doubling Beta & Possible Causes

Question
Hi,

I am 27 years old... and have been pregnant 3 times... none of which has managed to last longer than 5-6 weeks.  The first was in 2001 and miscarriaged occurred shortly after the positive pregnancy test.  The second was in June of this year-  I found out I was pregnant after 2 days of light bleeding.  This pregnancy ended with a d/c and then the diagnosis of ectopic.  This pregnancy has started with what appeared to be a period at 11, 12 and 13 dpo but a positive pregnancy test at 13 dpo then at 17 dpo with a beta of 17 and a low progesterone at 19 dpo the beta was 20... my doctor has told me this is a nonviable pregnancy... and I will see him next week.  

What if anything should I ask of my doctor to test for?  

Thank you for your help with this I appreciate it.  

Samara  

Answer
Miscarriage occurs in 15-20% of every pregnancy. It is doubtful that you will find out the cause for the miscarriages that you had. We usually do not start a workup until you have misscarried at leawt three times. (You only miscarried twice. The other loss was an ectopic pregnancy). It appears that you have a low progesterone level and I believe that you should probably start progesterone supplementation while you are trying to conceive.Once you conceive you should continue the progesterone until ou are 12 weeks gestational age. The miscarriages could be due to parental structural chromosomal abnormalities, genetic abnormalities, luteal phase defect (of which low progesterone is usually the culprit), polycystic ovary syndrome, antiphopholipid antibodies, lupus, tthrombophilia,thyroid antibodies, antinuclear antibodies, and completely unexplained pregnancy loss. Most of the time, less than 50% of women will find the cause for the recurrent miscarriages. However, there are some tests that can be done.Your doctor can test for some of the above mentioned entities. Don't lose hope. I have many patients who have had 5 or more miscarriages in a row and who then went on to have many normal pregnancies. Some women alternate between a miscarriage and a viable pregnancy. Some have several normal pregnancies and then several miscarriages in a row. There is no set pattern. I know you feel frustrated at this point. However , it is possible that your problem will be solved with the use of progesterone. Discuss all of it with your doctor.