Advice for broken-hearted 36 y.o. who cannot stay pregnant
November 24, 2013 5:00 PM   Subscribe

My best friend just lost her third pregnancy. She and her husband have been trying to have a baby for 3 years. Her first and second losses were both in the first trimester, causes unknown. This most recent loss was especially horrible - they terminated after profound birth defects (as in: the baby could not survive outside the uterus) were detected on the 20-wk ultrasound. She's 36, and wonders if she'll ever be able to carry a healthy pregnancy to term. Should she give up trying to get pregnant and give birth? Anyone been down this road before and have good advice for her?
posted by hush to Human Relations (28 answers total) 3 users marked this as a favorite
Has she asked you for advice on this issue? If not, I really wouldn't offer it unsolicited if I was you. There are tons of online message boards on this topic that she can check out if she's looking to commiserate, share experiences, talk to others who have been through what she has.
posted by amro at 5:25 PM on November 24, 2013 [10 favorites]

Has she talked to her OB/GYN about the next steps? I mean, after going through all this, it really is between her and her husband whether she wants to try further. I wouldn't blame her for not wanting to take the risk of more heartbreak. But there is a medical workup for recurrent pregnancy loss which she could look into undergoing. I believe it's typically done after 3 miscarriages, but I think she could push for it regardless of the fact that this latest was not a spontaneous loss. Genetic counseling would be something that I would look into in her position as well.

And most certainly I would recommend a support group, therapy, or both. My sympathies to your friend on these tragic losses.
posted by treehorn+bunny at 5:27 PM on November 24, 2013

From the link I included above: "A couple may be comforted to know that the next pregnancy is successful in 60% to 70% of those with unexplained recurrent pregnancy losses."

Still, I have been through infertility, and a 30-40% likelihood of suffering another loss does not seem all that comforting knowing how painful it can be. I guess I would just repeat that no one aside from her and her husband can decide what she should do, and certainly not whether she should give up.
posted by treehorn+bunny at 5:32 PM on November 24, 2013 [1 favorite]

Response by poster: 1) She asked my advice - obviously, I never offer unsolicited advice, especially since I know nothing about this. I ask this question here with her permission. 2) Her husband will go along with whatever she decides - this is 100% her decision really. 3) Her OB/GYN's go-to answer has been "I'm sorry, I don't know for sure what your chances are" and has not been able to offer her the kind of clear direction she's looking for in terms of data points and next steps.
posted by hush at 5:50 PM on November 24, 2013

Best answer: My partner and I were in a similar situation---a blighted ovum, and then a pregnancy that we had to terminate at 21 weeks due to severe genetic damage. When my partner got pregnant the third time, we were equal parts excited and terrified; we went to every ultrasound holding our breath. We stayed terrified right up to the birth (and really for a while after), but we now have a beautiful 3-week old baby.

If your friend's OB-GYN doesn't know what her chances are, that's good news; it means there's nothing actually wrong with her insides, just a whole lot of bad luck. One of the worst things about repeated failed pregnancies is how it shatters your relationship to hope; fear trumps hope when plans have been dashed so many times, through no fault of one's own. But if they've just had terrible luck, luck can change.

Feel free to MeMail me if you have any questions.
posted by ThatFuzzyBastard at 6:14 PM on November 24, 2013 [7 favorites]

Sounds like she needs to see a different OB/GYN. I haven't been through this, nor am I an OB/GYN, but a friend of mine has similar problems (possibly different reasons). Although there is no OB/GYN who can say for sure what the chances of a successful pregnancy will be, they should be able to say what the next step is, which I would think would be trying to determine the reason(s) for the miscarriages. That's certainly what my friend did with her OB/GYN. See the fact sheet treehorn+bunny linked to for examples of different things that could be going on. If her OB/GYN isn't able to offer clear direction, sounds to me like they are trying to hedge their bets. I'd say more information is required before your friend makes a final decision, but it is completely up to her. It's devastating to have to keep going through.
posted by Athanassiel at 6:24 PM on November 24, 2013 [3 favorites]

I have had several sets of friends that have tried very hard to get pregnant (with help), given up, and went on vacation to a spa or other stress-free environment to reconnect and come to terms with the idea that it just wasn't going to work for them. Then came home pregnant and gave birth with no issues. Their doctors chalked it up to them needing to relax and let nature take its course. YMMV and IANAD.
posted by jshort at 6:43 PM on November 24, 2013 [4 favorites]

Best answer: I've watched others go through similar situations, and I think everyone just has to find their own way. Even the best doctor can't definitively predict the future--the next pregnancy might be okay or it might not, and no one can tell her whether she can or can't handle another potential disappointment both emotionally and physically. She may not really be able to know that with any certainty herself. To the extent that it's helpful, there's some thoughtful advice for a similar situation here:
posted by gubenuj at 6:49 PM on November 24, 2013

For anecdotal evidence: I lost my first two at less than 12 weeks, carried the third to term, lost the 4th before I realized I was pregnant, and carried #s 5-7 to term.

It's definitely possible stress was a factor in #'s 1 and 4, but no clue why even worse stress wasn't a factor with later pregnancies.

I was extremely frustrated with the "we don't know why this happens" that was the answer with the first two. The ones that went fine, simply went fine, all or nothing, y'know?

No advice for dealing with medical details - I know nothing about that.
posted by stormyteal at 6:54 PM on November 24, 2013 [1 favorite]

It sounds like the OB can't find anything "wrong". In some ways this is good news as it just means your friend has had some bad luck. I am not a "hand waving", "relaxed" or even religious person, but motherhood and the path to get there has taught me "what will be, will be". She has no control over what will happen but if she wants the chance to be a mother she will have to try again. I wish her all the strength and love she will need on this journey.
posted by saradarlin at 7:17 PM on November 24, 2013

Best answer: Take an hour to watch this talk from Brene Brown, it's more recent than her TED talks, and she touches on miscarriage in this one. The most touching part of that talk, for me, was her remarks about the phrase "at least."

Realize that she is facing extreme amounts of judgment, real or perceived during this time. I sense that you would not knowingly add to that feeling of judgment, so please do some reading up about women who have come through the other side of infertility. All of the other sides. Some women adopt, some women do deliver healthy children, some women deliver preemies who have lifelong problems, some women remain childless. They each have different stories. Give your friend room to tell you her story. It is clear that she trusts you so much, and it is equally clear that you respect and value her trust.

You are already doing a great thing by wanting to be supportive, and by reaching out for help.
posted by bilabial at 7:19 PM on November 24, 2013 [3 favorites]

Best answer: Please do not tell her to "just relax" because stress is causing her infertility; it's insensitive and untrue. While there may not be a KNOWN reason for her losses, women who have suffered recurrent loss (and any woman struggling with infertility) should not have to have people suggest the loss is basically their own fault.

Your friend should seek a referral to a high risk maternal fetal medicine specialist who can review her medical history and give her a better picture of what is going on. Most OBs who do not deal with high risk populations do not have a good idea how to treat recurrent loss. Her OB may be able to provide a referral to an MFM specialist.
posted by devinemissk at 7:24 PM on November 24, 2013 [24 favorites]

Best answer: Yes, she should talk to an MFM doc and/or a reproductive endocrinologist. A fertility clinic can help her screen for other issues beyond what a regular OB/GYN can. I know more than a few happy parents who suffered devastating loss along the way but were eventually able to conceive and carry to term with the right assistance.
posted by judith at 7:34 PM on November 24, 2013 [1 favorite]

Anecdotal - My wife lost #'s 1 and 2, carried #3 to term, lost #4 and carried #5 to term.

Her OB had her screened after #2 and discovered two genetic clotting abnormalities. Easily treatable (though not a guarantee as #4 above attests.) So, based on that alone, she could ask her OB to test her for Factor V Leiden and/or MTHFR.
posted by Jacob G at 7:53 PM on November 24, 2013

I know a woman who had 4 miscarriages, so heartbreaking, switched doctors to a top specialist and then got pregnant twice and now has 2 little ones. I think going to the best specialist you can afford can make a real difference.
posted by wildflower at 8:58 PM on November 24, 2013

Best answer: Oh my goodness, your poor friend. If she is actively asking for advice, I would suggest asking her OBGYN to do genetic testing on her and her husband to rule out anything like a translocation that might be contributing to the non-viable pregnancies. It is very important that her husband be tested - if either partner has genetic issues that mean their sperm/egg can't create a viable embryo, it will have huge implications for their fertility, particularly around miscarriage and birth defects. If her OBGYN can't or won't do it, then a good fertility clinic and/or a reproductive endocrinologist would be the next step. They're just blood tests, not invasive or anything.

I would also caution against sharing tales of miracle pregnancies after giving up trying, adopting or... whatever. I know people share these stories to be kind and offer hope, but it can just add unwanted pressure and impose the expectation that she is, somehow, in control of whatever is going on ie if she just stressed less, she could stay pregnant. I would recommend gently acknowledging it is a hard road she's on and offering an unconditional non-judgemental ear when she feels like talking. You are a good friend for caring and supporting her. Continue to be guided by her in what she needs and avoid, as much as any human can, assumptions about what she may want. My advice is based on personal experience and my heart goes out to your friend.
posted by t0astie at 11:26 PM on November 24, 2013 [4 favorites]

I was going to suggest clotting abnormalities as a possibility, but in particular Antiphospholipid Syndrome (also called Hughes Syndrome). It is a cause of both miscarriage and fetal abnormalities incompatible with life. Treatment in pregnancy is typically with daily aspirin and injections of low molecular weight heparin and that works. (The syndrome also increases your risk of both DVT and stroke.)
posted by plonkee at 11:57 PM on November 24, 2013

Best answer: If she is not seeing a reproductive endocrinologist, she should be.

I had two miscarriages before conceiving each of my children, for four total. In my case, the problem was my thyroid; my first child was conceived on the heels of a miscarriage when everything was wacky enough to briefly be functional, and the second was conceived three weeks after we finally got my thyroid balance into the therapeutic range. So that's one avenue of exploration. Another is genetic testing; she may have a translocation or something that is making it harder for her to conceive, or her husband may. Thrombophilia (the factor V leiden mentioned above, although there are others) is yet another.

When I was miscarrying, the two most hurtful things I could be told were "Maybe this is just God's will" and "At least you know you can get pregnant." The best thing I could be told was "I am so sorry, this sucks so terribly badly."
posted by KathrynT at 12:20 AM on November 25, 2013 [1 favorite]

Best answer: Nthing that she should see an RE before making her decision. A good RE or MFM specialist should have the statistics your friend is looking for, a full repertoire of repeat loss testing to do, and, in my experience, be more prepared to deal with the emotional aspects of loss. Plus, she won't be stuck in a waiting room with baby magazines on the coffee table and half a dozen happy pregnant women.

Even though she asked for advice, it's probably better to just listen to her as she thinks it through herself. Yes, there are women who have three losses and then get to take home a baby. There are also women who don't, or who will experience more losses on the way. Personally, I felt that three was my limit. I had two 1st trimester miscarriages, and am currently pregnant. If this one doesn't work out, I don't think I will try again. But that's me, plus I'm older than your friend.

I also have a book to recommend, Knocked Up and Knocked Down by Monica Murphy. She has a blog as well. I found it really comforting after my losses, in a someone gets it sort of way. Her experience was a lot like your friend's, several early losses and then a late termination due to non viability. The memoir mainly focuses on the time after her late loss, when she was coming to grips with it and deciding what to do next. She has a bit of a black sense of humor, so I guess it depends on whether your friend would find that comforting or not.
posted by Kriesa at 5:45 AM on November 25, 2013 [2 favorites]

I might talk with her a little more about what she's actually been told - maybe in concert with her ideas and feelings about each piece of news. I have seen people boil medical advice down because they can't manage all of it or don't want to bore people or because they are just numb.

You don't want to suggest she seek information about this or that if she's already been down thst road.

Maybe a conversation where you say X and Y might be helpful - have you consulted with any or talked to your doctor about that?
posted by Lesser Shrew at 6:56 AM on November 25, 2013

Resolve is a national fertility organization. They have many resources, both scientific and emotional.
posted by Mr.Know-it-some at 7:27 AM on November 25, 2013

Best answer: We were told that 36 is an age where the difference between your chronological age and your reproductive age matters a lot. Some 38 year old people get pregnant easily enough, some 32 year-olds struggle. But this is (obviously) a major research area, and there's a lot of cutting edge stuff in clinics now.

Where does your friend live? If she's outside a major metro, can she travel to one? I'd definitely second the votes above for a detailed consult with a reproductive endocrinologist, but preferably at a major center.

If she wants to explore possible options, your friend might be interested in some of the resources here, for example.
posted by RedOrGreen at 10:33 AM on November 25, 2013

Best answer: I had a first-trimester loss followed immediately by a termination at 20 weeks due to trisomy 18. This all happened at age 28. My third pregnancy was perfectly healthy and I'm now the mom of a 3-year-old. I would get testing done in her position, if possible (I was planning to do so myself if we had lost that 3rd pregnancy). But many people have been in similar situations and gone on to have perfectly normal pregnancies/babies. That's not advice, it's just a fact.

Your poor, poor friend. I have blocked that "trying to have a baby" phase of my life out as much as possible, but it was by far the most miserable time I ever had.
posted by feathermeat at 2:24 PM on November 25, 2013

Oh yeah, I second the recommendation for Knocked Up, Knocked Down. It helped me a lot (oh yeah, and the author of that book--who I believe had an early loss, a second trimester loss, and a stillbirth--is now the mom of a healthy son as well).
posted by feathermeat at 2:26 PM on November 25, 2013

We went through all this for years culminating in two rounds of IVF that did not work. Finally we ended up with a fertility specialist doctor who recommended two things.

1) Baby aspirin every day. If you are not allergic to aspirin, this is obviously very cheap and easy to try. This is to help conception.

2) Lipid infusions. This is where the woman gets hooked up to a lipid drip, say once a week, for about an hour. This is primarily to help the womb hang onto the embryo.
I understand that this is a relatively leading edge technique, and not standard practice.

Anyway it worked for us. She got pregnant the normal way with her first baby, at age 44, and it all turned out perfectly.
posted by w0mbat at 2:35 PM on November 25, 2013 [1 favorite]

Best answer: I've been in a similar situation. I don't really want to get into specifies on the internet, but what I learned from the experience is the following:

(1) the only thing that can help is a good REI. Period. No amount of acupuncture, relaxing, etc. will help. She should try to ignore well meaning people who suggestthings like this.

(2) this is the best infertility clinic in the US (they take international patients too). I wish I had called them sooner. If anyone can help it's them. They have new technologies and procedures that other clinics don't. That's why she should go there if she can afford it. The consultation is free.

3) sometimes unfortunately your eggs are shot at 36 and that means the vast majority of your eggs are chromosomally abnormal (could be as high as 90 percent -CCRM will give her an honest assessment. That's hard to hear, but if it's the case she can grieve and then decide about her other options rather than having false hope. Donor eggs have a high rate of success--so while not genetically hers, she can still carry a baby to term.

Counseling didn't help me. It's not for everyone. You can suggest it, but let her make her own choices.
posted by bananafish at 2:42 PM on November 25, 2013 [1 favorite]

Best answer: Yes, definitely an RE.

I followed the blog of a woman who had a very similar story, including the 20-week scan. After they decided to stop trying, she found out that she has premature menopause. Who knows why that wasn't something her OBGYN checked for, but it wasn't. (Her blog is no longer public.)

I've been in a similar situation. What I had to decide, at every step, was whether I would feel worse doing it and having another loss, or not doing it and possibly never having a child.

Your friend will hear every possible story out there of other peoples' experiences, and how "we did this and it worked," but they don't matter. What matters is getting the best possible medical testing and advice, and deciding how much more she can take, one step at a time.
posted by orange (sherbet) rabbit at 5:27 PM on November 25, 2013

Response by poster: OP here with an update:

My friend says thank you for all of your kind comments here - she has an appointment with a RE later this week, and that is thanks to those of you who advised that idea here. She and I are both flabbergasted her (beloved, nice, older, male...) OB/GYN has never bothered to suggest that, so again, thank you so much to all of you who chimed in.

Nobody here said she should give up - thank you! That was very helpful to her because she was about 50% sold on the idea of giving up, as she does not know if she could handle another loss - but at this point she's willing to give it another year.

Nobody here said she should adopt - that was very sensitive and thoughtful of this community, as she has had several work acquaintances suggest that unsolicitedly {cringe}.

Thanks again!
posted by hush at 6:14 PM on December 2, 2013 [1 favorite]

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