Early Pregnancy Loss - 2

Friday, March 16, 2007

Kenneth F. Trofatter, Jr., MD, PhD

...When things had gotten quieter in the room, I went back to talk with the couple about our findings (see my last post). I could see the thousand questions she had on her lips and told them, “Let me just talk with you for a few minutes, and then I will answer any other questions you might have.” Asking my own questions first, I found out that this was her first pregnancy (in fact her husband was her first sexual partner); she always had regular menstrual cycles with periods every 28-29 days since age 13; she had no significant medical problems; she was on no medications other than prenatal vitamins; there was no family history of congenital birth defects, syndromic problems, inborn errors of metabolism, unexplained mental retardation, or chromosomal abnormalities; she did not smoke or use street drugs, but did occasionally “have a beer”; there was no family history of recurrent miscarriages, autoimmune diseases, or clotting disorders. I did not go into detail with her about why I needed this information, but told her that it would help me to counsel her with regard to what might have happened to her current pregnancy.

Then, to answer the first question I knew was on her mind, I told her, “Based on what you have just told me, it is very unlikely there was anything that you have done, eaten, smoked, or drank that caused this pregnancy loss.” “Then why did this happen to me,” she asked. “I know this will not make things any easier today,” I responded, “but, even if people don’t like to talk about them, early pregnancy losses are very common.” I then went on to explain. Across the board, at least 20 to 30% of all pregnancies miscarry. The most common reason for this in someone who has previously had one or more successful pregnancies is a fetal chromosomal abnormality (I did explain what that meant before going on). Most babies with chromosomal abnormalities don’t survive the first trimester, and even the ones folks are most familiar with, like Down syndrome, usually are lost in early pregnancy.

In her case, though, there is probably another explanation. This was most likely her very first conception and a much higher percentage of first pregnancies (perhaps 50-90%) miscarry, even if the baby is not chromosomally abnormal. At the risk of oversimplification, I explained to her that since the baby is only half herself, it is then ‘foreign’ to her body. And, using the analogy of organ transplantation, I told her that if I placed a kidney in her body from someone who was only half ‘matched’ with her, without using very potent immunosuppressive drugs, her body would reject the kidney in a very short period of time. From what we know, it appears that the mother’s immune system does have to be able to recognize that the baby is ‘foreign’ but then, rather than rejecting the baby, it must actually ‘learn’ to promote and nurture its growth. To successfully carry a baby, the mother has to become ‘immunized’ to pregnancy.

Then she asked, “What can I do so that this doesn’t happen again?” I told her that what happened this time may actually reduce the risk of a miscarriage with the next pregnancy. She did not have any factors to put her at risk to have repetitive miscarriages. Because this was her first miscarriage, and because of what I had told her about the risk for the same for someone having their first pregnancy, an extensive medical ‘work up’ for this was not warranted at this time. “Once this is all over,” I said, “give your body about 3 months to recover, continue taking your prenatal vitamins, and then, when you are ready, go ahead and try again. Most of the time things work out the next time around.” “And, what if they don’t,” she asked? “We’ll cross that bridge when we come to it,” I said; and, besides, that will be a good topic for another post………….

Permalink | Email Post

218 Comments:

At Fri Apr 27, 01:07:00 AM 2007, Anonymous said…

A sensitive and gentle explanation to a patient grieving the loss of a first trimester baby. Recomended reading for medical staff trying to help a patient deal with the grief.
At Tue May 01, 07:44:00 AM 2007, Anonymous said…

I myself have just recently suffered a miscarriage in the first trimester. I am 38 and this was my fourth pregancy. The first one I was talked into having an abortion at the age of 18. My second was born, she was full term and is now 15. My third child at first they thought that I was pregnant in my tubes but found out that I had a fibroid sist in my uterus, but that it would not cause any problems, he was full term and is now 8, a very active child. Now with this fourth one I wonder what happened to cause me to loose it I was 12 weeks but they are saying that the baby was only 9 and a half weeks. They could not find a heart beat, so I asked for a second opinion since I had carried two healthy full term babies. The blood work came back and the numbers are steadly dropping. My only concern is why I'm getting the run around and them not giving me a D & C. I just spent six hours in the emergency room and all they done was give me pain meds to ease the pain. I have delt with the loss of my baby fairly well, its just that I want the fetus out so my body can start healing and we can try again that I am having a hard time dealing with.
At Tue May 01, 11:07:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Based on what you have told me, this is most certainly a "missed" or "inevitable/incomplete" abortion (miscarriage). At your age, and with your past successful pregnancy history, this is also very likely to be the result of a baby that had a chromosomal abnormality and couldn't make it past first trimester. As you know, the risk for chromosomal abnormalities increases with your age. If you have an OB provider, you should go to them with the results of your ER experience. Some ERs will take the time to make the diagnosis, but be reluctant or unable to offer you a solution. You will eventually 'miscarry' the pregnancy on your own, but either medical therapy or a D&C is certainly reasonable for you to request under these circumstances now that you are ready. I am sorry for your loss and wish you luck in the future if you want to have another baby. Thanks for reading.
At Sat May 05, 05:57:00 AM 2007, Anonymous said…

may i ask a question? when u are about 3ays late in ur period does that indicate an early miscarriage? the first time i suspected i was pregnant, i saw my period a week later, 3mths later , i again thot i was pregnant , saw all the signs, but unfortunately my period started 3days later with sever bleeding and cramps. is this a miscarriage? pls advise
At Mon May 07, 11:10:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi anonymous,
You may or may not have lost early pregnancies. If you "felt pregnant" then it is more liekly you were. Most over-the-counter urine pregnancy tests are sensitive enough to pick up a pregnancy that early, or your doctor can send an even more sensitive blood test off if there is a question. If this late or abnormal bleeding is happening in consecutive cycles, there could be lots of other causes unrelated to pregnancy - endometriosis, fibroids, a polyp or even something worse. You should probably check with your doctor if it happens again.
At Mon May 07, 11:55:00 PM 2007, Anonymous said…

can i ask a question?. I have just had a miscarriage at 5weeks, but my doctor is making me go back again in a week for another blood test to make sure.my scan showed that i had thickening of the uterus but no sac could be found. the scan findings said i may be in early stages of pregnancy or have had a miscarriage, I thought at 5 weeks that something should have shown up. at the very least i could have been 4weeks again i thougth that a scan would have shown somthing. why are they makeing me wait a week again and to keep my hopes up that i am pregnant. If i have had a miscarriage how long do i ave to wait to try again.
At Tue May 08, 09:26:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

You could have had a very early miscarriage. At 5-6 weeks, we should clearly see a gestational sac, and if we use our imaginations just a little, an embryo with a heart beat. If you ovulate regularly, my greater concern at this point, since they did not see much in the uterus, is that you could have an ectopic pregnancy. Usually these are in one of the fallopian tubes. If you have more bleeding, or develop any abdominal pain, let your doctor know right away. Hope this helps. Thanks for reading!
At Thu May 10, 09:14:00 AM 2007, Anonymous said…

hi my daughter is 17 its her first pregancy and when she went for her first scan last week shes was 12 weeks they found no heartbeat they told her to come back a week later for another scan which shes been for still no heartbeat but how come the baby has moved its arms and shes also been given tablets and has to return on saturday for more tablets shes had no stomach cramps or bleeding can they miss a heartbeat thankyou
At Thu May 10, 01:09:00 PM 2007, Anonymous said…

First of all, thank you for the great information you post. I am hoping you have time to answer my question which you may not find unlike many others'. I have a healthy baby from my first pregnancy. I miscarried earlier this year between weeks 11 and 12 after having seen a good heartbeat at 7 and 9 weeks. Do you have any comments on the most likely cause of miscarriage? Also, I am pregnant again--currently at five weeks. I have felt some light fluttering twinges in my lower abdomin just this afternoon and some light, pinkish-brown/greyish discharge. Would you say the chance that I'm miscarrying or about to is extremely high or is there simply no way to tell? Other websites do not provide much detail about spotting during the first trimester even though I know several people who did and carried to term. Thank you very much for your time and consideration.
At Fri May 11, 10:33:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Response #1: With regard to anonymous whose 17 year old daughter has lost her first pregnancy, in my experience, it is not at all unusual to miscarry true first pregnancies. Often it does not mean there was anything wrong with the baby and your daughter's chances of carrying the next pregnancy are very high. She probably did not need the second ultrasound if no fetal heart beat was seen on the first one. Some physicians and patients "just like to make sure" and usually the woman who is miscarrying is in no immediate danger. I would presume the "tablets" they gave her are a drug called misoprostol (cytotec) in an effort to help her finish the miscarriage without needing a D&C. I suggest after this is all over, she start taking a prenatal vitamin on a daily basis to prepare for future pregnancy. If she is a smoker, she should stop. Otherwise no special evaluation is indicated at this time unless she has other medical problems

Response #2: With regard to anonymous who lost a baby at 12 weeks after a fetal heart beat was seen at 7-9 weeks, this baby probably DID have a chromosomal abnormality. That is the most common cause of isolated miscarriages in first trimester in women who have previously carried normal pregnancies. You are at slightly greater risk for another chromosomally abnormal conception than that based on your age alone if what I believe is true. The spotting you are having could be the signs of another loss in its early stages, but is more likely to be simple 'implantation bleeding' as the embryo attaches to the inner lining of the uterus. You might consider asking your doctor to have an early screening procedure done for chromosomal abnormalities, "combined first trimester risk assessment" at 11-14 weeks. Good luck to you and thanks for reading!
At Sun May 13, 12:19:00 PM 2007, Anonymous said…

Hi
I suffered a miscarraige at 7 wks last july & am currently pregnant again. I have had a scan at our local Early Pregnancy suite, because of the last miscarriage & as I also started bleeding 2wks ago now, which has been almost constant, but always dark brown in colour & so far I have had no pain. Even although I have not had a period for 9 wks now, the size of the sac when I was last scanned on wednesday suggested I am only around 6 wks. What is really worrying me now though is that today I woke up with cramps really low down & then the bleeding turned to bright red. When I went to the toilet earlier tonight & wiped, there was what looked exactly like a feoteus on the toilet paper! It was approx 5mm in size & bright red. I showed this to my husband, who also agreed it looked exactly like it. There has been no other tisse or clots passed since. Could I possibly have just miscarried again & passed the feoteus or are you more likely to pass the sac & not known what it really was? This was quite a disturbing sight & I would really appreciate your expert advise. Many thanks
At Tue May 15, 09:43:00 PM 2007, Anonymous said…

Thank you for answering my question on (Mon May 07 11.55.00pm)I have been back to my doctor for another blood test and the result showed that my levels have gone up and that I am still pregnant. I am still bleeding and i am going back tomorrow for another blood test. I went to our local hospital ER a couple of days ago because the bleeding had increased. again my levels have gone up a couple of points but the ultrasound still showed nothing. they sent me home. I am now worried about what you said about an ectopic pregnancy. Would i be experiencing pain now? I have what i would call mild period pain with the bleeding but nothing really bad. I dont know what to do.
At Wed May 16, 06:35:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

With that history, I am afraid that you either have miscarried, or will do so in the near future. I am so sorry...
At Wed May 16, 10:20:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

I am concerned by the slight rise in your pregnancy hormone (hCG) level. That should ordinarily double every 2-3 days at this point. If yours is going up slowly, you have either an inevitable/incomplete miscarriage or an ectopic pregnancy. Usually an ectopic is accompanied by persistent discomfort that can get quite intense. Do they see any evidence of a pregnancy within your uterus by ultrasound or any masses in your pelvis?
At Wed May 16, 04:09:00 PM 2007, Patricia said…

Hello, thank you again for answering my questions.I have a corpus Luteum in my left ovary but that is all they could see. My uterus had thickened up but no over evidence has been seen in both of my untrasounds.I am going back to my GP today hoping for some answers.I want to thank you again for what you do. To take the time to answer all of our questions and for free makes you a remarkable person in my books.God bless you.
At Thu May 17, 10:43:00 PM 2007, Patricia said…

I have again been back to my Doctor and my HCG level is upto 550(Thurs), which is up from 398 on Tuesday. I have no pain, although i am bleeding he has suggested I come back next wednsday and repeat my bood test and see what my HCG level is and if it is still going up i will have another untrasound.On my first untrasound two weeks ago a small bump could be seen but it was not conclusive. My Doctor says not to measure everything against my HCG levels as the rate they go up and the actual level can vary alot between people. Do you agree? What does the effect of low HCG levels cause to the growing baby? Doest it cause birth defects?thank you for your time once again.
At Fri May 18, 07:42:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Patricia, based on your first comment on May 7, you should be at least 7-8 weeks pregnant at this time. I am not going to try to second guess your doctor on this, but the hCG level is about 5-10 times lower than it should be for a normal pregnancy at this point. There is variation among pregnancies, but not this much. It should be easy to see a pregnancy with a heart beat by ultrasound if it is in the uterus and growing normally by this time. hCG is the "pregnancy hormone" that we measure in all pregnancy tests and it is made by cells called trophoblasts that form the placenta. If your hCG is low,it is because you are either not as far along as expected or there are too few trophoblasts or they are not able to produce normal levels of hCG. Low hCG does not cause birth defects. There is a small chnace you were not pregnant earlier and therefore not as far along as you thought, but with all the bleeding you have had, I still think it is much more likely this is a pregnancy that didn't get off the ground, or could still be an ectopic pregnancy that is just smoldering along. Again, good luck with things. At that low level of hCG you are probably not in any great danger right now even if you have an ectopic pregnancy.
At Mon May 21, 01:46:00 AM 2007, Patricia said…

Thank you again for taking the time to answer my questions. I have over this weekend had a miscarriage which my husband and I are now trying to come to terms with. I know that this one was not eant to be. We will try again when I have recovered and I hope to be able to post a good comment to you in the future. How long should i give my body to recover fully before we try again to give us the best chance. Thank you again for your advice. God bless you.
At Mon May 21, 10:09:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Hello again Patricia. I am sorry for your loss but glad it was not an ectopic pregnancy. In anticipation of 'trying again,' continue taking your prenatal vitamins and try to wait about 3 months before getting pregnant (until you have had at least two normal menstrual periods). At least that's what I usually tell my patients under these circumstances.
At Mon May 28, 04:49:00 PM 2007, Anonymous said…

I have had 2 miscarriages occuring within 5 months of each other I was told that they were both a blighted ovum. Before I miscarried the first time I found out that I had type 2 diabetes could this have been a factor into both miscarriages? Can you please explain this to me and tell me what I need to do to try to concieve again I want another baby so bad.. Thank you for your time.
At Tue May 29, 07:54:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi there. You didn't tell me if you have had a successful pregnancy (or pregnancies) in the past or if this is a new partner. Anyway, I suggest getting your diabetes in tight control (diet, exercise, and medication as needed). Get your thyroid function checked. Then start a prenatal vitamin with supplemental folic acid (2-4 mg per day) because of your diabetes and the increased risk for birth defects in diabetics that might be reduced by folic acid (neural tube defects and heart abnormalities). Ask your doctor about starting a baby aspirin (81 mg) each day as well. Good luck!
At Wed May 30, 08:23:00 PM 2007, Anonymous said…

I have a 5 year old child and have been trying to have another for over 3 years. I have had around 10 very early misscarriages. My Dr. has me on 81 mg. aspirin a day and folgard. I recently had a hysteroscopy and they removed polypoid tissue. The Dr. said that would not have caused the misscarriages. What do you think my chances of having a baby are? I am 36 years old! Thank You!
At Thu May 31, 12:19:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

If you had polyps, these CAN be associated with miscarriages, especially if they have become inflammed. They can act like an IUD inside the uterus. I am still concerend that you may need more help than you are going to get with aspirin and Folgard. At age 36, your 'biological clock' is ticking very fast and your chance of conceiving begins to go down quickly (just as the risk for a baby with a chromosomal abnormality rises dramatically at this time in our lives). If you have not sought out help with a physician who has a special interest in recurrenet early pregnancy losses, I would recommend you do so sooner than later. In many communities, a specialist in Reproductive Endocrinology and Infertility (REI) is where you should start.
At Sat Jun 02, 10:28:00 AM 2007, Anonymous said…

Thanks for responding Dr. Trofatter! I have been seeing the infertility dept. at Kaiser for two years. What other medication's do you think I need? (besides Folgard and aspirin) I really don't think I am getting the best care with Kaiser. Thank you for your response!
At Sun Jun 03, 06:31:00 PM 2007, Andrea said…

I appreciate the above post from March 15th. My first pregnancy has also ended in a m/c at 6 1/2 wks on May 15th. I was having symptoms of an ectopic (intense & increasing ab pain, more on left side) and had been spotting for a couple days so I was sent for an emerg u/s. After they did an abdominal u/s I was asked to empty my bladder and I gushed blood and clots. They then performed a transvaginal u/s which showed a small retention of tissues, which I passed on my own over the next 4 days. I then had another u/s a week later to confirm everything was complete and it was all ok.

The findings from the first u/s said I likely have a arcuate or bicornuate uterus and also a 1cm x 1cm cyst on my left ovary was found (the gync. said it was likely a corpus luteal cyst?). Should I have these findings further investigated?

Also, on the first abdominal u/s there was no evidence of an intrauterine gestation, did I experience a chemical pregnancy?

I am a very healthy 26yr old who, along with my husband, yearn for children. Do we have a chance?
At Tue Jun 05, 05:18:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Response to anonymous from June 2: If you have infertility doctors and they have been seeing you for several years and only have you on Folgard and ASA, you might want to get a second opinion. You have the right to ask! Your doctors surely know that you are running out of time as well. Have they considered stimulating your ovaries, i.e., "superovulation" with or without IUI (intrauterine insemination) or are you a candidate for IVF? As far as your 'empiric treatment' (the folgard and the ASA) is concerned, consider asking them to add heparin or low-molecular weight heparin to the mix! Good luck again and thanks for the feedback!

Response to Andrea from June 3:
Andrea, you probably had a "blighted" ovum that never much got off the ground. It was a little more than just a "chemical pregnancy" from what you described. These are often chromosomally abnormal babies, or in your case, the result of the fact that this was your first pregnancy. The cyst should be nothing to worry about. It was probably simply the site from which the egg developed that became your first pregnancy, i.e., a corpus luteum or CL cyst. If you really have a bicornuate or subseptate uterus, you are not only at increased risk for miscarriages early, but increased risk for later miscarriages in midtrimester and premature delivery as the result of cervical incompetence. So don't get complacent on this possibility (i.e., keep your doctor vigilant - have her/him check your cervix by ultrasound in midtrimester) even when you get through first trimester which I am sure you will, probably with your next try! I have some other posts on these subjects over the past year if you care to check them out.
At Thu Jun 07, 09:58:00 PM 2007, Anonymous said…

Thanks again Dr. Trofatter for answering my question!! With the "superovulation" do you mean something like the "Gonadotropin chorion" that they have me inject the night before the IUI? Three days after that I start the Prometrium. In June 2006 I got pregnant with triplets and made it 13 weeks ( that was the last time I used the Clomid). They never told me what may have been the cause. They did an autopsy on the one "baby" that came out at home. I will leave Kaiser a message about Heparin. I am willing to try anything. Thanks again! Nancy
At Mon Jun 11, 12:30:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Hello again Nancy. We are becoming old friends! Thanks for writing back and let me know how things turn out!
At Fri Jun 15, 12:59:00 AM 2007, Anonymous said…

Hi, My wife has just become pregnant and I estimate it to be 5 weeks since the first day of her last period. We are both very excited but my wife is telling everyone that she is pregnant and going to be a mother. I am concerned that there is a high percentage chance that the preganacy will not succeed. She says I am being daft as both her mother, my mother, her siter and my sister had no problems. Do these facts mean we have a better chance of it all going fine? I am worried that my wife will cope badly if she miscarries and that telling everyone at this early stage is not so sensible. Thank you.
At Fri Jun 15, 01:22:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

It's sometimes hard to contain the excitement, especially if this is a first pregnancy. Although the family history probably guarantees nothing at this point, I hope for the two of you that everything does go well! If it doesn't, there is no 'shame' or 'blame' in that and at least you both will have the support of the family. That is important for some folks, and your wife may be one of those!
At Mon Jun 18, 10:45:00 AM 2007, Anonymous said…

I too suffered miscarriage. I am 26 years old, and first became pregnant Nov 2004. i did have awful sickness and was admitted to hospital afew times. However at 17 weeks i had s gush of water. I went into hospital and was examined and everything looked ok and i was sent home. 2 days later i started to develop flu-like syptoms and within 10hours i was crying in agony and called an amubulance to then later discover i was miscarrying. My heart broke then and there. I had developed an infection and gave birth to my baby boy within hours. A post mortem was carried out and everything was normal. I went on to have various tests and they all came back normal as well. It was recommended that the next pregnancy i should be monitored closely and swabs taken every 2 weeks, and a test for cervical incompentence.

With all that we decided to try agin after 6-7months. I became pregnant again in august 06 and had a fair pregnancy. I was tested (high and low swabs) and everything was normal apart from alittle thrush. I had the internal scan to see whether a stitch was needed in the cervix. This was not needed as once again everything was normal. i was alittle nervous but i couldnt have been happier....until christmas day (20weeks) my waters broke again and i went into hospital. they examined me and said that my membrane had ruptured and they would observe me as baby could survive with little membrane. several days later scans revealed there was not enough water around baby and later on just b4 new years i was induced and gave birth to another baby boy.

I decided not to have a post mortem as the 1st miscarriage came back normal. test were done once again revealing nothing. i cant explain the torment i go through. no answers.....? the doctors just tell me there is nothing medically wrong with me? so why do i miscarry then i ask? nobody can tell me....has anyone experienced this? Does any1 have any advice?
At Tue Jun 19, 05:30:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous from June 18: I am not completely sure why you have had these problems,but I am quite sure that there was nothing wrong with your babies. Before you get pregnant again, I suggest that you have a specialist in infertility evaluate the uterine cavity to rule out a uterine septum, polyp or fibroid. After you get pregnant, I would have another specialist place a very good cerclage in your cervix at about 13 weeks; then have that person follow you with cervical lengths by ultrasound. This is one situation in which I suggest that you DO NOT have intercourse during the middle part (15-28 weeks) of the pregnancy. Don't ask me to explain that right now! Despite what you have been told, this is still most likely the result of cervical incompetence. By the way, is there any family history of connective tissue disorders such as Ehlers-Danlos??? Anyway, thanks for reading and good luck.
At Thu Jun 21, 04:02:00 AM 2007, JJ said…

A question- I have a 10 month old baby and got my first post-partum period on May 3rd, 2007. I was also still breastfeeding at the time. The only day in May that my husband and I had intercourse (or did anything at all that could have made me pregnant) was May 26th. I would have expected my next period to arrive either May 31 or June 1, but it did not come (I did usually have regular 28-29 day cycles). Took an HPT June 2- negative. Started having pregnancy symptoms June 5. Took another HPT June 7- positive and another June 13- positive. But how did I conceive 23 days after the start of my period? According to my doctor, based on LMP, I should be 7 weeks now, but that's impossible. Also, 2 days ago, my symptoms disappeared- breast size reduction, no more queasiness, energy level up. No bleeding, but I am concerned that something is wrong- with both the date of conception and with the baby. If it matters, I also stopped breastfeeding on May 28- which I had planned to do anyway since he was losing interest.
At Thu Jun 21, 06:38:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

You conceived 23 days after you started your period because that was when you actually ovulated. It is not unusual while breast-feeding that ovulate at times very uncharacteristic of your usual cycle. That's why we tell women they cannot use the "rhythm method" while they are nursing (probably never should depend on that anyway!). The fact that you "don't feel pregnant anymore" may indicate you have had a very early miscarriage (but don't count on that entirely either). Women who do not ovulate in midcycle regularly have higher rates of miscarriage for lots of reasons, often the result of the endometrium being out of synch and not as receptive to the embryo as it is under ideal circumstances. You might want to see your doctor, have them run a quantitative hCG (pregnancy test) and then if you are not pregnant, get something for birth control if you don't want to be! Thanks for reading!
At Tue Jun 26, 05:45:00 PM 2007, Anonymous said…

39yo IVF'er (G2P1001) with now missed abortion. Bled weekly (1d to 4d), although heaviest about week 3 for few days. Couple tiny (mm sized) clots one day last week. Early US showed small GS (esp compared to YS) usually lagging one week. At what should have been 6w4d, tiny fetal pole and no beartbeat (size 5w5d est) seen on TVUS. Recent US (travel intervened) at what should have been 8w EGA with no HB. Presumably chromosomally abnl but why the increase/persistence in nausea over the past week if hcg levels presumably decreasing (and now off progesterone too after recent US - awaiting d+c in few days)?
At Wed Jun 27, 04:44:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous June 26: Sometimes the placental tissues will continue to grow and make hCG even after the baby is lost. That's why some women will go for weeks sometimes before they realize the pregnancy didn't make it/ I imagine your symptoms will begin to go away soon. There is another possibility as well. Sometimes you can have an ectopic (tubal) pregnancy coincident with an intrauterine pregnancy that continues to grow and also makes hCG. How many emvryos did they transfer? Sorry for your loss and thanks for reading.
At Wed Jun 27, 08:06:00 PM 2007, Anonymous said…

Thank you. It was three although quality not as good as with prior success. Doubtful ectopic in this case given evidence of only small fetal pole intrauterine and nothing abnl outside.

Appreciate your opinions.
At Sun Jul 08, 02:02:00 AM 2007, Anonymous said…

Hello Dr.
I've had a miscarriage just a week back. It was my first pregnancy. Its ust been 4 months to my marriage. I am 25 years old.
my last period date was 9th May. Can u tell me that by 28th june how many weeks should have been my pregnancy.
On 28th i saw some blood in my urine. Went to Dr.She gave me some medication & asked me to get sonography done coz acc. to her i was 7 weeks pregnant(1 month 20 days). next day i got my sonography done which said that i was 5-6 weeks pregnant & there was no fetal echo. the Dr gave me some medicines and asked me to wait 4 10 days. But the same afternoon i had a lot of bleeding and with that i passed a big peice of tissue. i knew that i've lost my baby and i cried a lot. next day i had my D&C done in a nearby nursing home.
After my D&C i m experiencing some pain in stomach ne time of the day and the bleeding is still there. Can u tell me how long will this state continue?
Does trevelling by air and train, wearing heels, eating food outside, sexual contact with my husband, & a very bad cold & cough be the reasons for my miscarriage. or its something else. coz it all heappened in 2 days 26th & 27th. but on 28th according to my Dr. my fetus should be 7 weeks & my sonography says 5-6 weeks.
Now my Dr. will take up some tests 2morrow to find out the reasons 4 my miscarriage. Are they Important 4 me?????
Do reply as soon as possible coz it might happen that my tests would take place before i get the chance to read ur suggestions.

But Still i am eager to know what u have to say about this. Do reply i will wait for ur expertise on my issue.
Take Care
At Tue Jul 10, 09:22:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous July 8: I am so sorry you lost your pregnancy. It is always hard, but especially if it was the first one. Yes, you were supposed to be about 7-8 weeks pregnant (we count weeks from the first day of the last menstrual period if you have regular cycles every 4 weeks). Your baby was lost at 5-6 weeks. There is probably NOTHING wrong with you and none of the things you are concerned about were likely to have caused the miscarriage. The loss was probably the result of this simply being your first pregnancy (see my comments in the blogs about high rates of pregnancy losses with first pregnancies). Your bleeding and cramping should stop within a few days unless there were some other complications of your D&C or you have an infection. I usually do NOT recommend an expensive medical work up for first pregnancy losses because the likelihood of finding a problem is small and the odds are in your favor that the next time will be better. Good luck and thanks for reading!
At Mon Jul 23, 03:38:00 PM 2007, Nancy said…

Dr. Trofatter,
You asked me to let you know how things turned out from your "June 11th" message! I had another misscarriage from my last insemination (my level was only 31) two weeks prior. The infertility dept. gave up on me and said not to try again. I am crushed (we tried for over 3 years). What do you think?
Thanks again! Nancy
At Mon Jul 23, 06:12:00 PM 2007, Anonymous said…

I have had 2 miscarriages in the past year. The first was at 9.5 weeks and the second at 10 weeks (both with my husband). We have no history of live births. Both times, a heartbeat was seen at a 9 week ultrasound, where the beats per minute was average and the size of the embryo was also average. I've read after a heartbeat is seen (by transvaginal ultrasound), the risk of miscarriage greatly decreases. What are possible reasons for my miscarriages? I want testing to be done, but am afraid my health ins will not cover it because I've only had 2 and not 3. I am 31 and am feeling the pressure to have children before my late 30's. Thank you.
At Tue Jul 24, 07:10:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous July 23: The two most likely causes of miscarriages in your case are chromosomal abnormalities and what I like to term as an 'inappropriate immune response to pregnancy.' Chance usually takes care of the first and time (and unfortunately, miscarriages) the latter. Wait until the next pregnancy before you go through an expensive evaluation. Read my last posts in this series to get some idea of what diagnostic and therapeutic options are possible in your case. Consider asking your doctor about trying some of the approaches I discuss in "Empiric Therapy." Good luck and thanks for your question. Dr T
At Fri Jul 27, 05:20:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Nancy July 23: There are still more options. Consider getting a consultation for a 'second opinion' with another provider who has a special interest in this problem. One option you might consider, other than 'no holds barred' empiric therapy, would be to undergo IVF but hire a 'surrogate' to carry the pregnancy for you. Just a thought!
Sorry for all the trouble you have had. Dr T
At Sat Jul 28, 07:36:00 AM 2007, Anonymous said…

I am 10 days past my period due date. At 5 days late, a +/- blood test came up negative. Two days later, it came up as level 6 HCG. Two days after this (yesterday) it came up as HCG level 44. When the fertility nurse called and told me this I was happy, but she unenthusiastic and said its probably a Chemical Pregnancy. I am going for more blood work on Monday. I do not know when I ovulated (so unsure if my levels are lower then where they should be). My question is, based on the symptoms above, should I have any hopes that this is a normal prenancy? Thanks...Amy
At Mon Jul 30, 05:12:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

Amy, although the levels are low, that would be a good rise in 2 days! I cannot tell you if this is a good pregnancy or not. But you simply could have ovulated later than you thought. Good luck!
At Tue Jul 31, 01:27:00 AM 2007, Anonymous said…

Hi Dr. Trofatter, I appreciate your being available to field questions from all of us very worried pregnant ladies. I just started 8 weeks (LMP 6 June) and am concerned about my HCG levels rising but not doubling; 24 July - 3600, 26 July - 4470, 30 July - 5337. I have had very mild pregnancy symptoms too and had had some mild brown spotting 3 weeks ago which was what made me realise that I might be having a m/c even though I didn't know I was pregnant. I have not had an u/s yet, but based on your experience could this slow rise indicate a pending m/c? I had a very early m/c back in January. Thanks, Blissenz
At Tue Jul 31, 10:38:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous July 31: Yes, I am afraid the slow rise in hCG could indicate that you will miscarry. Your doctors should be able to tell you now by ultrasound if the baby is alive. Rather than getting serial hCG, why don't you just ask if they wll do the ultrasound. Good luck and thanks for reading!
At Tue Jul 31, 08:42:00 PM 2007, Anonymous said…

I have had three early m/c's. I just got done with testing and was told that it was "bad luck". I'm not sure if I'm ok with that diagnosis, but am ready to start trying again. My doctor did put me on progesterone starting at 3 DPO, and 81 mg of baby aspirin to be on the safe side. I have also been reading about Folgard being of help in some circumstances. I was wondering if it is ok to take it along with prenatal as a "reasurrance measure", or is that too many vitamins while pregnant?
At Thu Aug 02, 11:26:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous July 31: What testing did your doctor do? "Bad luck" is never a good answer. There ARE reasons for everything, even if we cannot identify the problem easily. The Folgard is fine. I usually just put my patients on high dose folic acid (4 mg) in addition to a prenatal vitamin and the aspirin. But, if this pregnancy does not work out, you might want to find someone who can give you a "second opinion" as to why. Good luck this time and thanks for reading! Dr T
At Sat Aug 04, 05:32:00 AM 2007, Anonymous said…

I am 39 years old. I have had hypothyroidism since my twenties.
At 33 and 36, I had two healthy babies.At 39 my third pregnancy ended in miscarrige after 8wks, I miscarried at home with no tissue samples taken. I got pregnant the very next cycle again and miscarried at 6wks again at home.I was taking prenatal vitamins and my generic synthroid. I waited 3months to try a third time. We got pregnant again. I went to a new dr who checked my progesterone and found it low in my 7th or 8th week and had me take natural progesterone up to the 14th week.We had seen a heart beat and all seemed well.It was shocking at a routine 15th week visit when no heartbeat was found.I had a D&I and they will do testing on the placenta. I would like to know what could have caused all this. What my chances for a heathy pregnancy will be and did I do something wrong to cause this. I worked out on a treadmill careful to keep my haert rate below 140 and swam almost every day, I have a five year old and two year old that I pick up and do lift heavy things just as an every day mom. Could I have caused this? I drank occasionally on weekends prior to the pregnancys and no alcohol when pregnant.

Judy
At Tue Aug 14, 05:24:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Judy Aug 4: Our fertility decreases with age for reasons that are not completely understood. In some cases it is simply the increased risk for having a chromosomally abnormal baby; in some, it is decreased production of hormones; in others, thet might have developed an intrauterine fibroid or polyp; or, you may have another medical problem that has not been identified. Is the father of the miscarriages the same as the father of your children? There are so many things that need to be checked out ASAP at your age that I strongly suggest that you find a specialist in Reproductive Endocrinology and Infertility if you want to do everything possible to have another baby. I sincerely doubt the alcohol or exercise had anything to do with your losses. Best of luck and thanks for reading! Dr T
At Fri Aug 24, 06:16:00 PM 2007, Anonymous said…

just wondering about my case. I am 1 week past my period due date and am pregnant with 8/22 hcg being 390 and 8/24 being 610, I began bleeding red three days ago. Not enough to be concerned but it hasn't stopped yet.There are no clots but some cramping like period cramps. The doctor doesn't seem concerned but I am worried. Is this a sign of miscarriage? What should I look for if it is and could this be implantation bleeding?
At Mon Aug 27, 06:18:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Aug 24: Your doctor may not be "concerned" because there is nothing he/she can do at this point tha might improve your chances for carrying this pregnancy and, unfortunately, it is a situation with which they must deal on almost a daily basis. The simple answer to your question is that the bleeding you are describing seems a little heavy for 'implantation' bleeding, so you are at increased risk for miscarrying. Is this your first pregnancy? Anyway, I hope I'm wrong. Thanks for reading and best of luck. Dr T
At Sun Sep 02, 09:31:00 AM 2007, Anonymous said…

I found out from my OB today that I miscarried (I found out I was pregnant on 8/22, and began bleeding on 8/29, he ordrered a hCG level test which went from 12 to 2 in a 48 hour period, therefor confirming a miscarriage). I have had only two other pregnancies, which resulked in two healthy chidlren (now 4 years and 21 months). Anyway he said I had to wait for my next menstral cyle to start trying to conceive again - why do we have to wait?
At Tue Sep 04, 05:55:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Sept 2: I am sorry for your loss. Since you have had other normal pregnancies, the overwhelming odds are that this baby you lost was chromosomally abnormal. You lost this pregnancy so early (very low hCGs) that it probably wouldn't make any difference if you "tried again" during the next cycle. But, I too usually suggest that a woman wait for one normal period before trying again, just to give any 'inflammation' that was associated with the recent loss a chance to resolve to improve the probability of successful implantation the next time around. Waiting also gives your hormones and the endometrium a chance to get back in 'synch' and this too might improve the chances for a successful pregnancy. Thanks for reading and for a good question that, I am sure, is on the mind of many women who are in a similar situation! Best of luck on the next go-around! Dr T
At Tue Sep 04, 08:35:00 PM 2007, Seema said…

I am 31 years old. I have a healthy baby boy, 4 years old. My first pregnancy resulted in a missed abortion where we had waited up to 8-9 weeks for a heartbeat and then did a D&C. My second pregnancy was healthy and I delivered a baby boy. My third pregnancy, at 7 weeks i started having cramps and spotting, which they called a threatened abortion, and i eventually had a complete abortion. again, in my fourth pregnancy, there was very good heart beat at 6 weeks 4 days, but when i went for a scan at 10 weeks, they said the fetus stopped growing at 7 weeks 4 days and they put some tablets vaginally and did evacuation. I had so many tests done including toxoplasmosis, CMV virus, herpes, anticardiolipin antibody, antiphopholipid antibody, lupus anticoagulant, antithyroglobulin antibody, thyroid function test etc. and everything came back negative. Now I am 10 weeks pregnant. My doctor has started me on subcutaneous low molecular weight enoxaparin from 4th weeks itself. He says I may be having some immune problems which causes these abortions and enoxaparin helps prevent this. But I am having a doubt, if i have some immune problem, how could I have a normal pregnancy and a normal kid? If the immune problem started after my son was born, then what about my first pregnancy which i lost before my son wasborn. Is it possible that such a immune problem caused my first pregnancy to miscarry and then the immune problem remained inactive during my normal pregnancy and then started acting up again wiht my 3rd and 4th pregnancies? The last doctor i was going to had asked to do a genetic testing for both me and my husband, but we did not do it since it was very much expensive. currently i am taking low dose aspirin 81 mg, low molecular weight enoxaparin 20 mg subcutaneous per day, and folic acid. My doctor says enoxaparin helps increase the blood flow to the baby, if it is so, then how will it increase the blood flow from 4-8 weeks when the placenta is not matured? Is there blood flow between the yolk sac and the baby? If i lose my pregncies due to chromosomal abnormalitiies, what will be the chance with my current pregnancy as now it is 10 weeks. Up to which week can i miscarry if i have a chromosomal abnormality? Kindly answer my concerns. I will be extremely grateful to you. Thanks a lot in advance.
At Thu Sep 06, 05:34:00 PM 2007, Anonymous said…

Dr. T,
Thank you so much for the response (I asked about a miscarriage and waiting a month to try to concieve again - Septmeber 2nd) - I would've asked my OB, but when I received the news I had miscarried, I wasn't really paying attention after that. Now I understand and we'll wait!
At Thu Sep 06, 05:52:00 PM 2007, Anonymous said…

Hi. Thank you for answering all these questions. I also had a question regarding Methotrexate. I was injected with a dose of Methotrexate on the 25 of July, 07.
I was told my 6 week pregnancy was eptopic and needed to be termenated. One week later I was still pregnant with rising HCG levels. I went to the Hospital, had an ultra sound done, and was told I did not have an eptopic pregnancy. I was about 8 weeks along with a living fetus in my uterus. They showed me the fetus with a strong heart beat. Two days later, on Aug 3, I was given a DNC to end the pregnancy. My husband and I would like to try again. We have three boys, I had one miscarriage my second pregnancy, but the others have been normal. I started my period on September 5. It's pretty heavy. I was wondering if the Methotrexate is out of my system now. Can we try again, or should we wait until after my next period in October? I'm having such a hard time thinking about waiting, but I do know it's important to be careful. I also read taking one baby asprin a day until concieving can help the uterus is this true. Thank you.
At Sun Sep 09, 06:21:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Sept 6: Ever since methotrexate became popular for treating ectopic pregnancies, I have seen this unfortunate scenario played out time and time again. You are probably 'safe' now, but I would suggest waiting until after your next period, starting supplemental folic acid 4 mg/day (methotrexate is a folate antagonist) to reduce your risk even more, and go ahead, throw a baby aspirin 81 mg into the mix as well as a prenatal vitamin. Start all of this BEFORE you try to get pregnant and continue through the first trimester. Good luck next time and let me know how things turn out. Thanks again for reading. Dr T
At Thu Sep 13, 09:27:00 AM 2007, Mark said…

I would like to know what the consequences of laser hair removal, aspirin, ibuprofen, and oral contraceptives are to a new pregnancy. My last period started August 1 2007. I had my first round of laser hair removal from my upper lip on Aug 28 (I took a pregnancy test that day and it indicated negative). A week or so later I took a couple aspirin for a headache and a couple ibuprofen that evening for cramps that I thought were premenstrual. I just tested positive for a pregnancy with a urine test, but it was undetectable on an ultrasound. (I think I should be about four weeks pregnant based on my LMP. I am having some pains like I normally do when I ovulate. Should I schedule an appointment to be sure I am not experiencing an ectoptic pregnancy or just wait? If I am patient and it turns out that I have a uterine pregnancy, have the above drugs and treatments endangered my fetus and to what degree? I am 30 years old and have never conceived before. Thank you for your time and advice.
At Thu Sep 13, 04:45:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Mark Sept 13: This is a little early to have symptoms related to an ectopic pregnancy. But, if you are having any pain or bleeding, you should contact your doctor. If this is your first pregnancy, you are at high risk for miscarriage, but I doubt any of the treatments or medications you had would be a cause for that if it happens. Good luck with your pregnancy and thanks for reading! Dr T
At Mon Sep 17, 06:34:00 AM 2007, Anonymous said…

Hi Dr T,
This is Anonymous Sept 6. Thank you for answering my question so quickly. I had one more question. I had an ultra sound done on the 1st of August. The radiologist saw a 1cm left parovarian cyst, in my right fellopian tube. Do these typically go away on there own? Can I get pregnant if it's still there? Can it block the fertilized egg from entering the Uterus? The cyst is right inside the opening to the uterus snug against the tubal wall. I have had no pain. Thank you.
At Mon Sep 17, 07:22:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Seema Sept 4: I apologize for the delay in addressing your concerns, so I devoted all of my post on September 17, 2007 to your many excellent questions. I hope I have given you some answers and some reassurance. Let me know how things turn out, okay? Dr T
At Mon Sep 17, 07:24:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Sept 17: A paraovarian cyst is OUTSIDE the fallopian tube and the uterus. They rarely grow large enough to cause pain and it should not interfere with your getting pregnant. Good luck! Dr T
At Thu Sep 27, 01:33:00 AM 2007, Anonymous said…

With a blighted ovum diagnosed at 7.5 weeks... have had brown discharge since week 6... am now in week 10.5, wondering when should one expect to miscarry?
At Fri Sep 28, 11:34:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Sept 27: I would hope soon. Have you considered either a D&C or medical therapy with misoprostol? The longer you wait, the greater your risk of complications related to infection that could impair future fertility. I am sorry for your loss. Thanks for reading. Dr T
At Fri Oct 26, 12:44:00 PM 2007, sgchick said…

Hello,
I'm Vietnamese, very healthy, don't smoke or drink. I'm 37 yrs old and had a son with my 1st husband at 16, he's healthy. I've been on b/c for a long time and got of it for 2 months, used protection and took 1mg folic acid daily. My cycle is normal 28-29 days with light flow. My husband is a healthy Caucasian 33 yrs old. I got pregnant right after went off protection but had a miscarriage at about 10 wks but I think the fetus died a few weeks earlier. 1 cycle later, I'm pregnant again, at 4wks beta was 437, 6 days later it was a low 565 and 2 days later was 906. What are my chances with this pregnancy? If this were to end in a m/c, how long will it take sa my leve is still going up and should I request for an u/s to rule out ectopic? What are my chances of normal pregnancies in the future since it seems I don't have a problem getting pregnant, just stay pregnant. Should I request for genetic testing since I'm with a different partner and perhaps this will be a consecutive miscarriage? I know there are a lot of questions but anything can help me to ease the stress and anxiety I'm going through right now.
Thanks so much!
At Mon Oct 29, 09:21:00 AM 2007, Anonymous said…

i have 2 children 12 & 9 had a tubal 9 yrs ago am now 7 wks pregnant a etopic has been ruled out but im having to go every wk for hcg levels and they're only rising by 30 point every time.63 93 123 the dr only gives me bad news that i'm going to lose it after some research it seems it's possible for everything to be ok,will it what's going on?
At Thu Nov 01, 11:36:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous OCT 29: Those are not normal levels nor normal rises for hCG ta this point in pregnancy, so even if this is not an ectopic pregnancy, the likelihood of spontaneous miscarriage is VERY high. I am sorry. Thanks for reading. Dr T
At Mon Nov 05, 04:38:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To sqchick Oct 26: I am afraid those hCG levels are not rising normally, so this is most likely a nonviable pregnancy either intrauterine or ectopic. An ultrasound might certainly help sort that out. I think your greatest enemy at this point in your life is your age. The risk of chromosomal abnormalities goes up and fertility drops for reasons unrelated to chromosomal abnormalities in conceptuses as well. I think it would not be a bad idea to discuss things with a genetic counselor. They are a source of support and very good information. Thank you for reading and for your questions. Best wishes. Dr T
At Mon Nov 05, 11:25:00 PM 2007, Anonymous said…

HI, my name is Leanne. I went to the doctors on Monday after having brownish discharge on Saturday which by Sunday had turned into Red bleeding but only when I wiped after going to the toilet. By my records I thought I was 6w5d but when having an u/s this showed up only 5w (my last period starting on the 19th sept) .. They used a prob to dectect the fetus which the lady doing the u/s said she could not find a heart beat for, also informing me that it looked as if the baby was trying to abort itself. My question being it is now Tuesday still have bleeding but only when wiping and on had a couple of clot one which was very dark brown and the other dark red.. I have to go back and have my bloods done again tomorrow and and u/s not Wednesday if no change .. is it likely that this will end is misscarrige or maybe carry through.. I have a 4.5yr old little boy.. but was preg. last year in oct 15wk with Trismony 21 baby we sadly choose to terimate.. Dec 18th not knowing I was pregnant I miscarriaged at 5.5wks.. some fresh advice would be nice do I loose all hope or hold on as 5wks my be to soon to even hear heart bet..Thanks Leanne.
At Tue Nov 06, 12:38:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Leanne: Why don't you wait to see what they find at your next ultrasound. At 5 weeks, it can be hard to see the fetal heart activity. If the baby hasn't grown and a heart beat is not found at that time, then you will know for sure that you have lost this pregnancy. Sometimes bleeding early in pregnancy is simply 'implantation bleeding.' We will be pulling for you. Dr T
At Thu Nov 08, 08:53:00 PM 2007, Anonymous said…

Wow, this is fantastic!! I finally found a site with recent postings that has an expert to answer questions. How God sent!

Anyway, here is my situation. I am 38 years old, and my husband is 58. He had a vasectomy reversal 2 years ago after 26 yrs. Mechanically it worked, but antibodies have inhibited his mobility, thus ICSI was the only solution.

Upon my first cycle, my basal levels were the following: FSH = (5.19)most recent, 4.0 (1.5 years earlier. Basal Estradiol = 40.19. 19 to 21 antral follicles. I responded very well to stimulation, and was at risk for OHSS. I procurred 24 eggs at retrieval, of which 21 were mature. Fifteen of them fertilized, and 12 made it to blast on day 6. Three blasts had been transferred on Oct. 30, and on November 7, I had a blood test that revealed only 10.7 HCG. The lab nurse that called me told me that this was quite low, and asked me if I was experiencing any cramping or bleeding. Well, it is now two days later and I go for a second beta hcg. tomorrow Nov. 9

What is going on here? How is it that I had a perfect stim cycle,retrieval, etc. and then test postive, but have only a 10.7 hcg. This is not my first pregnancy, I have a 13 year old son from prior marriage.

Please give me the cold truth! Is it possible that I implanted later? Is there any possibility that this could be a normal level for me? I have no cramps, no bleeding, nothing. I feel great! I had a chemical pg. years ago., and I got very sick with temperatures, etc., and had my period as usual on time. I would have never known b/c I went to the hospital thinking I had some infection in my uterus b/c it was on fire!!! When they asked me to take a test for pregnancy I told them that it was an impossibility b/c the guy I was with back then had a vasectomy as well. But to my surprise it was a chemical pg. that ended in fever, pain, but a period at the right timing.

Please tell me what you think about this number absent pending results from tomorrows test.

Here is my real question: Have you ever seen anyone with such low HSG as mine after 9 days past transfer of 6 day blasts, end in a viable pregnancy?? Is it possible that 10.7 is normal for me?

You don't know how much it means to me to hear from you. I am real anxious. :-)

Thanks,
L.J.
At Fri Nov 09, 11:21:00 PM 2007, Anonymous said…

I am a 32 year old mother of four live children. We just had a pregnancy that ended in a miscarraige last week at 12 weeks, but the baby had died around 9 1/2 weeks. Around that time, I woke up one morning to the smell of gas in our home, which I found coming from the stove. Could this have been a factor in our loss? Also, I have had two other miscarraiges, one with our first baby, and the other with our fifth pregnancy. They think my second was due to hypothyroidism, which I developed with our fourth pregnancy (third live birth). Also, my fourth baby was conceived 11 days after our second miscarraige, resulting in a term birth. I did have placenta previa in the beginning, but it cleared up. Is there any contraindications to becoming pregnant right away this time too? I did have a D+C due to horrendous hemorraging. Any help is greatly appreciated.
At Sat Nov 10, 02:42:00 AM 2007, Anonymous said…

Hi my name is Leanne and I wrote to you on ( Mon Nov 5 11.25 ) regarding the fact that i may have been having a miscarriage as I started bleeding at 6.5 weeks but after having scan only showed at 5.5wks and after blood test found that yes I was going to suffer a miscarriage.. This is something I have now accepted it is my second miscarriage (I am 38 years) have a 4.5yr old but was also preg. last year with a trismony 21 baby .. did not go through with preg. my worry is this time it started 7 days ago today being Saturday and I still only have small amounts of bleeding. I guess I am not sure if I should just go to a hospital and asked to be check for a D & C as the last things we want to to have invection and something else go wrong .. as we do plan to try again..And do you know if there is anything to maybe help carry a preg. full term as I am worried I will go through this again.. I am taking ELIVIT preg. tablet to help my chances. Needed advice.. ??

Thanks for your time.. Leanne..
At Tue Nov 13, 06:05:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To LJ Nov 8: That is a very low hCG. I am afraid you ar at very high risk for simply having another 'chemical pregnancy' this cycle. Let us know how things turn out. I am sorry I have not been able to respond to your question before today. Best wishes. Dr T
At Tue Nov 13, 06:08:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Nov 9: Sorry about your recent loss. I think it is good to wait a month or two afte a D&C to allow the inflammation to recede and the endomnetrium to restore itself. That may increase your chance for a healthy implantation and reduce your risk for a placenta previa or accreta that could result in the loss of your uterus. Good luck to you next time and please let us know how things turn out! Dr T
At Tue Nov 13, 06:14:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Leanne Nov 10: Sorry to hear about your loss Leanne. There is a high likelihood that you lost this baby because it was also chromosomally abnormal. Unfortunately that is one of the down sides of aging. However, as we age, sometimes our hormonal levels suboptimal and decrease the chance of normal implantation as well. Rather than beating around the bush with this, I would suggest you find a specialist in infertility who will help you rather than taking on the entire responsibility yourself! Time is limited at your age and you need to make the best of it if you want a chance at another baby. Good luck! Dr T
At Wed Nov 21, 07:15:00 PM 2007, Anonymous said…

I just wanted to ask a question about folic acid. Back in August I lost a pregnancy at 8 weeks due to an injection of Methotrexate. I am pregnant again, I'm 11 weeks today. I've been taking the folic acid and prenatal vitamins Since december, I start my second trimester next week and wanted to know if I should continue taking the folic acid, if so for how long. Thank you!
At Fri Nov 23, 12:43:00 AM 2007, Patricia said…

Hi Dr Trofatter, We last spoke on May 21 this year when I unfortunaltely had a miscarriage.Since then I have had periods but they can last 7-14 days. I had an ultrasould yesterday but it showed no significant abnormality. My doctor has referred me to a gyno but I cannot get an appointment until January. I do have a question with one remark on my report it reads " there are two neighbouring follicles in the left ovary, larger 19mm in diameter with the left ovarian volume being 10cc. the right ovarian volume a little under 3cc". Does this mean my right ovary is not working correctly because of its size? Does the body ovulate from the left ovary one month and then the right the next or is it random..My GP couldn't tell me. Does one small ovary limit my chances of becoming pregnant? Thank you again for taking the time to read my questions.
At Tue Dec 04, 09:27:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Nov 21: I know I answered this question awhile back but for some reason, the answer didn't appear under your comment. Anyway, you probably do not need any more folic acid than is contained in a standard prenatal vitamin from this point on in the pregnancy. It wouldn't hurt to keep taking it if you are worried about things, but the major benefits of reducing risk for fetal malformations have either been realized (I hope so!) or not by the end of first trimester. Thanks for reading and again, I apologize for the 'delay' in my response! Dr T
At Tue Dec 04, 09:36:00 AM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Patricia Nov 23: Hi again Patricia. If your perods are that irregular, and variable in length, I suspect a 'hormonal' problem is contributing to both your irregular cycles and your pregnancy losses. Indeed, it could be as simple as a thyroid disorder, or you could have 'polycystic ovary syndrome'. The gynecologist will be in the best position to walk you through an explanation and the proper studies to determine what is going on. My suggestion would be to hold off getting pregnant while you are awaiting that appointment and evaluation. By the way, you do not necessarily ovulate in an alternating fashion just because you have two ovaries; nor should you worry about the "size" of the smaller one becasue that ovary may actually be MORE normal than the larger one that has the cysts! Thanks for writing back to us and hope things turn out well! Dr T
At Sun Dec 09, 02:39:00 AM 2007, Anonymous said…

Dear Dr T

I recently had an incomplete miscarriage at 5weeks @ 09/11. I was not scanned at my local hospital as they were too busy and I was left in A&E for 4hrs! My Dr had concerns that I was possibly suffering from an eptopic pregnancy due to the abdominal pain, shoulder pain and arm pains that I was experiencing. I now have a scan booked in privately tomorrow pm (10/07).

I had unprotected intercourse on the 21st and 23rd of November and have at (07/12)begun to feel rather nauseous over the weekend together with swollen nipples (no pain)slight abdominal pain and hightened sense of allergies (sneezing etc). I would have been due on my monthly period on Thursday gone (6/12) regular 28 day cycle. I do not know whether the symptoms are simply from a possible pregnancy or are from high hormone levels as this time I would normally have had a period. I have tested with a HPT and it was negative, however with my first baby born in 2004 my HCG levels were very low and a HPT did not detect I was pregnant until 6 weeks.

Could you please advise as to when I would expect my next period after a M/C and on the U/S scan, would anything be able to be seen in terms of a sac?

Also my doctor thought that I may have been suffering from an UTI infection after my M/C (due to continued pain in my abdomen and back)and on the (26/11) prescribed me a course 15 tablets of co-amoxcillin tablets. I am now worried that these tablets if pregnant will harm my unborn baby as they were taken during the crucial first two weeks of pregnancy. My doctor was aware of the U/P sex on the above dates in November. A week later my swab result for infection was negative. I feel that perhaps the doctor should not have prescribed these until the results of my test were back in the surgery. Can you please advise on this matter as I am worried?

I look forward to hearing from you.

Mrs J
At Fri Dec 14, 01:17:00 PM 2007, Kenneth F. Trofatter, Jr., MD, PhD said…

To Mrs J Dec 9: Most women will ovulate within 6-8 weeks following a miscarriage and can then get pregnant again (before even having another period). You could be pregnant now or you could just be having the effects (nipple tenderness, mild nausea) related to the progesterone that is made in the second part of the cycle following ovulation. Sometimes that can be exaggerated for a cycle or two after a miscarriage as well. With regard to the antibiotic, that is about as safe an antibiotic and as far as I am aware, it is not associated with and significant risks for birth defects. Good luckk and thanks for your questions. Dr T
At Wed Dec 26, 06:21:00 AM 2007, Anonymous said…

Dr. T,
I asked a question of you back in Sept. after my OBGYN had told me to wait one cycle after a miscarraige (ended at 5 weeks)before TTC again (in which you quickly responded and I thank you for that). I have had only two other pregnancies which have resulted in healthy full-term babies. Anyway, since I miscarried at the end of August my periods have been different. The week before my period is due I spot daily and then get my regular period for 4-6 days. Well, my husband and I decided to TTC after December's period, but now that's even off. I was due to get my period 12/20, took a HP test 12/21 (first thing in the am) came out negative. Thought period was starting 12/22, but had extremely light spotting (no more than the size of a quarter) and have had that spotting every other day since then. I took another HP test 12/24 (again first thing in the am) and still negative. Prior to my miscarriage I would have spotting the night before my period was due and then by noon the next day my period would start. I don't feel preganant (which with my other two and even the miscarriage I knew I was pregnant before I was even late or took a HP test), I know that's not a certain indicator of pregnancy, but I just don't feel it. My breasts have been soar, but the usually are around the time my period comes too. When should I call my OBGYN? And could any of this be a "side effect" (so to speak) of my miscarraige 4 months ago? My cycles are usually 28 days, once in great while 29-30 days. Thanks Jennifer P.
At Wed Jan 02, 08:51:00 AM 2008, Anonymous said…

Hello

I had a miscarriage Oct 23rd 07, i was 6.5 weeks along and the doctor could not find a viable pregnancy when he scanned me. my hcg's dropped and I was given tablets and also an injection to make me expel the contents of my uterus and rule out the slim chance of an eptopic. I had a period 5 weeks later (28 nov) and then ovulated 14 days later. My period lasted 2 weeks and the doctor thought I might have a slight infection so gave me Metronidazole just in case i did, but never did a swab or anything. Then i found out i was pregnant on the 25th dec. I had mild cramps like period pains and then yesterday (1st jan) I started my period, alhough the pregnancy test still says positive. I assume I have lost the pregnancy again. Was it too soon to try again or was it the antibiotics. My doctor was aware i might be pregnant as we were trying at the time, but said the antibiotics were safe in pregnancy. could there be an underlying problem? I have a 3.5 year old son, that was a normal pregnancy
At Fri Jan 04, 06:27:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Jennifer Dec 26: Sorry for not answering sooner, Jennifer, but Healthline has had some 'technical difficulties' and I JUST got your comment today (Jan 4)! Anyway, maybe your problem has resolved by now. I hope so. It almost sounds as though you have had either an anovulatory (no egg) cycle or some delay in the normal timing of ovulation. A uterine infection is also a possibility under these circumstances. Hard to say, but if the problems keep up, please go find your doctor! Take care.
Dr T
At Fri Jan 04, 06:35:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 2: I doubt the metronidazole caused you ro miscarry. It is more likely that the reason you were give the metronidazole, a possible uterine infection, was the problem. I usually recommend that women wait at least two full cycles before trying to conceive after a miscarriage. This allows time for all the pregnancy tissues to be expelled and for the 'inflammation' and possible secondary infection of those tissues to resolve. It is hard for a new embryo to implant if there is much inflammation within the uterus. I wish yiou better luck next time. Dr T
At Sat Jan 05, 09:43:00 PM 2008, DLK19 said…

Hi there,
Two months in a row I have had a positive pregnancy test and early bleeding, and then my HCG levels returned to zero. I also have a short LP after ovulation (~8-10) days. I suspect LPD and plan to start B6 supps and was thinking of progesterone cream. My question is, after I begin this treatment, how soon can we start trying again? Thanks so very much!
At Thu Jan 17, 09:24:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To DLK19: I suspect luteal phase dysfunction as well, but there are many things that can lead to that. Before suggesting a 'solution', I guess I would like to know what sort of medical work-up you have had to date. Sometimes luteal phase defects benefit from a combination of ovulation induction and luteal phase (and early pregnancy) support with progesterone. Thankls for writing and I apologize for the delay in my response. Hope this finds you well! Dr T
At Sun Jan 20, 12:09:00 AM 2008, Worried sick! said…

(spell checked)
Dr.T,
Lots of questions, please bare with me...

My history includes one healthy pregnancy with a different partner twelve years ago. Soon after, I utilized Norplant for my birth control. I kept the Norplant in for 11 1/2 years and removed in February 2007. I had it removed because I had been trying to get pregnant with my husband for about a year, to no avail. Our thought was that the Norplant (even though should only work for 5 years) was still doing it's job. I also had laser hair removal in the bikini area this past year. I am 35 (soon to be 36) years old. My husband is 43. I have been taking prenatal vitamins since my first miscarriage. I do not drink, smoke, use drugs. I have no known medical issues.

Surprisingly, we got pregnant in May 2007. At 6 (LMP) weeks, I was getting side pains and dizzy spells. After much insistence, I got the Dr. to see me (after repeated phone calls and replies that some pain and minor bleeding was normal). They did a sonogram and could not find any fetus in my uterus, tubes, or ovaries. I was told the pregnancy was not viable and was sent immediately to the hospital for a vaginal ultrasound. The vaginal ultrasound did find a fetus either. They tested for my HCG level which came in at 2300. Was told this was too low and since they could not see anything, the pregnancy was ectopic. I was given Methotrexate to abort the fetus and it was successful. We waited three months and then started trying again. I got pregnant in December 2007 (LMP DEC 14). On DEC 28, I had a doubling over intense pain in groin area with hot flashes and almost passed out. The pain subsided that evening. I took two home pregnancy tests on DEC 30. Both indicated a "clear positive pregnancy". Two days later, I began light brown spotting. After two weeks of continual light brown spotting, I called the Dr and they had me come in for testing due to my last ectopic pregnancy. My HCG level on Monday was 1700. At my request, I had an sonogram on Wednesday and repeated the beta. The Dr said the sono looked good, my uterus showed a regular "pregnancy reaction" and no pregnancy could be seen in my tubes and/or ovaries. Disappointingly, by HCG level came in at 2006. My progesterone level was 5.5. Due to these results, I repeated the beta on Friday and expect the results tomorrow.

Now for the questions:
1. Could/does the long term non-removal of the Norplant result in higher instances of ectopic pregnancies and or miscarriages?
2. Could the Norplant still have been working after 11 years? It is seemingly so since I have gotten pregnant twice in the past year since it's removal.
3. Could the laser hair removal in the bikini area scar/damage my reproductive system?
4. Should I have waited for a second opinion or at least another beta with the first pregnancy? I have had a continuous nagging feeling that I jumped the gun to take the Methotrexate.
5. Is my current pregnancy nonviable? What precautionary measures should I take before I decide anything? My personal feeling is to wait for the fetus to miscarry on it's own or wait until my 8 week ultrasound if I have not miscarried.
6. If this pregnancy is non-viable, should I go through another pregnancy/probable miscarriage before doing any testing.
7. If I should began testing, what would you recommend?
At Fri Jan 25, 08:36:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To worried sick Jan 20: Let me answer your questions as concisely as possible -

1. Could/does the long term non-removal of the Norplant result in higher instances of ectopic pregnancies and or miscarriages?

NO, probably not.

2. Could the Norplant still have been working after 11 years? It is seemingly so since I have gotten pregnant twice in the past year since it's removal.

It is unlikely, but now that it is out, it should no longer be a concern.

3. Could the laser hair removal in the bikini area scar/damage my reproductive system?

NO!

4. Should I have waited for a second opinion or at least another beta with the first pregnancy? I have had a continuous nagging feeling that I jumped the gun to take the Methotrexate.

Yes, you might have jumped the gun. This seems to be a recurring problem now that methotrexate is widely used for managing early pregnancy complications. You were not in any particular danger at that point.

5. Is my current pregnancy nonviable? What precautionary measures should I take before I decide anything? My personal feeling is to wait for the fetus to miscarry on it's own or wait until my 8 week ultrasound if I have not miscarried.

I do not know if this is a viable pregnancy or not, but again, you are in no danger at this point and you just need careful follow-up. If this is a nonviable intrauterine pregnancy, you could just let nature take its course and there may be some benefit to that since you have never had a successful pregnancy with your current partner. You can always opt for a D&C if you start having heavy bleeding or if there is any evidence of an infection.

6. If this pregnancy is non-viable, should I go through another pregnancy/probable miscarriage before doing any testing.

At your age, I would suggest finding a reproductive endocrinologist who will be in the best position to fully (and efficiently) evaluate you and provide medical therapy suited to your specific needs.

7. If I should began testing, what would you recommend? See my last posts in this series that address evaluation and possible therapeutic interventions - specific and empiric.

Hope this helps! Dr T
At Wed Jan 30, 09:11:00 AM 2008, Anonymous said…

Hi, I am 13.5 weeks pregnant with my 3rd pregnancy. My first one ended in very early miscarriage. My second preg. was a still birth at 38.5 weeks due to a compressed cord (baby was perfect). I have had very few symptoms with this pregnancy and at 13 wks 1 day they all stopped. I try not to worry since they day this could happen around this time, but is this normal? A heartbeat of 158 was heard at 11.5 weeks and the baby measured to the day! What are the odds of losing the pregnancy between 11.5 weeks and 13.5 weeks in a healthy person?
At Wed Jan 30, 06:01:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 30: Probably less than 1% unless there is something else going on with you we don't know about yet! Good luck and let us know how things turn out. Dr T
At Wed Jan 30, 06:12:00 PM 2008, Anonymous said…

I am 34yrs and have 2 children 15yrs & 4yrs. I had 2 TOP's in between these children and recently had 1 miscarriage and 1 missed -miscarriage exactly a year apart. Incidently this was the same time my 4 yr old was due (I conceived on the same month 3 times!!) can I only conceive at a certain time of year or is this just coincidence?
Because of the miscarriages, I am now scared about conceiving again as I fear the result may be another miscarriage or carry full term with complications and/or fetal defects. I now have much more appreciation for the miracle of conception and childbirth and now see that I took it for granted after my second child. when i was expecting my first child at 19 I was so fearful of miscarrying that, I wasn't able to enjoy the pregnancy or appreciate it. After the second I relaxed. I guess I'm back to square one! what do you think? Is it all downhill from here? Do women start off normally then miscarry then back to normal? I don't want to put myself through that again.

Kind Regards
Anonymous
At Thu Jan 31, 05:53:00 AM 2008, Anonymous said…

hi everyone. just was wondering if anyone has been through the same. I had a missed miscarriage at the end of nov (i would have been 20 weeks this week!) but as it turned out last week i found out i was 5 weeks pregnant again i took 5 hpts just to make sure i took the last one on sunday i was so excited when everyone one of them turned positive! But i woke up this morning and found the slightest of brown discharge i was so worried that i phoned the early pregnancy clinic and they confirmed that its quite normal to happen could be implantation bleeding etc. I took another hpt and it was point blank neg no faint lines or nothing, so i called the ep clinic again and they said that it was a chemical pregnancy and now had to wait for my period to come. I am absolutely gutted i got no support from the midwife at all and am now all totally confused. is it possible for your hcg to fall that dramatically in the space of 4 days? or is it possible that i hadnt waited long enough to test again as i took the test only an hour after going to the toilet? I am under no illusion that the likely hood is that its a miscarriage but just dont want to contact the epc again as they were so unhelpful the last time. Sorry for the extremely long post xxx
At Thu Jan 31, 11:59:00 AM 2008, Concerned_in_Canada said…

This is a great thread! Anyway, I have a question regarding recurrent miscarriage and sperm quality. I'm currently facing my third miscarriage in 8 months.(I'm having an ultrasound tomorrow to confirm things...HCG wasn't doubling, now it is but still not looking too good) Anyway, I'm 33 and had my first loss in June 2007 at 6 1/2 weeks, the cause unknown as they don't test first pregnancies. The second was in September at 7 weeks and turned up as a trisomy. Now I'm pregnant again, the levels have been rising but slowly, they've picked up the last few days to double correctly but considering my history I'm not holding my breath for a good result. So, considering we keep getting told by doctors that they are 'sporadic' and 'bad luck' I'm concerned there is more to these chromosomal problems than just chance. We have both had the karotype testing and all is fine, however my husband has terrible quality sperm with extremely low morphology. His DNA fragmentation is fair. Why with such deformed sperm are our doctors not taking the chromosomal abnormalities more seriously? Can poor morphology increase the risk of miscarriage?
Sorry for the long post...but its been a frustrating few months and I'm really starting to lose hope for a healthy pregnancy.
At Sat Feb 02, 04:22:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 30: I am sorry...guess I am getting a little slow in my old age but you will have to tell me what "TOPs" are! Regardless, you are still not beyond the time when many women have children anymore. So don't give up hope. As you are probably well aware, your risk for pregnancies with chromosomal abnormalities starts increasing dramatically from this point forward, but the odds are still in your favor. You might consider finding a fertility specialist to see if there are any problems that might be interfering with your success and perhaps undergo a treatment regimen that might further increase your chances. As for the timing of your conceptions, I don't know eitehr! Is there something special that occurs at that time of year for you or are you just more relaxed. I really think those things may make a difference! Thanks for reading and good luck! Dr T
At Sat Feb 02, 04:33:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Jan 31: I am sorry, but it does sound like you had a very early pregnancy loss - sometimes referred to as a "chemical pregnancy." These are very common. The home pregnancy tests are now very sensitive and this may actually be a drawback of using them for some women- it can be so heartbreaking to find out you are pregnant and then lose the pregnancy a few days later. So, the answer is yes...you most likely had an early pregnancy and now the hCG level is below that detected by the ept. It is not unusual to have a period that is delayed just 1-2 weeks under these circumstances (it is often a little heavier and may be accompanied by heavier cramping as well), but you should not need a D&C or any medication to complete the miscarriage under these circumstances. Keep you chin up. Dr T
At Sun Feb 03, 03:01:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Concerned in Canada Jan 31: Very interesting question - worthy of a full response. See my new post of February 3, 2008 and I hope that helps to answer your questions! Thhanks for reading and best of luck to you! Dr T
At Sat Feb 16, 01:19:00 PM 2008, Anonymous said…

Hi. I am 28 years old and have a 10 year old son from a previous relationship. My husband and I have been trying to conceive since September 2004. In September 2005 we started seeing a fertility specialist. After every test imaginable our fertility problem is undetermined. We had 7 IUIs with either clomid or injectables turn up negative. In January 2007, we started an IVF cycle. The first fresh cycle failed. We used our frozen eggs and got pregnant. At 12 weeks we had a miscarriage caused by Trisomy 22. My husband and I had the genetic blood test done and it came back normal. We did another fresh cycle and had a chemical pregnancy. My doctor then ordered more blood test for me (to check for lupus and anti immune issues, 13 test in all, I believe). We then used our frozen eggs and it failed. So, again, we go through another fresh cycle with assisted hatching. We had another chemical pregnancy. (I did take a baby aspirin with every cycle.) We have decided to take a break. We currently have 5 eggs frozen. My question is, do you think there is anything that we can do, or add to a cycle at this point to achieve a full term healthy pregnancy? I thank you so much for any advice you may have.
At Thu Feb 28, 05:44:00 PM 2008, Anonymous said…

Hi, I am 23 yrs old and I am a month and 2 wks late for my period. Does this mean I am pregnant? I've had this problem twice before in the past 2 yrs but have never checked for pregnancy..my period just comes late. Do you think I've miscarried before and can a doctor tell if you've ever miscarried? Should I even bother with a pregnancy test?
At Fri Feb 29, 04:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Feb 16: There could be so many possibilities at this point even though they haven't found anything to this point. I am presuming your workup included a semen analysis, hysteroscops and/or sonohysterogram and perhaps a diagnostic laparoscopy. Did they find anything at all suspicious? You could have 'subclinical' endometriosis. Since you are still young, you might consider holding off for awhile, going on Lupron for six months and then cycling and ovulation induction with Letrozole (an aromatase inhibitor) and hCG that seems to be highly effective in endometriosis patients and infertility that cannot be clearly accounted for. Another option is to start low-molecular-weight heparin with progesterone during the luteal phase after ovulation induction or IUI or IVF. Of course, there is a small possibility that you and your husband share some 'bad genes' in common (or in combination) that make the prospects for a viable embryo very low when put together. Regardless, stay in touch and let us know how your care progresses! Thank you for writing. Dr T
At Tue Mar 04, 06:36:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Feb 28: There is no way to tell from what you have told me so far. You could just be ovulating irregularly. Why don't you just go ahead and get the pregancy test and even if it is negative, you should tell your doctor if you are having irregular menstrual cycles. Good luck! Dr T
At Thu Mar 06, 12:12:00 PM 2008, Anonymous said…

Hi I had a misscarriage back in December. I had no pain and didn't even reliesed I was pregnant until my GP sent me to hospital. I bleed for u to 20days, than had a week break than started to bleed again for 4 days. Since than I have had no periods. I thought I would take a pregnancy test in middle of Febuary and it was postive, I thought I would wait another few weeks and still postive. I went for a ultrascan today and they couldn't detect a baby. Not sure if new pregnancy or if a molar pregnancy. I am very confused and upset. Could they have told me toady if it was molar. They just took my blood to check my HCG levels, than got to go back in 2 days. Could this still be a result from my misscarriage in December as no mentsraul cycle since. please try and help
At Sat Mar 08, 04:48:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Mar 6: Let me know what your hCG level is and then I will be in a better position to tell you what I think. this could be another early pregnancy, it could be an ectopic pregnancy, or ot could be choriocarcinoma arising from your pregnancy in December. The latter would be the only reason you would test positive at this point related to that December pregnancy. Best of luck and please let us know.
Dr T
At Tue Mar 11, 06:04:00 PM 2008, Anonymous said…

Having third miscarriage 9 months (2 IVF, one spont pregnancy). Underwent D+C with first two but doing misoprostol this time as find surgical procedure depressing. Clearly, I may not be meant to have more children (have one but am 40 now) but wonder about the cont'd danger to myself if I happen to get pregnant again (a success would be wonderful) if again not viable.
At Wed Mar 12, 12:32:00 PM 2008, Anonymous said…

Hi!
I am 27 years old. My last period 25th february which lasted the normal 5 days but was VERY light. My period before that was on the 28th January which was a full normal period. I have been on the pill for a good few years now which has regulated my period to a T. However around the 9-11th February (when i suppect I was ovulating) I missed a pill and took it abour 9 hours late. I have take 4 HPT 26th Feb, 29th Feb, 5th March and 12th March. ALL negative. I went to my OB/GYN today and he performed an external and internal U/S as well as an internal exam and he said he see no signs of pregnancy and my ovaries and abdomen seem fine. But I have been feeling bloted and my boobs have been swollen and tender for the past 2 weeks or so. This i normally get the week before my period but never to this extent. My next period is due on March 24th. Can you advise me what could be causing these pregnancy symtoms?
At Wed Mar 12, 06:08:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Mar 11: The primary danger to a pregnancy at your age is not your age alone, but the medical problems you bring into the pregnancy. If you are healthy, you are still at a little greater risk for diabetes and hypertensive complications in pregnancy because of your age, but given a normal baby inside, your chances and the baby's are quite good for doing well. Best of luck to you! Dr T
At Sun Mar 16, 05:49:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Mar 12: The "bloated" feeling and the tenderness in your breasts are often related to progesterone. You may have actually ovulated and made your own progesterone during the second phase (luteal phase) of the menstrual cycle. This might be more than is usually present in combination birth control pills, causing the symptoms you describe. Sounds like you may have 'dodged a bullet' as far as pregnancy goes! Best wishes. Dr T
At Thu Mar 27, 12:41:00 PM 2008, Anonymous said…

I found out I am pregnant for the 6th time on march 7th I have had 4 miscarriages 2 were missed at 8 weeks and at 5 weeks and 2 just happened I have one daughter who is three. my hcg level was 10,357 on march 7th on the 12 they dated the pregnancy with an u/s due to the fact that my last m/c was in january and i never had a period between. i was 6 weeks 2 days they started me on 40mgs of lovenox and on baby asprin then on the 18th they did another u/s and the baby was 7 weeks 1 day so everything seems fine but i feel sad i feel almost like ive had a miscarriage is this just because of so many losses or should i call the dr. and tell him about my feelings i have had no bleeding or cramping just a sense of dread. i do not have morning sickness or anything. what are the chances of carrying this baby since i am on the lovenox and asprin? are they better?
At Thu Mar 27, 06:10:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Mar 27: Your chance of carrying the pregnancy depends to some extent why your doctors think you lost the other pregnancies. Did they ever identify a potential cause? Regardlesss, your chances are better because you have had one successful pregnancy and the aspirin and Lovenox are the foundation for the empiric treatment of recurrent early pregnancy loss even if no reason has been identified. Good luck and let us know how things turn out. Sounds like you are in good hands, but be sure to share your concerns with your doctor. Dr T
At Sun Mar 30, 07:16:00 AM 2008, Lisa said…

Hi,
I'm 27 years old and my DH is 30. I have been trying to conceive since Jan 07. I had a miscarriage on april 07. Since then I didn't ovulate so I was put on clomid. Then clomid and metformin.Now on march 08 a got a BFP after an IUI taking clomid, metformin, progesterone and estradiol.I'm still waiting for my first scan but I already feel like last time.. started having sore boobs no more symptoms and then after a couple of days I didn't feel pregnant anymore. Right now I'm experiencing the same and I'm wondering why? I got pregnant in the same month and the baby stopped growing at 5 weeks. What could have caused that? There is no miscarriage history in my or his family. I had an HSG and my tubes were fine. My hormones level were fine. the only thing I know is that I have irregular cycles and I wasn't ovulating after my first miscarriage.

Thanks,
Lisa
At Tue Apr 22, 05:54:00 PM 2008, Missy Impatient said…

So i had an ectopic pregnancy on March 3/08 and on that same day had only one metho treatment, the egg was on my ovary and my hcg was 296 at the time of finding out. 9 days later my hcg had gone down to about 5 and was done shortly after. I have since had a period on Apr4/08 and it was as normal as all my others, now I have taken the Ovu tests to see if I have ovulated and on the 18th the test said positive now on the 10th I had a ultrasound and the guy said my ovary looked great and he no longer see's anything. Is it ok to try again, I am back on the folic 1mg a day plus the other prenatal's and have been on them for over a month now, would it be wrong to try again???
At Thu Apr 24, 11:32:00 AM 2008, Anonymous said…

I am 29 years old. I have two boys ages 3 and 5. With both I became pregnant the first time I tried. I have now had three consecutive miscarriages all at about 5 wks. I see the doctor tomorrow to get my final results from my hcg scores. With all the miscarriages I had a positive test result then a few days later I start bleeding. I don't understand what has changed.
At Thu Apr 24, 04:16:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Lisa Mar 30: I am sorry, but for some reason, I just got your comment in my mailbox today. If you are not ovulating regularly, then some 'hormone' is probably out of whack. You have not told me what your actual workup for miscarriages has been to this point, but if you are actually able to conceive with the clomid and metformin, and are miscarryong all so early, you probably have either an implantation problem or babies with chromosomal abnormalities. The 'implantation' problem could be the result of something that was missed when you had HSG, such as a polyp or fibroid, or perhaps even endometriosis. Recurrent chromosomal abnormalities are usually not the result of chance but more likely to be secondary to either you ro your partner being a balanced translocation carrier. Have you been screened for any of the acquired or genetic thrombophilias yet? Your doctor can explain what thiose are or you can search for information related to these in other posts that I have written on recurrent pregnancy loss. By the way, if you are not seeing one already, you should probably consider getting an appointment with a specialist in Reproductive Endocrinology and Infertility. Good luck and let us know what you find out! Dr T
At Thu Apr 24, 04:19:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Missy Apr 22: I usually recommend waiting at least 2-3 months. I am not worried about the methotrexate at this point because of its short half life and the fact you are taking the extra folic acid. However, your chance for another ectpoic is greater if the tube has not returned to a more 'normal' condition and the inflammation related to the pregnancy has not had a chance to die down. Good luck to you and thanks for reading.
At Thu Apr 24, 04:28:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Apr 24: Well, it's hard to say. Nothing might have changed or everything might have changed. In the case of the former, for example, if you or your partner has a balanced chromosomal abnormality, you might have been fortunate and your first pregnancies ended up with a normal chromosomal complement or are, themselves, balanced translocation carriers and the next pregnancies ended up being chromosomally abnormal as the result of either that or simply chance. Then again, since your last normal baby, you might have developed an internal structural abnormality of the uterus (such as a fibroid, endometrial polyp or endometriosis), a hormonal imbalance (thyroid or otherwise), or even a thrombophilia (such as antiphospholipid antibodies or a lupus anticoagulant). You could also have a genetic thromobophilia that just did not rear its ugly head until you got just a little older, or even a genetic problem as the result of recessive gene abnormalities that you share with your partner. Some of these things are simple to evaluate and others harder (and more expensive); and, all the 'workup' in the world may come up with no clear reason! Why don't you discuss this with your doctor or ask for a referral to a specialist in Reproductive Endocrinlogy and Infertility and then get to us when you find something out! Wish you the best. Dr T
At Mon Apr 28, 06:38:00 PM 2008, Anonymous said…

Hi Dr. I had a low HCG starting level of 87 at 4 1/2 weeks. It did go up 48hrs later to 170.

However, my worry is that it was so low to start with. The Dr doesnt want to do another HCG test since she said the doubling rate is fine.

I woke up this morning and all my symptoms have disappeared. My nipples which had darkened were suddenly lighter & they were no longer sore. I am no longer as tired, and my stomach is no longer bloated. I really don't feel pregnant anymore...

I am wondering what are the possibilities? I would like to prepare myself so I am able to ask the Dr. some questions. I would like him to run some tests to see if I have miscarried, as I would like to find out sooner than later

It's my first pregnancy, and I am 6 weeks tomorrow

Thank You!
At Thu May 01, 05:59:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anaonymous Apr 28: I am sorry, but that hCG is too low if you are really getting close to 6 weeks and if your symptoms have gone away, this is probably a nonviable pregnancy. At 6-7 weeks, a baby should be readily visible and have a visible heart beat by ultrasound. That would be a simple test to do to assess the status of the pregnancy at this point. As I have explained in other posts, there does seem to be a high rate of early pregnancy loss in women having their first pregnancies and these are probalby more 'immunologically-based' rather than being associated with anything wrong with the baby itself. Best wishes to you and thanks for writing. Dr T
At Thu May 01, 08:25:00 AM 2008, Anonymous said…

Hi again Dr., thanks for your reply regarding my HCG levels taken at approx 4.5 weeks, and nearly 5 weeks
(87, and then 166)

If everything has doubled as it should then at 6 weeks the Hcg would be approx 2090. Is this still too low?

I doubt I am less than 6 weeks, as there was only 1 possible date conception could've taken place and it puts me at around 6 weeks.

I will consider asking the Dr. when I see her next if they would consider an U/S. However, she may only do another blood test.

My symptoms have still not come back, and I am feeling really doubtful. I wish the Dr. would be more understanding and run some more tests.

Thanks Dr.
At Thu May 01, 09:26:00 AM 2008, Anonymous said…

Hi again Dr, I have reread your reply over a few times. To be honest, I am confused where you say "To anaonymous Apr 28: I am sorry, but that hCG is too low if you are really getting close to 6 weeks"

The HCG levels I stated are for 4.5 weeks and 5 weeks. Not 6 weeks. I did not have another quantitative HCG level taken between 5-6 weeks, so am unable to provide those results...

I am a bit confused? I assume you meant those levels are too low for 4.5 - 5 weeks? Hope to hear back asap

Thanks
At Thu May 01, 10:53:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anaonymous May 1: Sorry for the confusion. I thought you were taliking about more recent hCGs, but point in fact, even 2090 would be low for 6 weeks. Rather than endless blood tests, an ultrasound this week or next should answer the question for you. Still wishing you the best. I never mind being proven wrong under these circumstances! Dr T
At Thu May 01, 06:18:00 PM 2008, Anonymous said…

Thanks Dr. for clearing that up. I am glad you are matter of fact about things, it makes it easier to deal with. If I do MC I feel more prepared. My Dr. tries to sugarcoat things, which could make things harder in the long run. Anyway, thanks again I will update you with the outcome
At Fri May 02, 10:07:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous May 1: Hang in there and best wishes to you. Dr T
At Fri May 02, 11:34:00 AM 2008, J-in-CT said…

Dr; first let me thank you for your time and effort here - it's truly unique to find a reputable and responsive online source for medical information!

My wife and I (29 and 28, resp.) have been TTC for ~15 months since she stopped "the pill" in Nov, 2006(our first time TTC). Before and during her cycles were always 28/29 days in length. We decided to wait 2 cycles after stopping the pill to TTC - those cycles were 28/29 days as well. Starting Jan 2007 her cycles have varied quite a bit - from 27 to 36 days in length. During that time we didn't get a positive OPK or BBT (to their credit, we didn't really have a good "protocol" for BBT and the OPKs we were using were the clinic-kind (strips)). Starting Dec, 2007 we saw a RE who has been very helpful. Coincidentally since then, all her cycles have been steady at 34/35 days (even *before* treatment) and we have had positive OPK and BBT each cycle and they even agree (ov on 17th day)! (How nice it is for *some* things to make sense). After the usual barrage of tests (bloodwork, vaginal U/S, HSG, semen analysis - all OK) our RE put her on Clomid & IUI for 3 cycles and showed positive results (50mg with 4 follicles the first cycle, 25mg with 1 on the second and 50mg with 2 on the third). This cycle we've had positive results as we're 42 days LPM and hcg tests were good last week however it's growing lethargically (151, 286 (4 days later), 351 (2 days later)). We've pretty much resigned ourselves to the idea that the preg won't work out, but to me this is can be seen in a positive light as we now know fertilization is happening at least (my wife isn't so optimistic). Our main concern now is the chance of it being ectopic (she feels fine and has no apparent predisposition towards it), which we will hopefully settle on Monday with another vaginal U/C.

Anyway I've been trying to make sense of it all and the best I can figure is that after being on the pill for 7 years, it took another year for her cycles to self-regulate again, which probably also meant she wasn't ovulating (or doing so sparsely) in the meanwhile. Now that the cycles are regular, 4 months in we have some positive fertilization results. In other words, it can't just be coincidence that for 13 months she had varying cycles, and there was no evidence of ovulation even with OPK and BBT (and no "results" either); and then after 4 months of consistent cycles (and confirming BBT/OPK), we suddenly see some fertilization results (albeit not what we'd hoped).

Our RE doesn't seem to put too much stock in BBT, but I'm an engineer so I'm into numbers, and if BBT's are agreeing with OPK's and we're seeing some results, then something must be going right.

Regarding the lethargic growth of hcg numbers, could this just be an early sign of miscarriage? Our RE/nurse gave us all the *possibilities* and the idea of an ectopic is scaring my wife to tears (compound that with the wealth of misinformation available online, which she seems to put more stock in than the word of a trained professional). I'm also under the impression that a typical ectopic presentation would be "normal" hcg progression (doubling, that is) until 1000+ where is plateaus (and the symptoms of abdominal pain and etc begin). Is this inaccurate?

Also is there any correlation between ART and ectopics? Why is this? With IUI, does it have to do with the sperm getting a "head start" on the egg and fertilizing too "early" in a tube?
At Fri May 02, 05:13:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To j-in-ct: Your wife has ovulatory problems that may require more than clomid to overcome them. Your REI will probably consider adding supplemental metformin or some of the bigger guns with regard to ovulation induction. But like you, I am optimistic that you have made some progress. Unfortunatley, I am also pessimistic about the current pregnancy. It is most likely an intrauterine pregnancy that is not going to be successful. Ectopics are more frequent in ART procedures, but whether that is due to the procedures themslves, or the 'milieu' (your wife and any other infertility patient) in which they are performed is unclear to me. (Don't tell you wife I called her a milieu!). All pregnancies that are successful are fertilized in the tube (or in the test tube - actually petri dish- as the case might be). It sounds like she is in good hands and under those circumstances, if she does have an ectopic pregnancy, it will be picked up early enough that she should not be in any danger. She needs to relax about that for the time being and trust her doctors. The greatest risk of an ectopic is not susoecting it as a possibility and both you and the docs have that in good perspective right now. Have they found anything else wrong with your wife other than her ovulatory dysfunction at this point? BTW, you two still have plenty of time to work on this at your ages. Best wishes and thanks for writing! Dr T
At Fri May 09, 07:39:00 AM 2008, Anne said…

Hi, Is a hcg level of 3125 at 6 weeks considered low?It has been doubling.Though I am refusing more blood tests at this point, as to be honest I can't stand another needle! I am waiting a few weeks for an Ultrasound, but just wanted your perspective
All my Dr has to say is "some people have low levels". Thats all he would say!

Thanks!
At Fri May 09, 08:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anne: At that hCG level, hey should be able o tell you now whether or not the baby is alive. If the hCG levels have been doubling normally, then that is very reassuring at this point. Let us know how things turn out. Dr T
At Tue May 13, 06:39:00 PM 2008, Anonymous said…

Hi Dr, this is anonymous Apr 28.
Unfortunately I have not received good news from my U/S. I have 3 blighted ovums (they were possible triplets I suppose).

Is this unusual? Do you think it warrants some genetic investigation?
I'm wondering if this is equivalent to three blighted ovums in a row. I'm praying it's just a one off!

It was my first pregnancy

Thanks for your help!
At Thu May 15, 06:10:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous May 13: I am so sorry. This could have simply been a chromosomally abnormal pregnancy or, more likely, you lost the babies because this was a FIRST pregnancy. The immune system has to figure out how it is going to deal with something that is only half you and sometimes it may take a pregnancy loss or two before that happens. I would not recommend an expensive workup for miscarriage quite yet. Dr T
At Mon May 26, 04:43:00 PM 2008, Dayna said…

Hi, I have just had two early miscarriages, one at 4.5 weeks and one at 5 weeks the past two months. They occurred back to back with no period in between. I have not been pregnant before and have had regular menstrual periods since I was 13. I was on the pill for 6 years, and when I went off in october, I was regular immediately. I had a regular gynocologist exam and blood work done prior to trying to conceive and there were no issues that concerned my doctor. I have no family history of fertility problems. I am taking prenatal vitamins but am not on any other medications.
With the first I felt my period coming and had slight cramping, with the second I had sharp and constant pain on one side of my pelvic area and it felt different then camps, the next day my period started. I had not had this pain before. Do I need to see my doctor? How long do I have to wait to try again? Is there anything I can do to help my chances of being successful next time?
At Tue May 27, 05:28:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi Dayna: Did you have a pregnancy test done to confirm that you were pregnant? Has the pain resolved? If you were indeed pregnant, I would suggest simply continuing the prenatal vitamin and supplement that with extra folic acid (2-4 mg/day). It will probably be best to wait 22-3 months to give your body a chance to recover. When you do decide to try again, the only other thing you might consider taking is 1 baby aspirin (81 mg) per day. Make sure you let your doctor know about that if you have one. You are young, so there is plenty of time to work on this. It is not unusual to lose a first pregnancy very early and two back-to-back wouldn't surprise me under the circumstances. At this point I would not recommend the MEGA work-up for recurrent early pregnancy loss. Best wishes and hang in there! Dr T
At Wed May 28, 05:16:00 AM 2008, Dayna said…

Thanks Dr. T. for the information. I have a doctor but have not been able to reach him. The pain continues, but is much less severe. However, if asked I can identify exactly where it is. This is most concerning thing to me, as I have not had isolated pain before with any period.
I took home pregnancy tests both times, after I missed my period that confirmed the pregnancy. I read that additional B6 supplements could help as well. Is it is safe to take an additional 50mg if my prenatal vitamins have 25mg ?
At Wed May 28, 05:07:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Dayna: The vitamin B6 should be fine. You could have a corpus luteum cyst or a hemorrhagic corpus luteum and that's what this discomfort most likely is related to, but if the pain continues or worsens, you need to see you doctor on the chance that you could have an ectopic (tubal) pregnancy. Good luck and let me know what you find out! Dr T
At Thu Jun 05, 08:16:00 AM 2008, lisa said…

Hi there Doc. So glad I stumbled across this site! Anyway, I'll try to keep it short. I'm 34 and my husband is 42. I have normal periods, 28 days, although they seem to be 27 occasionally as of late.

We've had three miscarriages, all at 6 weeks or less. For one of these, I did happen to get an U/S that showed GS in the uterus at, I believe approximately 5 weeks 3 days and on that one I miscarried the next day. For the first two, my OB wasn't convinced that I needed testing, and when the third was imminent, I couldn't even get a return phone call!

Found a new OB that ran some tests and apparently I have "1 copy of G20210A prothrombin/factor II" and was told that this deficiency was the reason for the early miscarriages, that I would be started on Lovenox, and all would be well.

Became pregnant this past January after what I initially thought was a period (although it was unusual) and a week later started spotting, realized that I still had breast tenderness and subsequently had a positive pregnancy test. Began the Lovenox shots, had terrible follow-up and had very difficult time getting in touch with the new OB and/or the gazillion doctors in his practice...(let alone a nurse, phlebotomist, or even a receptionist without getting stiff-armed away), they noticed my progesterone was crazy low and started me on the suppositories, and then they finally decided that I must have been ectopic because they finally noticed that my hCGs were all over the place - 197, 193, 216, 280, 163, 240. They gave me methotrexate, even though the U/S i forced them to give me showed no signs of a pregnancy anywhere.

We waited three months before trying again after the methotrexate injections and found new OB (thank goodness!) who said i should see an RE. have now been unsuccessful in achieving pregnancy the last two months (still waiting to see if it worked this last month, actually took an ovulation predictor test this time and found out my LH surge was at day 14) I am going to go see an RE now, but am worried about still getting terrible care and nonexistent follow-up, but will go forward.

but what really is bugging me right now is that i just found out after some further obsessive research on my part that the prothrombin deficiency usually isn't responsible for miscarriages earlier than 10 weeks! why did my previous OB not know this??!! any thoughts on what could be happening with me? am worried that now my supposed ectopic has affected my chances of conceiving again - we've been successful (conceiving, that is) every time we've tried thus far before the "ectopic"...i'm so frustrated and trying not to lose hope, but this has been so difficult, especially with the care I received. I hope the RE will actually help me find some answers...thank you for these postings, you're the best. WOW - so much for making this short!! so sorry about that! thanks and please help!!!
At Sat Jun 07, 07:10:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi Lisa: It's okay to vent a little! Don't knock your doctor too hard about the prothrombin mutation. It may or may not be a problem and the final answer is still out on how many of the 'thrombophilias' affect pregnancy outcome. I think you are doing the right thing seeing the REI doctor. You need a thorough and efficient evaluation at this point that is more than a few laboratory tests. The REI will be in the best position to complete that evaluation and present the most reasonable approaches to getting you pregnant and, perhaps, keeping you that way! Best of luck and let us know what they find! Dr T
At Fri Jun 13, 01:24:00 PM 2008, Anonymous said…

Hello there, I am so glad I came accross this site, and am hoping to get a response to my question, since it seems like I am getting the run around from my doctor's. I am 29 years old, and had a miscarriage in Jan 08 while around 8 weeks pregnant. I am now 10 wks pregnant and a couple of days ago, started bleeding very heavily- along with about 2 large blood clots and 3 smaller ones, no tissue was visible. I thought I was having another miscarriage, but there was no pain like my previous miscarriage. The next day at the doctor's, we were able to see the heartbeat as well as the baby moving. Thankful, yet worried if something may be wrong with my child. Is it normal to bleed SO much, have blood clots and still have a healthy pregnancy? The bleeding was about 2 days ago, and I now just have old blood coming out. I went to radiology yesterday for another ultrasound, but am still worried. No response yet. Is this normal? Thank you in advance!!!
At Sat Jun 14, 07:47:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous June 13: It is not "normal" to bleed heavily in early pregnancy, but that does not mean you are necessarily going to miscarry either. If you are a smoker, take this as a signal to stop. It is also probably best not to have intercourse for at least a couple of weeks. If the bleeding stops and you get through the next few weeks, there is a good chance you will carry the pregnancy. Best wishes to you. Dr T
At Thu Jun 26, 11:58:00 AM 2008, Rhonda said…

Hello, I have recently had all the signs os pregnancy, being very tired, feeling sick etc. Me and my boyfriend have been trying for a baby, and was disappointed when i had my period. Before my period i had a light browny colour discharge, which is very abnormal and iv never had before, about 5 days later i came on my period, which are normally very heavy and painful, but this time i was suprised as i didnt have any pain, and was also not that heavy. could i be pregnant?
At Thu Jun 26, 07:44:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Rhoda: You could be pregnant and had some "implantation bleeding" or you could have miscarried a very early pregnancy ("blighted ovum"). Why do't you go have a pregnancy test done or by one at the pharmacy? Good luck! Dr T
At Sun Jun 29, 03:31:00 AM 2008, Rhonda said…

Thank you.
i am either buying a test today, or going to the doctors some time this week.
another thing is, i am a very skinny person, but my friends have told me that i have put on weight, which never happens, i havent put on weight in about half a year or more. i also had a very bad back while walking yesterday, and my nipples feel tender and kind of like sting. could this be another sign?
just want to know before i go doctors. Rhonda x
At Mon Jun 30, 02:22:00 PM 2008, Dayna said…

Hi, I wrote back on May 26th about 2 early miscarriages and sharp pelvic pain with my period. Since then, the pelvic pain lessened during the course of the month, I felt it now and again but nothing too serious. You suggested the possibility of a cyst.

However, this month when my period began (on day 30), by the end of the first day I was doubled over in pelvic pain on the left side of my pelvis, as if someone was stabbing me. (the same location as last month) I actually suffered through the ER because of the pain. My period was very heavy and quick this month, lasting two full days with some spotting after.
The ER did an ultrasound, and determined that everything looked okay, no cysts, normal uterus and ovaries. Pelvic exam, Blood work and urine showed that everything was fine as well. I am waiting for the results from a pap smear.

The pain has continued, although to a lesser degree. I have been waking up sweating in the morning but do not think that I have a fever during the day. My period has ended at this point. But they left me hanging with no concrete advice other then pain killers and I am not able to see my regular OB/GYN until next week due to the holiday.

Any advice on what could be causing this? I am concerned since the pain clearly occurs with the onset of my period and has happened twice in a row.

Thanks!
At Tue Jul 01, 07:34:00 PM 2008, Stephanie said…

Dr. I am 27 years old. In my first pregnancy, I went in for an appointment and the doctor found that I was dilated to 6 and fully effaced with no contractions. After a week of bedrest, I started hemorraging and having contractions at 22 weeks and delivered my son. I am now 13 weeks pregnant again. At 11.6 weekes I had red, gushing blood that lasted for a few hours and then slowed to spotting. It has now turned brown. However, my cerclage has been postponed due to the bleeding. What should we do if we never stop bleeding? I also take Lovenox for Protein S definiancy. They have not determined a cause for the bleeding. I forgot to mention it is twins. Is there a chance for these babies?
At Thu Jul 03, 06:57:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Rhonda: All those things could certainly be a sign of pregnancy. It is so easy to dind out - so go buy the test! Dr T
At Thu Jul 03, 07:00:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To dayna: Sounds an awful lot like endometriosis to me. Check that out on the internet if you haven't already and you will see what I mean. You may need a diagnostic laparoscopic procedure to find out for sure. Dr T
At Thu Jul 03, 07:05:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Stephanie: What led to the diagnosis of the "protein S deficiency" and how much Lovenox are you taking. If you have not had a thromboembolic event, then your doctors might consider discontinuing that until you have had a chance to stop bleeding for a couple of weeks and then placing the cerclage. By the way, have you been evaluated to see if you have a congenital uterine malformation (septum or a bicornuate uterus) and were the twins conceived spontaneously or by fertility treatments? Do you have any other medical problems? The answer to your final question depends on all those things. I will say this, if you do not stop bleeding, the risk of not carrying the pregnancy successfully or of delivering very early are extremely high. Best of luck and please check back with us. Dr T
At Fri Jul 04, 10:17:00 AM 2008, Stephanie said…

Dr. Trofatter,
The diagnosis of protein S deficiancy came after they did an analysis of the placenta. They found clots in the placenta, umbilical cord, and behind the placenta. After a series of blood tests they found the Protein S defficiancy. I am on 40 mg. of Lovenox once a day. I have now been bleeding for 12 days, but now it is a stringy, brown mucus. I am on bedrest to try and get it to stop. The twins were concieved using Gonal F treatments. My perinatologist has never been sure of the incompetent cervix diagnosis, and cannot rule out that I dilated because of the clots. 3 other OB's have all said I need a cerclage. Their best explanation for the bleeding is a burst blood vessal. In my last pregnancy, i dilated to six and was fully effaced with no contractions of bleeding. I did however, after a week, have contractions that caused the labor. The only other health problems I have are PCOS, and Insulin Resistance. I appreciate your help.
Stephanie
At Tue Jul 08, 04:29:00 AM 2008, Rhonda said…

i bought two tests, but they both said negative. but i keep having signs, my boobs are killing and have grown, and i dont stop eating.
At Thu Jul 10, 08:56:00 PM 2008, Deb said…

Dr. T, I found out June 13 I was pregnant. I took 5 urine tests at home, 1 at my dr office, and even had a blood draw to be extra sure. This was not my OB, so he suggested I schedule to first prenatal appt with them. We "guestimated" by the first day of my LMP of April 29 that I was approaching 8 weeks when I noticed light brown discharge on June 23. I called the OB and they advised me this was nothing to be concerned about and i had no pain whatsoever. It didnt sit right with me so I went to the urgent care walk in that Monday evening (06/23) for an exam. They sent me for an u/s both outside and internal. The tech never even let me see the screen and the dr waited for the results to be sent to him before he examined me that night. He did a pelvic exam and told me the u/s definitely showed a sac. i didnt think to ask how far along or size or anything, as I'm not well versed in this whole fertility thing. They did a blood draw that night and instructed me to bed-rest and come back weds and fri for blood draw to see HCG levels. I rested all Tues, then Weds am I started the ever slightest pink then bright red spotting when i used the restroom in the morning. I immediately went back to urgent care walk in and they had me see the OB right away. She did the internal u/s very quickly and said, "nothing, nothing..there's nothing in your uterus. Heres your ovary,...other ovary...looks good...again, here's your uterus and nothing but lining." this was all in a matter of around 30-45 seconds. She took the probe out and said i needed to do my next blood draw to compare levels to see if it was in my tube. I asked if she was telling me i m/c'd. she said, well i dont see anything but i need to see the labs. I wasnt comprehending it as i was overwhelmed and dismayed at the sad news. she was very matter of fact about the whole thing. she walked out and didnt even give me anything to tidy up before dressing myself. I had to find a towelette to remove some gel from myself. i walked out numb and went to the lab. Later that afternoon the dr called me at home and said the levels went from 603 on mon night to 627 that day (weds). She said the # may drop on it's own as i m/c and there was really no chance of this working out for me to carry. She said to come again to do labs fri and she would f/u with further instructions depending on the HCG level. I continued very light spotting Weds - Fri and went back for my 3rd blood draw. The dr called back and said the HCG was now 325 and my body was m/c naturally so nothing was needed on my part other than waiting. she gave me the option of the vaginal pills to induce the passage of tissue, but she said from the u/s i had very little lining and needed nothing if i didnt want. she said i also had an option of d&c but she didnt recommend a procedure that was unnecessary. I chose to wait the weekend and try to relax and let nature take its course. Well, i never started a heavy bleed. It actually subsided a little back to brown an intermittent red, but nothing more than a small pantyliner was required. I decided to have the d&c after researching a little and determined it was better to evacuate my uterus of any remants all at once and be sure it would all be gone so I could start over. The dr seemed to push me into doing the vaginal pills and i knew i did not want this for myself despite her recommendations. I ended up getting an appt with another OB since I felt this dr was very insensitive and seemed preoccupied. she definitely had poor bedside manner and was not sensitive to this devastating news i was trying to wrap my head around. the 2nd OB was an extremely sensitive, well spoken dr who made me and my husband feel that our situation mattered to him. he took the time to explain everything and after a lengthy discussion about our emotional well being and the pain of losing a potential family member, he went on to examine me internally and do an internal u/s. He talked us through the whole thing and wouldnt you know it, he saw that i definitely needed a d&c. He showed me the remnants inside and said this wasnt coming out on its own. while he was in there he showed me each of my ovaries and even pointed out the eggs and said they looked potentially like good eggs from the looks of them. of course i know nothing about what "good" eggs look like, much less ovaries, but he was very encouraging to us. He didnt feel anything was out of order on my end...it was just one of those things that happens to some women randomly. I was scheduled for surgery that day (July 2, last weds) and had the d&c. All went well and i never experienced any heavy bleed from start of m/c to finish upon complettion of d&c. I had minor achiness the following day, but have been taking it easy since. It has now been 1 week since d&c and I wnt back to work Monday night, july 7. I noticed my ovaries feel achey and my lower back is kinda like when i pms. I have no more bleeding or discharge of any type. I have no fever. I have nothing other than the aching ovary area. not even cramping. they are more like twinges of gentle pulling at the ovaries and it causes some discomfort more than pain. I can feel it more when i get up from the sitting position and when i walk around. My lower back feels the same way it does the day before my period. I guess I'm kinda wondering if I'm ovulating already. Could I be? Since I was so early in the pregnancy when it came to an end, does this make for a quicker recovery? Could i be ovulating and releasing one of those "good" eggs my dr showed me? The dr recommended waiting for my first period to begin trying to conceive if i wanted to. Of course now that I had a taste of the potential of motherhood and I have always wanted to be a mother, I am thinking I should not wait until i am any older. I am dealing with this loss and accepting this fact of life as God's will for me right now. I am emotionally ok, with only occasional moments where I get a little overwhelmed with the sadness. I have a wonderful and supportive family & friends who have helped me through this. I think i would like to try this very soon.

I have never been pregnant and we were not actively trying to start our family just yet. Nonetheless, my husband and I were actually happy and looking forward to next Feb welcoming our first child. I am 30 years old, and he is 39. My medical hx is pretty normal other than that I am irregular, however all pap exams show nothing significant to cause any alarm. No tumors, cysts, endometriosis, etc. Around 6 years ago, one dr (not ob or re) put me on prog. only pills to take 10 days out of the month to attempt to regulate my cycles. She told me it would be difficult to impossible to conceive w/o medical intervention since i'm irregular and may not be ovulating. Now in retrospect I took her word to heart a little prematurely and always thought something was wrong w/me. I only took those pills for 1 month because I would dry out and felt horrible. Then I took the bc pill to attempt to regulate my cycles, but whenever i would stop (once after 6 mos of bc pills, another after 1 yr of bc pills) i'm back to my irregular cycles. Usually 40 days or a little more and occassionally up to 3 mos w/o a period. That is pretty rare, but it has happened. I never really have had heavy periods other than when i began my periods at age 11. They are usually 3-5 days and i never clot or have a very heavy bleed. Just normal without bad cramps at all. I also have Fibromyalgia but try to cope with it by stretching and moving rather than rx intervention. I occassionally take Baclofen when my muscle burning is troublesome, but again, I take a portion of a pill and try to use other methods to deal. I am an emergency 911 dispatcher and work 12 1/2 hour shifts, and currently work night shifts from 6pm-630am. I feel when i work nights my cycles and my entire system is on overload and never really recouperate on my days off. Can working nights negatively affect my fertility an/or reproduction progress? I will be switching to day shifts next month and think this may be a good time to TTC. Any suggestions.
Sorry this was such a lengthy post, but it's been a traumatic couple of weeks and I feel my dr is a little inaccessible due to our provider (Kaiser Permanente So California). They make you call their main 800 # and leave a message w/a call taker, then they email a message to the dr to return the call sometime w/in the next 24 hours or so. my first OB deleted all my messages and then called to tell me she thinks she saw a message from me but erased them all on the computer screen. I have been reading many of your posts here and find your information very useful and educational. I wish you were my dr!
At Thu Jul 10, 09:01:00 PM 2008, Deb said…

Dr. T, I found out June 13 I was pregnant. I took 5 urine tests at home, 1 at my dr office, and even had a blood draw to be extra sure. This was not my OB, so he suggested I schedule to first prenatal appt with them. We "guestimated" by the first day of my LMP of April 29 that I was approaching 8 weeks when I noticed light brown discharge on June 23. I called the OB and they advised me this was nothing to be concerned about and i had no pain whatsoever. It didnt sit right with me so I went to the urgent care walk in that Monday evening (06/23) for an exam. They sent me for an u/s both outside and internal. The tech never even let me see the screen and the dr waited for the results to be sent to him before he examined me that night. He did a pelvic exam and told me the u/s definitely showed a sac. i didnt think to ask how far along or size or anything, as I'm not well versed in this whole fertility thing. They did a blood draw that night and instructed me to bed-rest and come back weds and fri for blood draw to see HCG levels. I rested all Tues, then Weds am I started the ever slightest pink then bright red spotting when i used the restroom in the morning. I immediately went back to urgent care walk in and they had me see the OB right away. She did the internal u/s very quickly and said, "nothing, nothing..there's nothing in your uterus. Heres your ovary,...other ovary...looks good...again, here's your uterus and nothing but lining." this was all in a matter of around 30-45 seconds. She took the probe out and said i needed to do my next blood draw to compare levels to see if it was in my tube. I asked if she was telling me i m/c'd. she said, well i dont see anything but i need to see the labs. I wasnt comprehending it as i was overwhelmed and dismayed at the sad news. she was very matter of fact about the whole thing. she walked out and didnt even give me anything to tidy up before dressing myself. I had to find a towelette to remove some gel from myself. i walked out numb and went to the lab. Later that afternoon the dr called me at home and said the levels went from 603 on mon night to 627 that day (weds). She said the # may drop on it's own as i m/c and there was really no chance of this working out for me to carry. She said to come again to do labs fri and she would f/u with further instructions depending on the HCG level. I continued very light spotting Weds - Fri and went back for my 3rd blood draw. The dr called back and said the HCG was now 325 and my body was m/c naturally so nothing was needed on my part other than waiting. she gave me the option of the vaginal pills to induce the passage of tissue, but she said from the u/s i had very little lining and needed nothing if i didnt want. she said i also had an option of d&c but she didnt recommend a procedure that was unnecessary. I chose to wait the weekend and try to relax and let nature take its course. Well, i never started a heavy bleed. It actually subsided a little back to brown an intermittent red, but nothing more than a small pantyliner was required. I decided to have the d&c after researching a little and determined it was better to evacuate my uterus of any remants all at once and be sure it would all be gone so I could start over. The dr seemed to push me into doing the vaginal pills and i knew i did not want this for myself despite her recommendations. I ended up getting an appt with another OB since I felt this dr was very insensitive and seemed preoccupied. she definitely had poor bedside manner and was not sensitive to this devastating news i was trying to wrap my head around. the 2nd OB was an extremely sensitive, well spoken dr who made me and my husband feel that our situation mattered to him. he took the time to explain everything and after a lengthy discussion about our emotional well being and the pain of losing a potential family member, he went on to examine me internally and do an internal u/s. He talked us through the whole thing and wouldnt you know it, he saw that i definitely needed a d&c. He showed me the remnants inside and said this wasnt coming out on its own. while he was in there he showed me each of my ovaries and even pointed out the eggs and said they looked potentially like good eggs from the looks of them. of course i know nothing about what "good" eggs look like, much less ovaries, but he was very encouraging to us. He didnt feel anything was out of order on my end...it was just one of those things that happens to some women randomly. I was scheduled for surgery that day (July 2, last weds) and had the d&c. All went well and i never experienced any heavy bleed from start of m/c to finish upon complettion of d&c. I had minor achiness the following day, but have been taking it easy since. It has now been 1 week since d&c and I wnt back to work Monday night, july 7. I noticed my ovaries feel achey and my lower back is kinda like when i pms. I have no more bleeding or discharge of any type. I have no fever. I have nothing other than the aching ovary area. not even cramping. they are more like twinges of gentle pulling at the ovaries and it causes some discomfort more than pain. I can feel it more when i get up from the sitting position and when i walk around. My lower back feels the same way it does the day before my period. I guess I'm kinda wondering if I'm ovulating already. Could I be? Since I was so early in the pregnancy when it came to an end, does this make for a quicker recovery? Could i be ovulating and releasing one of those "good" eggs my dr showed me? The dr recommended waiting for my first period to begin trying to conceive if i wanted to. Of course now that I had a taste of the potential of motherhood and I have always wanted to be a mother, I am thinking I should not wait until i am any older. I am dealing with this loss and accepting this fact of life as God's will for me right now. I am emotionally ok, with only occasional moments where I get a little overwhelmed with the sadness. I have a wonderful and supportive family & friends who have helped me through this. I think i would like to try this very soon.

I have never been pregnant and we were not actively trying to start our family just yet. Nonetheless, my husband and I were actually happy and looking forward to next Feb welcoming our first child. I am 30 years old, and he is 39. My medical hx is pretty normal other than that I am irregular, however all pap exams show nothing significant to cause any alarm. No tumors, cysts, endometriosis, etc. Around 6 years ago, one dr (not ob or re) put me on prog. only pills to take 10 days out of the month to attempt to regulate my cycles. She told me it would be difficult to impossible to conceive w/o medical intervention since i'm irregular and may not be ovulating. Now in retrospect I took her word to heart a little prematurely and always thought something was wrong w/me. I only took those pills for 1 month because I would dry out and felt horrible. Then I took the bc pill to attempt to regulate my cycles, but whenever i would stop (once after 6 mos of bc pills, another after 1 yr of bc pills) i'm back to my irregular cycles. Usually 40 days or a little more and occassionally up to 3 mos w/o a period. That is pretty rare, but it has happened. I never really have had heavy periods other than when i began my periods at age 11. They are usually 3-5 days and i never clot or have a very heavy bleed. Just normal without bad cramps at all. I also have Fibromyalgia but try to cope with it by stretching and moving rather than rx intervention. I occassionally take Baclofen when my muscle burning is troublesome, but again, I take a portion of a pill and try to use other methods to deal. I am an emergency 911 dispatcher and work 12 1/2 hour shifts, and currently work night shifts from 6pm-630am. I feel when i work nights my cycles and my entire system is on overload and never really recouperate on my days off. Can working nights negatively affect my fertility an/or reproduction progress? I will be switching to day shifts next month and think this may be a good time to TTC. Any suggestions.
Sorry this was such a lengthy post, but it's been a traumatic couple of weeks and I feel my dr is a little inaccessible due to our provider (Kaiser Permanente So California). They make you call their main 800 # and leave a message w/a call taker, then they email a message to the dr to return the call sometime w/in the next 24 hours or so. my first OB deleted all my messages and then called to tell me she thinks she saw a message from me but erased them all on the computer screen. I have been reading many of your posts here and find your information very useful and educational. I wish you were my dr!
At Sat Jul 12, 06:20:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Stephanie: I learned a long time ago that PCOS and insulin resistance is associated with cervical incompetence. That is also entirely consistent with your obstetrical history. I would suggest both progesterone supplementation and the cerclage, even if that needs to be placed later than we usually prefer because of the bleeding. Even after that, I would continue to follow cervical lengths by ultrasound. Incidentally, even though there is not evidence to support their use with cerclage under ordinary circumstances, whenever I have to place one in a woman who has had bleeding, I usually treat them with antibiotics. If your doctors are interested, I will tell them what I use. Dr T
At Sat Jul 12, 06:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Deb: I am sorry for your loss. Some doctors who care for women, see so many early pregnancy losses that they do become somewhat callous over time. I would have only a couple of suggestions. First, if you have a history of irregular menstrual cycles, you might consider seeing a specialist in reproductive endocrinology BEFORE you get pregnant again. Also, this has been a traumatic experience for you and there are support groups and counselors who can help. Reducing stress will improve your chances for a successful pregnancy in the future. Again, sorry for your loss and best wishes for when you are ready to try again. Dr T
At Sat Jul 12, 06:41:00 PM 2008, Deb said…

Thank you for your response and kind words, Dr. T. I hope to be able to have a positive outcome to my issues in the near future. I will take your advice.
~Deb
At Tue Jul 15, 08:58:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Best of luck, Deb. Look forward to hearing from you again! Dr T
At Tue Jul 15, 01:06:00 PM 2008, Stephanie said…

DR.T,
I had the cerclage placed yesterday. I finally quit bleeding! I am on antibiotics as well. So far all seems to be well. I will keep you posted.
Thanks,
Stephanie
At Tue Jul 15, 04:03:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi Stephanie: Great! Keep us posted. Dr T
At Sat Jul 26, 11:41:00 AM 2008, Anonymous said…

I am 44 years old, have hashimoto's/hypothyroidism (presently taking 100mcg levoxyl - b/w wnl); high FSH (~19); low estradiol (<10); low inhibin a/b (1.4/<10, respectively); typical ovulation on cycle days 17-19; short luteal phase of 9-11 days; and cycle length of 28-29 days.

Six months ago, after being on levoxyl for two weeks (50mcg at the time), I received a positive blood test for pregnancy. At 5 weeks, I suffered an early miscarriage.

Nearly every month since, my luteal phase has lasted up to 18 days, but there has not been any other blood test confirmation of pregnancy.

I have been to reproductive endocrinologists, but have discontinued, as they recommend IVF - due to the high FSH - and we are financially unable to afford it.

This past cycle, I took clomid 50mg on cycle days 4-8. I had an IUI on cycle day 18.

My BBT showed 3 distinct rises, the OPK strips showed 3 "potential" ovulations, and the salivary microscope also showed several full ferning results. Ultimately, due to incredible right-sided pain (typical of ovulation), stat progesterone and a vaginal ultrasound were ordered. Based on this information, ovulation was noted to occur somewhere between cycle days 25-27. As a result, the IUI was very poorly timed, at 8 days too early.

I am taking the correct dose of prenatal vitamins, folic acid and vitamin D. I also started wheatgrass juice this past cycle on day 20, and will continue to do so as I have been advised that it may balance out reproductive and thyroid hormones.

We used pre-seed as my mucous was very scant from the clomid.

My period started today, 17-19 days after suspected ovulation.

Questions:
1. Did the clomid affect my cycle and cause ovulation to be over two weeks late?
2. Is there anything else you would recommend for scant mucous instead of Robitussin? I must avoid artificial colors and saccharin.
3. Do you have any suggestions for me or my ob/gyn?

Thank you very much for your input. (and taking the time to read this lengthy note!)
At Mon Jul 28, 05:25:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous July 26: I honestly do not know what is bst for you. I know you cannot afford IVF, and quite frankly, many REIs would not even consider it at your age, but you might ask if they would consider using something a little more reliable than clomid for ovulation indution and then timing the IUI better. You are running out of time, so there can be no more beating around the bush if you truly want to get pregnant again. Dr T
At Wed Aug 13, 10:15:00 AM 2008, Anonymous said…

My first two pregnancies were live births they are now 8 years old and 3 years old. I had a late misscarriage in December of 2007 at 14 weeks. They did a sonogram at 16 weeks and there was no heart beat. Baby measured in at 14 weeks. I found out I am heterozygous for Factor V Leiden Mutation. I got pregnant again three months later. Doctor put me on 60 mg of Lovenex and a baby aspirin. Went in for sono at 18 weeks again there was no heart beat. Baby measured at 14 weeks. What are my chances of having another successful pregnancy? Why didn't the lovenex and baby aspirin prevent this. They did tests and the babies had no chromosome abmoralities. We see a genetic specialists on Sept 8. My OB ran other tests and couldn't find anything wrong except for the Factor V Mutaion.
At Sat Aug 16, 07:09:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Anonymous Aug 13: The losses might have nothing to do with the Factor V Leiden mutation. They could have been chromosomally or genetically abnormal babies or there could be another still undiscovered cause. Find out what the geneticist has to say and then let us know. Thanks for writing! Dr T
At Sun Aug 17, 06:17:00 PM 2008, Anonymous said…

Dr. T, Thanks for replying to my comment from August 13. I will let you know what the geneticist has to say Sept. 8. I also forgot to tell you that when I miscarried my fourth baby (they induced my labor in the hospital and I delivered) the umbilicle cord was wrapped around his neck twice very tightly. Could this have been the cause of death even at 14 weeks gestation? I've heard of this happening later on in the pregnancy but never this early. My husband and I are only 27 years old and would still like to try again, but we don't want to have another loss. We have two living children already, but we would like to have atleast one more live child before we call it quits. Please let me know what you think about the cord being wrapped around his neck. Like I said, my OB said it was wrapped around twice and really really tightly.Thanks!
At Wed Aug 20, 10:54:00 AM 2008, Anonymous said…

Dr. T, Thank you for replying to my comment from Aug. 13. I forgot to mention that when I had my last miscarriage I had to be induced and deliver the baby like I did the first time this happened. When I delivered the 14 week fetus the doctor said the cord was wrapped arund his neck twice very very tightly. Could the cord accident have caused the baby to die? I know this can happen later on in the pregnancy but I've never heard of it happening this soon. My husband and I are 27 and have two living children already but we'd like to have another one. We just don't want to have another loss. Although it's terrible that it happened, it would put us more at ease if it was just a cord accident and did not contribute to me having Factor V or some unknown cause. Like I said before, my doctor had put on 60 mg of Lovenox and a baby asprin. She said this usually takes care of the problem with Factor V issues in pregnancy loss. I'm hoping it was just a random cord accident and their isn't something else seriously wrong to cause the losses. Please let me know what you think. I will let you know what the specialist tells us when we go to the clinic on Sept. 8. Thanks!
At Fri Aug 22, 04:57:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Aug 20: That is a little early for a cord accident. However, if the cord was abnormal in some way (too long, too short, abnormally coiled, had too little Wharton's jelly, too thin) or if the placenta was abnormal because of the Factor V or some other reason that has yet to be found, then it could be. I am getting a healthier respect fro "cord accidents" in pregnancy and will eventually devote a series to the topic. Again, I look forward to hearing what the geneticist ahes to say and recommend. Regards,
Dr T
At Mon Aug 25, 06:09:00 AM 2008, lisa said…

Hi there! Any chance you'll be moving to Florida any time soon? We could use a doctor like you! Thanks for being so helpful to all of us anxious would-be mothers! I wrote a few months ago. Just to quickly summarize, I have suffered three miscarriages, all at 6 weeks or less, after which I was discovered to have 1 copy of the prothrombin gene mutation (which i'm told doesn't affect pregnancies until 10 weeks and my doctor still insists upon) and then in January I went through a supposed ectopic pregnancy (never saw anything on U/S, just up and down levels) with methotrexate given. I've since visited a RE, had multiple tests performed, and nothing else found, other than a small fibroid (less than 2.5 cm) towards the top, that the RE doc is not concerned about. She said basically that I am fine and to keep trying. For the last 6 months, we have continued giving it quite a good try, unfortunately unsuccessfully. the last two months i have been CONVINCED that i was pregnant, but never even made it to the end of my usual 28 day cycle before loss of serious breast tenderness and other symptoms and beginning to bleed on about day 26 (and never being able to test to see if i was pregnant). During my workup with the RE, i had a progesterone level of 4.6 on about 8 days post ovulation. my RE says that progesterone fluctuates throughout the day and was concerned and never did any further luteal phase progesterone testing. she not does believe that progesterone levels should be worried about until actual pregnancy is achieved. in my case, though, with the three very early miscarriages and what i believe to be the last two months of being pregnant and losing before even being able to test after missing a period, and what seem to be increasingly shortening luteal phases (had always been 28 days like clockwork - within this past year, had shrunk to 27, and now the last several months 26....) should i be taking progesterone post ovulation? is it true that if i'm getting too much that i could cause an ectopic pregnancy? they've found nothing else wrong with me but aren't doing anything about the progesterone levels and i feel like i'm just sitting on my hands here letting the clock tick away. i've been dealing with this heartbreak for over a year now and am worried that if i could have been doing something as simple as taking progesterone, that maybe it would finally work. i was actually seeing an accupuncturist for a while and she put me on a natural progesterone cream, but i told my RE about it last week and she made me stop it...please help. what are your thoughts on luteal phase progesterone supplementation??? (sorry for the long post)
At Mon Aug 25, 07:44:00 AM 2008, lisa said…

p.s. - just got back an additional lab that was missed somehow - a MTHFR A1298C single mutation was identified. don't know if this is a contributing factor or not as it seems to say that the c677T mutation is the one to worry about it and to take extra folate, b6 and b12....so now i have two gene mutations. maybe i shouldn't be trying so hard to pass on my abnormalities anyway....but too bad, i am fine (other than the lack of reproducing thing!). help me please!
At Mon Aug 25, 06:17:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Lisa: How old are you? You said your doctor told you that you have a small fibroid, but did she do anything else to evaluate the uterine cavity or to see if the fallopian tubes are open? I am not convinced you were actually pregnant the last couple of cycles, but it is disconcerting that your cycles are shortening. Is your doctor sure you are actually ovulating and when in the cycle is that occuring? Anyway, if the tubes have been shown to be open, there are many options: 1) Just keep trying - I know many REI doctors who would put you on progesterone support unless they could clearly document a norma luteal phase level. 2) Consider ovulation induction (even if you are ovulating). 3) Consider a 3 month course of Lupron followed by ovulation induction. There are more options, but those are places you might start. Best wishes,
Dr T
At Mon Aug 25, 08:22:00 PM 2008, lisa said…

I'm going to be 35 in a few weeks. My husband will be 43. I had an HSG that supposedly showed tubes open and everything fine. Today, relayed through her nurse, she said she was not concerned about shortened luteal phases at 26 days. i typically have been ovulating at around day 14. i have taken ovulation predictor tests and have gotten positive LH surges and supposedly have good ovarian reserve (tested on day 3 of cycle a few months ago) i also had a P4 progesterone drawn a few months ago on cycle day 22 when i happened to be in the office (with positive LH surge on day 14) and it was 4.26. every time i questioned her about this low level, she stated that progesterone levels fluctuate throughout the day and that low progesterone levels during the luteal phase have been discounted to be proof of anything...i ask her almost every time if i should be on progesterone and she thinks not. also, today after the MTHFR result she put me on .....i can't remember the name and am picking up the Rx tomorrow - supposedly something that has like 2.8 mg of folic acid? - i haven't picked up the prescription yet - was thinking i would get folgard or something like that. anyway, i did also try this month at day 18 starting lovenox as i had some around but to no avail. we'll see if the extra folic acid does anything. i do have an Rx for progesterone suppositories from the previous supposed ectopic (before they knew it was ectopic) that i may just refill and take post-ovulation. i know i shouldn't be going over her head but i'm tired of getting nowhere with south florida doctors....i will mention the plan you described...and anything else you might have to add after this post. thanks so much! you're the best!
At Tue Aug 26, 08:42:00 AM 2008, lisa said…

p.s. i just started Metanx today - the nurse that described it to me said it was just folic acid - but seems its B6 & B12 too. she said the doctor didn't need to check my homocysteine levels when i asked. perhaps my hematologist will next week at follow-up...
At Wed Aug 27, 03:07:00 AM 2008, Patricia said…

Hi Dr T, We last spoke back on the 4th Dec 07, prior to my first appointment with my gyno. I am happy to say after a couple of rounds of Clomid and a Tubal Patency test, I am now 5mths pregnant with a baby girl...I just wanted to say thank you for taking the time to answer all of my questions along the way. God Bless.
At Wed Sep 03, 11:19:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Patricia. Congratulations and thanks for letting us know. Best wishes for the rest of the pregnancy. Let us know when you have the baby in your arms! Dr T
At Wed Sep 03, 11:56:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Lisa: Best of luck to you! You can vent here anytime you want to :) Dr T
At Fri Sep 05, 10:20:00 PM 2008, Stephanie said…

Hello again,
I wrote to talk to you in the beginning of July concerning previous loss at 22 weeks, a new twin pregnancy with bleeding delaying the cerclage, and Protein S deficiancy. I am now 22 weeks 6 days pregnant with a cerclage at 15weeks. The bleeding has not returned. I am worried because my cervical length was only 1.5 cm today. I am truly hoping to make it to 28 weeks at least. I am on bedrest, and I take the 17P shots. Is there hope for the 28 week mark? What has been your experiance with these measurements? Anything you can explain to me is appreciated.
Thanks,
Stephanie
At Mon Sep 08, 04:15:00 PM 2008, Anonymous said…

Dr. T, this is anonymous from August 20. My husband and I went to see a reproductive specialists today who deals in infertility and recurrent pregnancy loss. They are running nine more tests on me that my ob/gyn had not done already. These tests are Lupus anticoagulant, prothrombin gene G20210, Protein c activity or functional, Protein S activity or functional, Anti-beta-2-glycoprotein I, Thyroid stimulating hormone, Prolactin, Random blood surgar, HgvA1c. They ran a semen analysis on my husband and everything looks good. They did a sonogram on me and everything is fine. After my next cycle they want me to schedule an appointment for a Sonohysterogram. They said the blood tests results should be back in two weeks. I asked about the cord being wrapped around the baby's neck at 14 weeks. He said what you said about it probably being too early for that to cause a fetal demise. I will keep you posted on what the results are on the blood tests. Thanks!
At Tue Sep 09, 11:43:00 AM 2008, Anonymous said…

Hello Dr. T.

I am a 32 y/o and have been trying for over 3 years now. I am pregnant for the 6th time with no live births. I have had 2 chemical pregnancies (< 5 weeks) and 3 later than 8 weeks but less than 10. I am pregnant now for the sixth time. I have been seen/treated by RE for a uterine septum, put on Clomis (produced two miscarrages), ureasplasma, and put on prescription folate for MTHFR altho I don't have the bad combination., can't remember if it is homo or hetero.

In all pregnancies I have had a terminal heartbeat when they went late enough. Two Clomid enbryos were tested and were trisomy 16, none of the others were genetically tested.

This pregnancy everything has measure on time (new for us), we saw a strong heartbeat at 6w3d (also new for us). But I am still very worried that I never got an answer in the first place. With 5 previous miscarriages, even with seeing a strong normal heartbeat, what are my chances for carrying this pregnancy to term?

Deb
At Fri Sep 19, 04:13:00 PM 2008, Anonymous said…

Dr. T, I posted a comment a few weeks ago but it was never posted on this sight so I'll just try again. A few weeks ago I told you I had Factor V Leiden Mutation and have had two losses at 14 weeks within 6 1/2 months of each other. On the second loss, the cord was wrapped around his neck twice, but you said that probably was'nt the cause of fetal demise. My first two pregnancies turned out fine. I went to see the reproductive center on September 8 for some testing. They discovered that I also have Protein C diffiency along with Factor V. I also found out that I am 5 weeks pregnant. oops. The baby is due May 23. They put me on prenantal vitamins, baby aspirin, and 2 shots of Lovenex a day 40 mg. each. What do you think my chances are of this pregnancy being a live birth? Please let me know what you think. The reporductive center is going to monitor me throught the first half of the pregnancy. I go in for an ultrasound on Oct 7 at 7 1/2 weeks.
At Sun Sep 21, 09:55:00 PM 2008, lolita said…

Hello Dr.,
I had 2 blighted in a row this one was in oct 07 and the second was in march08.My doctor is telling me to try again but im to worried of this nightmare hapenning again.I have read in one of your post about hormonal imbalance.I have my period every month with a 28 day cycle but the problem is that i only bleed for one day and only when i urinate .When i was younger i used to bleed much more ,i also suffered from a eating disorder which i have stopped.Can u tell me what kind of teating i should do.Please help me.
At Mon Sep 22, 10:09:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Stephanie: Sorry for the delay in my response but I just got this in my email from Healthline alond=g with about 150 others. To answer your question, of course there is hope. The advantage of the cerclage is that it may give your doctors time to prevent delivery if you start contracting. I wish the cervical length was longer, but there is no fixing that at this point unless they can find someone who will put a stitch in your cervix above the initial one. Bu now you should be almost 25 weeks, so please keep me up on how you are doing. As always, best wishes. Dr T
At Mon Sep 22, 10:11:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Sept 8: It sounds like you are in very good hands. Let me know what you find out! Regards, Dr T
At Mon Sep 22, 10:13:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Deb: Well, everything is going well so far and since several of your prior losses were chromosomally abnormal, those were pregnancies you could not have done anything about anyway! Hang in there. The next several weeks should tell the story. Let us know how you do and after you get through the first trimester, I may have some other thoughts. Best wishes! Dr T
At Mon Sep 22, 01:14:00 PM 2008, Stephanie said…

Dr. T,
I am 25 weeks now and have not lost any more cervix. I am still on bed rest, and the 17P. Both babies are doing fine so far. i do not have any vaginal discharge or bleeding at this time. My peri seems confident that even with a cervical length if 1.5, I can make it into the 30's. My OB seemed shocked that I made it this far, but seems to be more and more confident now that the stitch has held these past few weeks. He and I's next goal is 28 weeks. Contractions were not an issue in my last pregnancy as I fully effaced and dilated without them. I did eventually have an abruption that came with fierce, sudden contractions at 22 weeks. Hopefully, the Lovenox will prevent that this time. I just had to start insulin for GD, but I think that is the least of my problems. I am just trying to make it far enough to help with the chances of long term health problems with these babies. I appreciate your optimism. There is no hope of getting another cerclage, I had to fight to get this one as my peri wanted to do cervical monitering instead. There is only the one perinatologist in my area. She does not believe in bedrest, but my OB does and I am on complete bedrest at his request. Thank you for your feedback.
Stephanie
At Mon Sep 29, 10:37:00 AM 2008, Anonymous said…

I had my first child at the age of 39. She was concieved very easily and there were no pregnancy complications other than the discovery of a 4cm fibroid on the outside of my uterus. I am now 42 and started trying to get pregnant again 4 months ago. My periods are regular and I am ovulating every second month. I am fairly sure that I managed to concieve immediately (I felt implantation pain 10 days after ovulation) but I think I miscarried around the time of my period. I am pretty sure this has happened twice now (I get cramping and a brown discharge a couple of days before bleeding and this not usual for me). I have made an appointment to speak with my doctor but would be very interested to know your opinion. I am fit, healthy, dont drink/smoke. Is my body trying to tell me that I'm simply too old for another round of motherhood? It may or may not be relevant but I had 2 terminations whan I was in my late teens.
At Tue Sep 30, 05:18:00 AM 2008, Tricia said…

Hi, Hopefully you can give me some answers. We have been trying to get pregnant for 16 with one miscarriage exactly a year ago today. Last week after 5 IUI's, an hsg and 2 rounds of clomid, we found our we are pregnant again.

The first beta was 619 and the progesterone was 24. Great. Very happy.

The second beta was between 1100 and 1200. I can't remember the exact number. My first concern is that the beta didn't exactly double? But, it is pretty close. I wll be 5 weeks tomorrow.

But, my BIGGEST concern is that the second progesterone was 21. The nurse who called was not concerned at all. She said if it goes lower they will prescribe some progesterone. But, my next appointment is not for a full week.

Do you think this fall from 24 to 21 means an impending miscarriage? Is there a natural fluctuation in progesterone in early pregnancy? I have been feeling great so far. I will tell you the breast swelling seems to be going down today. I am really really worried.

Thank you.
At Wed Oct 01, 06:44:00 AM 2008, Anonymous said…

hi dr T,
i have lost 3 pregnacies, the 1st was at 27 weeks,after that i tried to get pregnant and i couldn't, so i started taking fertilization treatment,and i got pregnant.and had a miscarrage the hcg wasnt going up properly as it should.i waited 10 months and got pregnat again and had an ectopic pregnancy, it's been now over a year and i had some blood test done it turns out that i have high antithyroglobulin and high prolactin levels. with my first pregnancy i got a very bad urine infection and started urinating blood ,but didnt loose the pregnancy straight away. my question is whould you have any idea what could be causing all my problems? could the high antithyroglobulin cause a stillbirth and miscarrage?
and what do u recommend i do?
thanks. leanne
At Fri Oct 03, 06:28:00 PM 2008, Anonymous said…

Hello...I have a 6 yr old son conceived just after a LEEP. On Wednesday was confirmed pregnancy after taking 1st cycle of Clomid with HCG doubling from Monday to Wednesday. I am at a seminar and went walking with a co-attendee and last night upon getting back to hotel had pinkish/brown discharge at wiping. This morning, after a bowel movement, wiped and had bright red bleeding (not flowing, just happened when I wiped). I called OB and they said to be in bed for rest of day, travel home (airplane) tomorrow and go in for blood tests at hospital when I get home. I should be 6 wks today, still have a dull feeling in my pelvic region, sore breasts, but nausea I was having is gone. I have drank water to keep hydrated and have passed no clots and no more red since 8:45 this morning. Am wondering if I'm having an early miscarriage or if the bright red could have been implantation bleeding. Sorry for the long post...I'm scared and thousands of miles from home, thankful to get back there tomorrow. Any discussion will be helpful!
At Fri Oct 03, 07:45:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Sept 19: Healthline has been very inconsistent about posting comments and sending them to me lately - I am sorry. Regardless, that sounds like a great regimen to help counter the effects of the Factor V Leiden and protein C deficiency. Hang in there and let us know how things turn out. You appear to be in very good hands. Best wishes. Dr T
At Fri Oct 03, 07:50:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Lolita: You did not tell me how old you are. How long has the bleeding been diminishing? Have you had any D&Cs prior to the miscarriages? Do you have any other medical problems? Are you on any medications? To start off with, I would suggest having a TSH, Prolactin, FSH, and perhaps screens for thyroid and adrenal antibodies performed. and maybe even chromosomal studies on you. Let me know the answers to some of my questions and I will probably have some additional thoughts. Best wishes. Dr T
At Fri Oct 03, 07:52:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

Hi again Stephanie: Thank you for the update. I am glad to see things are going well and you are now 10 days closer to term than when you last wrote to me. I think you are going to get your baby out of this pregnancy too! Hang in there. Dr T
At Fri Oct 03, 07:56:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Sept 29: Fertility drops dramatically in many women after age 40. If you reall want to have another baby, I suggest you see a specialit in Reproductive Endocrinology and Infertility ASAP. The early terminations should have no effect on what you are experiencing now. It's biological age! Good luck. Dr T
At Fri Oct 03, 07:58:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Tricia: Tell the nurse that you are very worried and would like to speak with the doctor or simply consider starting progesterone empirically. Good luck and let us know how things turn out. Dr T
At Sat Oct 04, 07:08:00 PM 2008, lolita said…

Hi Dr.
I just turned 33 and yes i had d&c prior to the miscarriages.I am not on any sort of medication and dont have any medical problems.My bleeding have become more lighter its been a while already about a good three years .Do you think it has to do with the d&C?
At Tue Oct 07, 03:28:00 PM 2008, Anonymous said…

Hi, I've had one miscarriage over a year ago at 6 weeks or so, no heartbeat. Since then done treatment on Fostimon which helped mature my follicules, 4 IUI's, no luck. I recently changed doctors and the new one sent me for a hysteroscopy, I was given antibiotics for a congested uterus for 15 days, I am not sure why it occurs. The new doctor put me on a fake cycle on Provames and Duphaston. My scans have all shown an endometrium lining between 3-6mm. He hoped Provames would help, but it did not, 5.6mm. I will be started Puregon 100ml everyday from the 4th day of my cycle, and he suggests we try with more than one follicle/egg. Ovitrelle probably closer to mid-cycle. Progesterone probably in the second half of the cycle. Can you tell me if it's possible to get pregnant and hold up despite a thin uterine lining? Is there any treatment that works well? Does folic acid improve the lining much, I've heard mixed reviews. Otherwise my uterus test results are good in terms of vessels, blood circulation etc. My tubes are fine, and I usually always ovulate spontaneously without ovitrelle between the 10-13 day.
Thanks alot.
At Tue Oct 07, 05:41:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To lolita: It could be that you have scrring in the uterus. Look for my blogs on Asherman's syndrome that I posted over the past year. You should probably have a sonohysterogram and diagnostic hysteroscopy performed before you try to get pregnant again. I would recommend that you find a specialist in Reproductive Endocrinology and Infertility to help you with that and any other evaluation necessary to help you have a baby. Best wishes. dr T
At Tue Oct 07, 06:55:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Oct 3: It is frightening to be away from home when miscarriage is threatened. At six weeks, your doctors should now be able to tell by ultrasound if there is a potentially viable intrauterine pregnancy. I hope there is, and yes, this could also simply be implantation bleeding. Best wishes. Dr T
At Wed Oct 08, 09:00:00 AM 2008, Anonymous said…

I am writing from Anonymous Oct. 3: I did lose my baby but am keeping the positive outlook that we were at least able to conceive. Everything is clear and we should be able to try again after my next cycle. I do believe these things happen for a reason! To everyone experiencing these scary situations keep your hope alive. God bless and thank you so much for writing me back, Dr. Trofatter.
At Wed Oct 08, 10:46:00 AM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To Leanne Oct 1: The presence of antithyroid antibodies has been correalted with pregancy loss and poor preganncy outcome, however, whether this is a direct effect of the antibodies, or the antibodies are a 'marker' for some underlying imunlogic problem hat makes it more difficult for some women to have successful pregnancie, is unclear to me. Your prolactin levels may be high because your thyroid function is low. If you do not have a specialist in Reproductive Endocrinology and Infertility that you are seeing, I would recommend finding one who can evaluate you thoroughly and prescribe a treatment regimen that might improve your prosoects for a successful pregnancy. Best wishes. Dr T
At Wed Oct 15, 09:22:00 AM 2008, Anonymous said…

Hi, I am currently 6wks & 2 days pregnant, but i started spottin on monday night, & i only noticed when i wiped (sorry) (went to the docs & he done a blood test to check hcg levels, won't know until tomorrow) since coming back from doctors, loss has turned from brown to redish brown, i am almost certain im losing the baby, i had a m/c back in march of this year, i wanted both so bad, but my husband & i have already said if this one goes we will try again, but i don't knw if i can go through all this pain again.. I have to great children, a son & a daughter, this will be the third m/c, i had a loss between my son and daughter, now 1 already this year & what i belive to be another 1..
At Wed Oct 15, 02:06:00 PM 2008, Anonymous said…

im 29yrs ive had 5 pregnancies... 1 full term he is now 8yrs old i was 21yrs then
1st m/c jan 2006 8weeks along
2nd m/c may 2006 14 weeks along
3rd m/c jan 2007 8 weeks along
4th m/c may 2007 4 weeks along
all show signs or normal so doctors thing hormonal imbalance as i have all ready carried to full term
ive had a wire loop excision in dec 07 for cervical abnormal cells (no hpv found) and doctor thinks i may have poly cystic ovaries (no tests done yet) im charting my cycles and found im at dpo5 and with intercourse right before ovulation im feeling i may just well be pregnant again with all my other pregnancies i see i have breast tenderness at dpo4 nausea at dpo 5- on going what can you tell me to ease my mind i can fall pregnant easy enough but cant seem to make it past 3 months will i require hormon shots ( i carry the hormonal cancer gene in our family but its eostrogen fed)so i asume it will be progesterone to keep a pregnancy right? can i ask for a stich in my cervics since ive had the wire loop excision is my cervics now weakened ? any help is great please
At Wed Oct 22, 07:31:00 PM 2008, Kenneth F. Trofatter, Jr., MD, PhD said…

To anonymous Oct 8: I am so sorry for your loss. Thanks for letting us know and for the kind words. Dr T
At Wed Oct 29, 05:47:00 PM 2008, Anonymous said…

Hello Dr. Trofatter. I am going through a very puzzling situation right now and would like to get your insight please.

I am 32 years old, healthy and this was my first pregnancy. I was on the pill for the last 5 years and went off it on April 2008. I found out I was pregnant on Sept 5. My LMP was August 11. My HCG levels never went past 330. I started spotting on Sept 18 so I went to the nearby hospital that afternoon. The Dr. indicated that I was going through an early miscarriage as my hormone level has dropped to 233. He sent me for U/S on Sept 20 where they found a complex mass posterior & inferior to the right ovary (quite a distance from the ovary) measuring at 3.4 x 2.8 x 1.9 cm that was inseparable from the right pelvic sidewall. They thought that this may be a intra-abdominal pregnancy so they sent me to the OB on call to get further diagnosis. My uterus was normal in appearance and the endomitrium was around 9 mm. No fetal pole or heartbeat was located. When the OB did a pelvic exam, I did not have any symptoms of pain. No fever, nausea or vomiting and my BP was normal. The OB did not think it was an ectopic pregnancy but sent me for another U/S to be sure. The next U/S occured on Sept. 22, same mass was found with no increase in size. My hcg levels were at 149 at that point. Went to see the OB at the office on Sept 24 and was told that I was experiencing a SA. I started bleeding more significantly for that week and was told that this would probably last for 2 weeks. I was asked to get another blood test after 10-14 days to ensure that my hcg level has dropped. I went for my blood test 14 days after and my levels were at Oct 3-270, then 255 one week later then 230 3 days later and I was still spotting (the 3 tests were done at a different lab which could explain the variance in levels). 4 weeks after my initial diagnosis, I was still spotting so I went back for another U/S. Same mass was found but my HCG level started slowly dropping. It went from:

Oct 18 - 136
Oct 21 - 81
Oct 26 - 71

Still concerned over the idea that my HCG levels were dropping so slowly, I was prescribed a shot of methotextrate on the 26th. My question is, how could I tell if this was indeed a true ectopic pregnancy as I didn't manage to get a confirmed diagnosis? Could this be an incomplete miscarriage instead? Who can I see in order to get an answer? Your feedback would be much appreciated.

Learning Centers Acne Allergies Anxiety Arthritis Asthma ADHD Bipolar Disorder Breast Cancer Cholesterol	Depression Diabetes GERD Heart Disease High Blood Pressure Managing Your Knee Pain Menopause Migraine Multiple Myeloma	Osteoarthritis Overactive Bladder Pregnancy Prostate Cancer Sleep Disorders Stroke View all

Diseases A to Z Symptoms A to Z 3D Body Maps	Treatments A to Z Drugs A to Z 3D Videos	Physician Specialties A to Z Alternative Therapies A to Z

Videos Alternative Medicine Children's Health Cholesterol Fitness Gyno Healthy Aging Heart Health	Men's Health Mental Health Nutrition Pain Management Pregnancy Sexual Health Sleep Disorders	Teen Health Women's Health Videos A to Z Videos by Disease

Health Expert Updates

Recent Posts

Archives

Who We Read

Early Pregnancy Loss - 2

218 Comments: