We finished fertility testing. If you don’t want to read the details about my reproductive system, feel free to stop reading here. 🙂 The results are both not hopeful and hopeful. They found three things about me that are “worthy of note” but only one of those things seems it could explain my recurrent miscarriages.
- I have a genetic mutation that makes me prone to clots. This clotting gene may have explained my subchorionic hemorrhage I had at 11 weeks gestation with Cami when I almost miscarried her. However, our fertility specialist said that there is no evidence that this gene increases the risk of miscarriages. In fact, apparently 70% of Mexicans have this gene but they don’t have higher incidence of miscarriage in their population. The potential treatment for this concern is to go on heparin shots while pregnant, but as the specialist pointed out, if I had started bleeding, I wouldn’t have stopped bleeding due to the heparin and probably would’ve miscarried Cami for sure. He says heparin shots are not indicated given that I am a “heterozygote carrier” of the gene and not a “homozygote carrier.”
- I have an underactive thyroid. My numbers fall within “normal” range but it’s not a range they want to see for someone trying to get pregnant. So they initiated me on thyroid medication and want to monitor my numbers and will give us the “green light” to try to get pregnant after my numbers are in a healthy range. So even though they want to make my thyroid more active, apparently hypothyroidism isn’t associated with miscarriages either. It’s just dangerous for the baby if I don’t have a good functioning thyroid. Although my internet searching does say there is a link between hypothyroidism and miscarriage…who to believe? The omniscient internet or our sub-specialist? Either way, treatment for my hypothyroidism is helpful and puts my mind more at ease about trying to get pregnant again, knowing my thyroid levels are in a better range.
- Now to the reason our specialist thinks I keep miscarrying: my egg quality. Doctors can’t directly measure egg quality. They can only measure egg quantity but they know that egg quantity is correlated with quality. As our doctor said, “When you get to the bottom of the barrel, the apples aren’t the greatest.” There are four categories of egg quality: excellent, good, fair, and reduced. I am in the “fair” category. Our doctor thinks that my miscarriages might be a result of “bad eggs” or as he puts it, “You might have flipped tails three times in a row.” He thinks it’s possible for us to get a good pregnancy from trying naturally, and sustain the pregnancy because maybe some of my eggs that are left are decent eggs. But he says, given my age (approaching “advanced maternal age”) and the quality of my eggs, we need to “be aggressive.” The doctor recommends that if we don’t get a sustainable pregnancy ourselves in three months, we need to start “moving up the ladder” of more aggressive interventions, ending potentially with at least one round of IVF.
How do I feel about all this? There needs to be a word that articulates: between hopeful and not hopeful. I feel both hopeful and not hopeful. I feel like we got some answers and that there is reason to hope, but I also feel that we didn’t get a complete picture of what is going on. For example, does my egg quality explain why I miscarry at exactly six weeks gestation? (I didn’t tell our doctor that I actually had a fourth chemical pregnancy that miscarried at 6 weeks at the end of April…so is it possible to flip tails four times in a row?). And these results don’t explain the autoimmune response I have when I get pregnant (swelling fingers that resembles rheumatoid arthritis). I asked our doctor about that and he said that in pregnancy the immune system if extremely suppressed, so if I have an early stage autoimmune disorder, symptoms could be manifest at that time because the immune system isn’t up to speed to hold the symptoms at bay. That does make sense to me and while it seems to me that a weird autoimmune response is related to my miscarriages, the doctor doesn’t necessarily think so. It’s hard when I’ve been tested for a couple autoimmune disorders and they all come back as negative. I’m not complaining, I don’t want a diagnosis of an autoimmune disorder. But I would like to know what is going on with my body in that regard and know if there is something that can be done. The biggest suspect for an autoimmune disorder that I could have is Hashimoto’s disease. When they were looking at my thyroid nodule, my ENT said that my thyroid looks like it has Hashimotos but the test came back negative. My swelling fingers and “lower register” voice, as well as fatigue and low thyroid numbers all fit that profile. Ugh, I’m getting bugged writing about all these medical concerns, let alone imagining how your eyes must be glazing over to read all this! Anyway, it’s a mystery yet to be solved. Maybe one day we’ll figure it out. The fertility doctor said that Hashimotos complicates pregnancy in that the thyroid needs to be monitored more closely as thyroid levels can change more rapidly and inconsistently, but I still wouldn’t need to be monitored more than once a month.
So, who knows what the future holds for us? We are going to go ahead and keep trying. If I miscarry again, the doctor wants me to get a D&C so they can collect the tissue and see if there are chromosomal abnormalities present that explain the miscarriages. He doesn’t think that’s likely though, since we’ve had three healthy babies.
What a guessing game this all is! Who knew that at 34 (I still feel young), I’d be looking at the edge of my fertility? I never thought I’d be in this place, considering significant medical interventions to help us have another baby, while also not knowing if those interventions will even help! As our doctor said, “We’ve gotten good at getting people pregnant, we aren’t nearly as good at keeping people pregnant.”
Taking deep breaths and continuing into the journey…wherever it leads us!
PS Chad’s swimmers passed with flying colors!