RPL testing advice *loss mentioned*

[emmylo413]

Hey ladies, I hope you don't mind me asking for advice/experience with RPL here...

I'm looking for advice that would be best from this group....

I just miscarried my second pregnancy at 7 weeks (another blighted ovum) and found out that insurance is covering genetic testing and blood work for me.  For those of you who have walked this path, what tests did you have done?  Did you find them to be helpful?  Were you able to come to any conclusions or make any changes that are making or have made a difference for you?  My doctor doesn't seem hopeful that we'll find any useful answers and really believes it's all luck at this point, but I want to explore every option we can.  Thanks in advance for sharing.  

[grneyes]

*lurking*

So sorry for your loss. I actually just posted what RPL testing entails on CAL. Scroll down to see my post:
goodbyecb.proboards.com/thread/8171/rpl-testing-results-expect

Edit: Feel free to PM me anytime you want or have more specific questions. Your OB should refer you to a RE to do the RPL testing.

[emmylo413]

Thanks for the info! Totally going to print out your list and take it with me to my follow-up. At this point we haven't discussed referral to an RE, so we'll see. I'll def PM you for more info!

[grneyes]

Feb 1, 2015 14:35:54 GMT -5 emmylo413 said:

Thanks for the info! Totally going to print out your list and take it with me to my follow-up. At this point we haven't discussed referral to an RE, so we'll see. I'll def PM you for more info!

I would encourage you to check with your insurance about the RE - since they are the ones who are specialists in RPL, not OBs. If anything comes back concerning with CD 3 blood work (FSH, E2) or AMH you would need to see a RE anyway. My OB is the one who started my testing for me, then referred me to the RE (some of the tests that I had listed my OB didn't know to order, it was the RE who did). My saline sonohysterogram (where they check for structural issues of the uterus, and polyps, fibroids) wasn't something that my OB did, so had to go to the RE anyway. Some REs are strict about 2 vs. 3 losses, but if your insurance covers it then I would have the testing done to rule anything out.   Good luck!

[littlecookie]

I had many of the test that were on the linked thread. All of my results came back normal, but as a PP mentioned, I'm still glad we did them before TTC again.

I'm sorry for your losses. Best of luck.

[bunnybun]

I really echo seeking out an RE for the testing and not an OB. They can give you a full work up and that is what they do.
AFM all of my RPL testing came back normal (minus mthfr) and then months later they decided to check my cd3 bloodwork and found out my AMH was really low which is most likely what was causing my early losses (poor quality eggs). I love my RE and he didn't have any reason to believe my amh sucked (got KU three times with no assistance) but I do wish that they had tested that stuff in the first place.

[eliz77]

Lurking...

Just to give you a side of someone who it had made a difference for...after having two losses-MMC and EP-combined with being AMA, I was referred to an RE. That RE did all the prolactin levels, karyotyping, AMH, thyroid, CD 3 testing, an HSG (due to the EP), SA for H, and basically said all is well, despite a very low AMH (0.27). I had another MC, went to a different RE who redid all blood work and did an SHG. He wasn't concerned about my low AMH either-said since other levels were normal, chalk it up to age related, a quantity not quality issue. BUT he also found two copies of MTHFR gene, which the previous RE overlooked for whatever reason (not all Drs believe it to be related repeat loss). The new RE put me on baby aspirin, extra folate and referred me to an hematologist for blood thinners/monitoring.

My point being...you never know what may be discovered and what treatment plan could be offered. I do believe if you have to undergo testing, you are better off with a Dr who specializes in it. As my ob told me-RE's are in charge of getting you pregnant while obs help you maintain that pregnancy and delivery. I have no idea if my 3 losses were related or all bad luck incidents with old/poor quality eggs. I am very glad I saw the 2nd RE and had a plan, and I would definitely do it all over again if I had to. If your insurance covers it, I'd go for it. Good luck!

[ProfessorChaos]

I'm a big fan of testing, although most of the tests for me turned up nothing wrong. I definitely think you want to be with an RE, not an OB, and be sure to get the common clotting factors done, in addition to things like karyotype. It's true that the vast majority of women will come back as "normal" on all these tests, but if you're among the small % who has, say, a MTHFR mutation, you're unlikely to successfully carry a pregnancy without treatment. There are a bunch of different sets of RPL panels that doctors will run, so you'll have to see what your RE likes to do. But if your insurance will cover it, and the doctor is willing, definitely get it done!

I'm so sorry for your losses. Good luck!

[ashtog]

I have no advice, just wanted to send {{hugs}} I'm so sorry for your losses.

[lav17]

I am sorry for your losses ((hugs)). I was referred to an RE after two early losses (I had a nice GP, I suspect she went through some fertility issues, too). Because both losses were around the same time (6wks), she didn't make me wait for a third. The RE did caryotyping for my H and me, I got a SHG, they did some of the usual RPL bloodwork (except immune/blood clotting issues because losses were so early). The only thing they found wrong was that my AMH was lower than it should have been for my age and I had a vit. D deficiency. 6 months after I started taking vit. D, AMH rose to high-average. This is something I haven't heard of before, so you may want to look in to it, too.
Because I had spotting in my luteal phase most cycles, I was put on progesterone when we did a monitored cycle at the fertility clinic. This was about a month or two after all the testing (we had to wait while the clinic was closed for holidays). I got pregnant again and carried to 10 weeks while on prometrium, but we knew pretty early that things weren't going right - my betas started out pretty low (17 @ 14dpo, but then rose normally), at 7 wk u/s I was measuring a week behind and the heartbeat was slow. We waited 2 more weeks before scheduling D&C, because I didn't start bleeding on my own after it was confirmed that heartbeat had stopped and I stopped taking prometrium. Genetic testing confirmed that the loss was due to trisomy 16.
I read somewhere that women who get pregnant easily are also more likely to miscarry. It sucks, but I think it makes sense. I think that in addition to possible low progesterone or reduced egg quality due to vit. D deficiency, maybe my body just wasn't very selective about which embryos to "accept." This is not very scientific, but it helped me deal with my losses.
Best of luck to you. Feel free to PM if you'd like to talk.

[ProfessorChaos]

Feb 3, 2015 11:57:05 GMT -5 lav17 said:

I am sorry for your losses ((hugs)). I was referred to an RE after two early losses (I had a nice GP, I suspect she went through some fertility issues, too). Because both losses were around the same time (6wks), she didn't make me wait for a third. The RE did caryotyping for my H and me, I got a SHG, they did some of the usual RPL bloodwork (except immune/blood clotting issues because losses were so early). The only thing they found wrong was that my AMH was lower than it should have been for my age and I had a vit. D deficiency. 6 months after I started taking vit. D, AMH rose to high-average. This is something I haven't heard of before, so you may want to look in to it, too.
Because I had spotting in my luteal phase most cycles, I was put on progesterone when we did a monitored cycle at the fertility clinic. This was about a month or two after all the testing (we had to wait while the clinic was closed for holidays). I got pregnant again and carried to 10 weeks while on prometrium, but we knew pretty early that things weren't going right - my betas started out pretty low (17 @ 14dpo, but then rose normally), at 7 wk u/s I was measuring a week behind and the heartbeat was slow. We waited 2 more weeks before scheduling D&C, because I didn't start bleeding on my own after it was confirmed that heartbeat had stopped and I stopped taking prometrium. Genetic testing confirmed that the loss was due to trisomy 16.
I read somewhere that women who get pregnant easily are also more likely to miscarry. It sucks, but I think it makes sense. I think that in addition to possible low progesterone or reduced egg quality due to vit. D deficiency, maybe my body just wasn't very selective about which embryos to "accept." This is not very scientific, but it helped me deal with my losses.
Best of luck to you. Feel free to PM if you'd like to talk.

VERY common!!!