Infertility in 2017
November 8, 2017 2:15 PM   Subscribe

After my third miscarriage in a year, I have an appointment with my ob-gyn clinic to “talk about my options” and a possible referral to an infertility clinic I guess. I don’t really understand what is happening or what to expect. I don’t know anyone else who has gone through this. What is the usual course of treatment for infertility? Am I even infertile?

I am 31, my husband is 39. I am a healthy weight, I don’t have PCOS or any risk factors. I don’t know why I can’t just stay pregnant ? My miscarriages have all been within first trimester. What usually happens in this instance?
posted by pintapicasso to Health & Fitness (12 answers total) 6 users marked this as a favorite
I'm so sorry. It's not a nice place to be.
I don't have a lot of time to write now, sorry, but 3 is usually considered a threshold for further investigation. There are a range of relatively common things that they will seek to rule out, aside from PCOS, by doing blood screens, tests on your partner, etc. But often - I think about 50% of the time - the cause of "recurrent miscarriage" is never identified. I would also add, look up symptoms of endometriosis because many people don't even realise they have it...however it is more indicated in fertility rather than miscarriage.
On the positive side, the odds are still pretty high that you will have a successful pregnancy even if no cause is found for the miscarriages.
There's a book called "Coming to Terms" which explains why miscarriage is so poorly understood; however some of the information about treatment options is probably out of date by now. Basically, the entire early stage of conception/pregnancy is pretty opaque, as it's fundamentally hard to study. Humans also have a high miscarriage rate, iirc, compared to other animals.
Sorry this is brief but it's been a while since I was looking into that. Be kind of yourself. PM me if you need.
posted by 8k at 2:30 PM on November 8, 2017 [6 favorites]

my wife and i had two miscarriages in our mid/late thirties before our son was finally born. after the second miscarriage we saw a fertility specialist who did some blood tests on both of us, some in-depth ultrasounds and possibly some more slightly invasive testing on my wife (i've got toddler brain and have forgotten specifics but i don't recall it being out of line with the already invasive nature of general pregnancy care for women).

the doctor ultimately found nothing wrong with our blood and the only intervention was a progesterone supplement vaginally every day for several weeks/a couple months after ovulation. my wife had to monitor for ovulation for a couple weeks as taking the progesterone beforehand would obviously interfere with it.

so it's quite possible that it'll be something simple like that.
posted by noloveforned at 2:50 PM on November 8, 2017 [1 favorite]

My heart is with you.

I had 3 losses in about a year beginning in December of 2015- all of them first trimester. In November of 2016 I got rid of all of my baby stuff and figured that I wouldn’t have another. Last week I gave birth to my third child, so it IS possible. I don’t know why I lost the three I did and I don’t know why this last one stuck. I didn’t do fertility, so I can’t help there, but I can say that I understand the pain that you are in.

I am so, so sorry that you have gone through all of this.
posted by PorcineWithMe at 3:12 PM on November 8, 2017 [3 favorites]

When you meet with your specialist, they'll propose an infertility work-up, which consists of blood tests on you, test your partner's sperm count, mobility and motility, and an internal ultrasound for you. Additional tests may include an endometrial biopsy and genetic testing, but that often comes later and isn't always standard.

The stats I have are that 33+% of the time, miscarriage is due to a male factor, 33+% are female, and 33+% it's an unknown reason. Your "fix" may be incredibly simple, or it might be complicated with big decisions along the way.

I'm sorry you're going through this. A lot of us have been there.
posted by Ink-stained wretch at 3:58 PM on November 8, 2017 [1 favorite]

I'm so sorry you're going through this. It's a roller coaster and it's heartbreaking. I know several people who are in their late thirties/early forties who are going through this, and time is not on their side. You still have time (though that doesn't make it any easier emotionally). My heart goes out to you.

One of the pioneers of IVF (Samsi S. David, M.D.) wrote the book "Making Babies" about infertility and its common causes, many of which are classified as "unexplained infertility" and can potentially be resolved without IVF. It's well written, well researched and may be worth your time. I like that it's written by someone who pioneered IVF because they deal with infertility all the time, they've been in the field for a long time, and they make a case for finding simple solutions for people who have unexplained infertility. Many people think they need IVF, but the solution turns out to be more simple than that for them.

This is anecdata and you may not be interested in alternative methods, but... have you considered acupuncture? I had hormonal problems for, well, forever until I went to an acupuncturist who specializes in women's health and fertility. Acupuncture sorted it all out, and that's something that can be done in conjunction with IVF. Again, I don't know if you're interested but just throwing it out there.

I hope you get what you need. Best of luck.
posted by onecircleaday at 5:02 PM on November 8, 2017 [1 favorite]

So sorry, pintapicasso. I've had four first trimester losses since we started trying in January 2016. My husband (39) and I (33) got full infertility workups after the third one (February 2017) - lots of blood tests for us both, semen analysis for him, saline ultrasound and hysterosalpingogram for me. Our testing didn't turn anything up that we didn't already know from using ovulation strips at home (I ovulate late in my cycle and have a short luteal phase). We're both otherwise in good health and at a healthy weight.

I'm now just taking supplemental progesterone every cycle after ovulation, but otherwise we're not doing anything special. We have an IVF consult later this fall and I think that IVF might be the next step for us.

It was frustrating to go through all this testing and find nothing obviously wrong, but we knew going in that there was a decent chance the doctors wouldn't turn anything up, and we're glad to at least have ruled some things out. If doing an infertility workup is a possibility for you, I recommend it - just know that you may not get any clear answers at the end.

Again, so sorry you are going through this - MeMail me if you want to talk.
posted by Synesthesia at 5:25 PM on November 8, 2017 [2 favorites]

First- I’m really sorry that you’re going through this. It’s awful and extremely isolating.

Next- the information stuff. I’ve been fighting this battle for a while- I’ve had four miscarriages, no live children, over the course of three years (we have been taking breaks in between- they are really tough on us.)

What you can expect next will be a lot of blood tests and probably some scans/internal exams. They’ll most likely do what’s called a “RPL Pannel”, or recurrent pregnancy loss test pannel. They’ll look for likely causes such as anatomical issues, hormones, clotting, thyroid, etc. About 60% of people who suffer RPL won’t find a medical reason to explain it, but even when it’s unexplained, there is a pretty high success rate. If they can’t find something, it isn’t necessarily the end of the game.

RPL is much less common then standard infertility (where you can’t get pregnant). There is a lot less information about it, and it’s not always easy to find a doctor who has a lot of experience with it. The same kind of doctors treat both infertility and RPL. I found that being treated by reproductive endocrinologists at clinics were much much more knowledgeable and kind about unique challenges that come with RPL than OBGYNs.

RPL has some upsides compared to standard infertility. It has a high rate of eventually producing a live birth, and often have much more things covered by insurance.

You may see RPL on your paperwork, or it’s possible you’ll see the term “habitual aborter”. It can be off putting or jaring, but it isn’t intended to carry any connotations.

I hope some of this is helpful, and while I rarely check memail- if I can be of any more help please let me know. It is really lonely and can be such a slow car wreck. It can also feel very lonely because people who have experienced RPL often become invisible once they have a live birth. A lot of the reason why there isn’t as much information or science on it- is simply that most women eventually give live birth, even without treatment.
posted by Blisterlips at 5:50 PM on November 8, 2017 [1 favorite]

Treatment: If they are able to isolate a cause, there is often really easy treatment fixes- like if you have a clotting problem, they give you blood thinners and you’re good to go.

If they can’t isolate the reason, they will likely offer things that may or may not have much effect. A daily baby aspirin, some progesterone support. For unexplained RPL, there are studies that have shown outcomes are greatly improved with attentive medical care. Pretty much- the best treatment is being well cared for. It’s really worth finding a doctor who is attentive and who you feel is on your team.
posted by Blisterlips at 6:07 PM on November 8, 2017

I am sorry for your losses. And I know how rough it can be on a marriage. Try to be gentle with one another.

I've commented many times that we did IVF, and we were also members of RESOLVE (an infertility support group) while we were going through it, so I have a lot to say on the subject. I don't want to say much here for fear of overwhelming you. We are still very close with our RESOLVE friends (even though we all, thankfully, have kids now), so I highly recommend attending some meetings if there are any in your area.

My advice to you now is, don't wait for the OB visit, call the infertility specialists (Reproductive Endocrinologists) in your town tomorrow and get on their calendar for a consult. In my city (LA) the average wait time for a consult is 3mos. You can always cancel it or change it later. But get on the calendar now. Ask them what blood work they want to see when you come to the meeting. They will probably tell you to wait for the meeting, but don't be afraid to push back and say that you have a dr visit scheduled and that you want to have the blood work done before the consult. This is strictly for the purpose of saving time for yourselves. Your insurance is going to pay for your blood work so there is no benefit to waiting for the RE to order it.

When you go to the OB and ask for the blood work to be ordered, insist that she order a test for MTHFR. Don't let her talk you out of it or tell you it's not relevant. There is lots of research saying that MTHFR is linked to early miscarriage.

I mean this with kindness, but please don't put too much stock in what your OB has to say. OB's are not fertility specialists. I was shocked by how much more I knew about the issue after educating myself than my OB did (actually, 3 different doctors/practices when it was all said and done), and that was not an uncommon story among my peers. Go to the OB for OB stuff, go to the RE for fertility stuff.

Please memail me if I can elaborate on anything for you.
posted by vignettist at 6:08 PM on November 8, 2017 [4 favorites]

I don't have anything more to add to the good advice above, but I just wanted to say I'm very sorry for your losses. I've been through infertility and pregnancy loss and it is very emotionally draining. Please be gentle with yourself. I'll be thinking of you.
posted by hurdy gurdy girl at 11:11 PM on November 8, 2017

You're in Portland, ME, right?
If you're having trouble finding anyone local Brigham and Women's has a satellite program in NH closer to you.

My heart goes out to you.
posted by mareli at 11:14 AM on November 10, 2017

I have a lot to say on this topic, but not sure how much is useful to you. I have had three "failed pregnancies" -- they weren't all technically miscarriages.* But these all occurred after I began my stint at a fertility clinic. All but one of of these were "spontaneous" (one was a clomid pregnancy). Our official diagnosis was the dreaded "unexplained infertility."

After loss #3, I insisted I get a recurrent loss blood panel. My RE didn't want to do it, because technically I didn't fit the criteria. That was also an incredibly frustrating experience.

After a lot of wasted time, I ended up conceiving via IVF (knock on wood, only 9 weeks in). Partly I'm relieved; partly I'm annoyed, because I don't think I actually needed IVF, I was just running out of time (or, more accurately, I perceived I was running out of time and after 3 years I don't think anyone could blame me).

With every loss, your ability to trust in the process decreases rapidly. My husband and I don't even talk about our pregnancy, that's how harrowing this whole process has been. I'm not even sure when we will talk about it as a thing that's actually happening.

This is the one thing I have to say about infertility diagnosis: it's a rare case where you actually hope for something to be wrong with you, since there is nothing more frustrating or paranoia-inducing to be a statistical anomaly. But you're aren't alone and there is hope!

*I have joked that I couldn't even succeed at failing to be pregnant.
posted by Mrs. Rattery at 3:26 PM on November 10, 2017

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