Question:
Dear Dr.Ramirez,
I am a 32 years old and my husband is 34. We have been trying for a baby since July 2008. In early 2009 we conceived and were over the moon. An early dating u/s at 6 weeks showed a heartbeat but sadly I started bleeding 2 days later and naturally lost the pregnancy.
Two months later we conceived again and my doctor suggested progesterone supplements. At the 7 1/2 week u/s the baby had an extremely slow heart rate and passed one week later. I had another natural m/c.
After the second miscarriage we decided to go to a Fertility Clinic and do a full work up. Everything came back perfect. Good FSH (5.9 & 6.8), AFC count of 20, normal karyotypes, no autoimmune or blood clotting issues. All other hormones were great as well including husbands DNA sperm test.
We decided to try agian with the aid of a low dose fertility drug (puregon) and timed intercourse. I got pregnant that first cycle this January. All of early ultrasounds were perfect but sadly we found out the baby had a large cystic hygoma and T21 at 12 weeks. I just had my D&E and am totally devastated.
Could we really have such bad luck? Or is there something else going on like poor egg quality at my age? What would you recommend we try for next time?
Your response is much appreciated. D. from Canada
Answer:
Hello D. from Canada,
Despite the fact that you had three losses, I am not sure that you can bunch them together. For one thing, the last loss was due to a congenital anomaly. It was not technically a miscarriage. I presume that you doctor checked chromosomes in both you and your husband to make sure that you are not passing something along. If that is the case, and it was normal, then the congenital anomaly was just chance, as was the miscarriages.
The most common reason for miscarriage is spontaneous genetic defects. That means that when the egg was dividing, there was chromosomal breakage and so the embryo developed abnormally. In most cases, the body detects the abnormal embryo/fetus and stops the pregnancy leading to a miscarriage. It is known that most patients with multiple miscarriages will eventually be successful, so one piece of advice is to not give up. Certainly, getting pregnant is not an issue for you. Also, because you are still young, it is unlikely that you have "bad" eggs or poor egg quality. That is usually an age related phenomenon.
I know that it is emotionally draining and an absolute heartbreak to go through all these losses. But you will eventually be successful if you keep trying, so, not to belittle the losses, but it might help if you think of these as practice runs for the real thing. Also, in addition, to the progesterone supplements with each cycle, you might want to add low dose aspirin and folic acid to the regimen. Hopefully, the next pregnancy will be the good one.
Good Luck and God Bless,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
Comment: Dear Dr.Ramirez, Thank-you so much for your prompt and informative response. My husband and I will certainly try again in the future after we take some time to heal emotionally. Your answer has given me much hope ! Also, yes we had our karyotypes checked and we do not have any genetic/inheritable issues. All of those tests were normal. I pray for a healthy baby soon.
Thank you so much for visiting my blog & your kind words! I'm so glad that IVF also brought you your child & that you are continuing to further this amazing work. I'm honored you would quote me on your facebook page...thank you so much, you made my day:) Most importantly though thank you for the work you do every day on behalf of couples like myself & my husband.
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