Blogger Problems!?!

14 Comments:

• At Mon Nov 10, 04:22:00 PM 2008,  Anonymous said…

  Dr.Trofatter - I am 33 years old and have had three m/c within the 1 1/2 years (all with my husband). After the second m/c, my o/b sent me to REI which was then discovered that I am heterzygous for the Factor V Leiden alle as well as elevated levels of Factor VIII. The last two m/c a heartbeat was seen, but I lost the first two at 6 1/2 wks; third at 7 1/2 wks. The last pregnancy I was taking low dose aspirin and the docs talked about heparin, but I started bleeding before I began the treatment. My thyroid has been tested and is normal. I have asked about the possibility of progestron therapy, but my doc says that treatment is beyond 'emperic'. Would it be beneficial to have my levels tested once I get pregnant again? should I begin the heparin in the first weeks of the next pregnancy? I believe a full work up was done on me after the second m/c, but don't know if I should ask my doc for further testing on anything. I do have regular periods, but witin the past year they come every 30-31 days rather than 28 cycles that I used to have. Any help or insight you have with my condition is appreciated.

   

• At Tue Nov 11, 05:16:00 PM 2008,  Amber said…

  Dr. Trofatter
  
  I am 31 years old and just found out I had a partial molar pregnancy. I had two visits to my Dr and saw the baby's heartbeat on the 3rd visit I found out I miscarried, and then found out this week I had a molor pregnancy. I found information on the internet and can understand why it occurred. The hardest part is knowing that I have to wait a year to try again to have a baby. If my beta hcg levels were at zero for the next six months what is the likelhood that the molor pregnancy would reoccur? I can't find any information on reoccurrance after long time of zero levels. I would appreciate your assistance as a lot of the information on molor pregnancy says the same thing.

   

• At Sun Nov 16, 11:14:00 AM 2008,  Amanda (Henry) said…

  I have a healthy two-and-a-half year-old son and he was my first pregnancy which was completely normal and uncomplicated. We wanted a second baby and have had three miscarriages since he was born. All three first trimester. One occured without us meaning to conceive (I was still taking a mini-pill and wonder if that had anything to do with the loss), one we discovered at our first ultrasound at 10 weeks and didn't actually lose it until 3 weeks later(opted out of the D&C for insurance reasons) and conceived again directly after that loss with no period in between, which we probably shouldn't have done, and lost that one day before yesterday at what I assume was about five weeks. I think it was a new pregnancy and not something incomplete from the last one because I saw what I am almost sure was the tiny embryo. Could this one have been lost because we conceived it so immediately after the last loss? Would you recommend testing at this point, or does this sound like three random happenings? I have a consultation with my doctor on Thursday, but wanted to hear another opinion about what we should look for or if the workups would be likely to turn anything up.

   

• At Mon Nov 17, 09:06:00 AM 2008,  Deciding in NY said…

  Dr. Trofatter, I'd like to ask your input on an amnio ...
  I became pregnant naturally just after my 41st birthday so I'll be 42 when baby is born(due date 5/21/08). I recently had a 1st semester ultrascreen at 12wk4d.
  NT(mm)=2.1, CRL(mm)=64.1, Free Beta hCG(MOM)=1.04, PAPP-A MOM=1.22, Delta NT +.049. Down's risk before screening 1/45 and after 1/735, Trisomy 18/13 risk before is 1/82 after is 1,621. I would love to feel 100% confident that our baby will not suffer these abnormalities, but I'm afraid of the possibility of having an amnio and causing a miscarriage. I'd appreciate your thoughts.

   

• At Mon Nov 17, 08:41:00 PM 2008,  Shaken Mama said…

  Hello Dr. Trofatter -- I just wanted to let you know how much I've enjoyed your Fruit of the Womb blog. I'm planning to recommend it to the readers of my Health.com Fertility Blog this week. I'm using an older post of yours regarding nuchal fold scans -- thanks for providing such great information, and I hope you get even more readers through my blog as well!

   

• At Tue Nov 18, 10:09:00 PM 2008,  Anonymous said…

  Dear Dr.Kenneth,
  
  Greetings from Kathmandu, Nepal.
  I saw this blog site and read your advise on CPC's and I was happy.
  During my 22nd week US, a 1.5 cm CPC was detected in the right brain of my baby. I am 32 yrs old. The radiologist said that they disappear in time. I consulted my gynac doctor and she said that follow up is needed for next US. She siad its not 100 percent normal and also siad that there is not tests than can be done in Nepal to see risks.
  
  I would like to know from you on what should be looked at in the next US; what kind of tests are needed to assess risk if there is a need. Since, there isn't much good facility here so I am worried about this. Please offer me honest advice on this. I would be grateful to you for your help.
  
  Thanks
  Tara

   

• At Sun Nov 23, 04:55:00 PM 2008,  juliazhang said…

  Dear Dr Trofatter,
  
  I am 15weeks pregnant and had a down syndrome screen test at 14wk 1 day. The result are: AFP=1.69MoM, free beta HCG=3.63MoM. uE3=1.17. Risk of DS is 1:234. I was offered the amnio test. This is my first pregnancy and also IVF. I will be 35 at the due date. I am generally skinny but fit. No medical history. I am scared of the risk of miscarriage and infection if i go for the amnio. Just need your opinion about it.
  
  Thanks Julia zhang

   

• At Thu Nov 27, 03:21:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Nov 10: I don't know whether we are dealing with a thrombophilia or autoimmune problem, a uterine anatomy problem, a chromosomal problem, or a hormonal problem (now that your menstrual cycles are becoming prolonged) or a combination of the above. If you can give me a list of the studies that have been done on you, your husband and even any of the miscarriages, I might be in a better position to offer some advice, even for empiric therapy. If you are working with an REI doctor, he/she may be aware of the impact of subclinical endometriosis on early implantation failure. It might be worth a 3-4 month course of lupron therapy followed by ovulation induction and then the empiric anticoagulation therapy with aspirin and prophylactic doses of heparin or lovenox (starting the latter either in mid-luteal phase or as soon as a pregnancy is confirmed). Of course, if there is a chromosomal rearrangement in either you or your partner or if the conceptuses were aneuploid by chance, even that therapy will not be beneficial. Best wishes. Dr T

   

• At Thu Nov 27, 03:26:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Amber: Was it a true partial molar pregnancy or could the fetus have had a chromosomal abnormality that caused 'hydropic degneration' of the placental tissues to make it look like a molar pregnancy? Did your doctors try to do chromosomal studies on the products of conception? Regardless, at age 31, waiting a year many not be reasonable. After you hCG levels drop to zero, 3-4 months is generally going to be 'safe' enough but you must be aware that in the unlikely event you do develop choriocarcinoma coincident with a pregnancy, the prognosis for you will be worse. Best wishes. Dr T

   

• At Thu Nov 27, 03:31:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Deciding in NY: For a 41 year old woman, and looking at all of the test results, you have a very reassuring first trimester screen. The risk of an amnio is greater than the chance that you have a baby with a chromosomal abnormality. Many women in your situation will simply have a 'genetic' sonogram done at 18-20 weeks. If that is reassuring, your risk is reduced another 60-80% and if something nonreassuring is found at that time, it is not too late to have the amnio done. However, in the end, the final decision is yours and yours alone. Best wishes and let us know how things turn out. Dr T

   

• At Thu Nov 27, 03:41:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Amanda: I an sorry for your losses, but it is not ideal to conceive on oral contraceptives, or to get pregnant immediately following a loss. So the reasons for your losses have a high likelihood of being the result of unrelated conditions. Waiting 2-3 months and planning the next pregnancy is more likely to result in success. Discuss things with your doctor. Probably a modest evaluation is reasonable including thyroid studies, perhaps chromosomal studies on you to look for a chromosomal rearrangement (but this is expensive), and a screen for the more common acquired thrombophilias (antiphospholipid antibodies, lupus anticoagulant, and maybe antibeta2glycoprotein-1). Some would argue that hysteroscopy or a sonohysterogram would be appropriate as well at this point. However, since none of your losses might be related, I would not overdo at this point, and even offer you simply the opportunity to conceive again under more controlled circumstances and hold off the mega-evaluation pending the outcome of that pregnancy. Best wishes and thanks for writing. Dr T

   

• At Thu Nov 27, 03:42:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Shaken Mama: Thanks for the kind words. You can use anything you want. Just let me know if anything is inaccurate or out-of-date! Dr T

   

• At Thu Nov 27, 03:44:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Tara: Usually a follow-up ultrasound is all you will need to have done under these circumstances. If anything more abnormal is seen at that time, you might be offered an amniocentesis to evaluate the baby's chromosomal status but that is usually not recommended if the only finding is a choroid plexus cyst. Best wishes and thank you for writing. Dr T

   

• At Thu Nov 27, 03:49:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Julia: The risk is what it is and that is just about the same as your 'age alone' risk for Down syndrome in the midtrimester of pregnancy at age 35. You have to make your decision whether you want to do an amnio, wait to see what the baby looks like at the time of a good ultrasound at 18-20 weeks (a normal exam at that point reduces your risk about 60-80%), or do nothing at all. The choice is entirely yours. The risk at this point is no greater or less than that which has been quoted to you based on the combination of maternal serum markers. Best wishes and please let us know how things turn out. Dr T

   

Post a Comment

<< Home