Tuesday, May 24, 2005
Skipping Ahead
Briefly, I took a leave of absence from work, the second IUI was successful, but third beta fell and miscarriage followed shortly after stopping the progesterone. I returned to my doctor who agreed that IVF with PGD was a reasonable next step, but the nurse also mentioned a doctor who is actually a specialist is recurrent miscarriage in Chicago. (I'm really starting to appreciate nurses.) I started plans to undergo IVF but also set up a referral with the Chicago doctor in Chicago. (While Chicago seems a far place to go for a simple doctor's appointment, we have no insurance coverage for IVF, so plane tickets, a hotel room and our co-pay seemed very reasonable in comparison with the high price of IVF.)
Dr. Chicago met with us and reviewed our history and discussed where to go from here. She was strongely against IVF with PGD on the basis of two recent Belgian studies published in the December 2004 volume of Human Reproduction and the March 2005 volume of Fertility Sterility (I haven't actually read them) which did not show any increased likelihood of successful pregnancies for women with unexplained recurrent miscarriage who underwent IVF with PGD. Instead, she recommended additional auto-immune testing and an endometrial biopsy with endometrial function test. The endometrial function test is apparently something new performed at Yale. I can have the endometrial biopsy performed locally. The tissue sample is then sent to Yale. Dr. Chicago has worked with the doctor heading this up at Yale and believes that his work is aiding in the identification of uterine lining issues not discoverable through the endometrial biopsy alone. We've decided to take Dr. Chicago's recommendations (although I haven't have the endometrial biopsy).
Dr. Chicago was very big on the role that stress plays in early recurrent miscarriage. I appreciate, but hate this fact. The chance of me staying calm during any future pregnancy seem virtually nill. But, I've started my first foray into alternative medicine. I started at our local naturopathic teaching clinic. I'm on supplements, am eating more often and have hugely increased the amount of water I drink a day. I also started acupuncture. I'm going to a yoga class tonight. I have roughly a month and a half before I return to work.
I had the auto-immune blood work done two weeks ago. I just spoke to a nurse who said that all of the results look normal, but that Dr. Chicago will be calling to discuss them with me in the next few days.
One of the hardest parts of this has been the unexplained nature of the miscarriages. Because its unexplained, there is nothing we can fix. There is nothing we can work on or work toward. My local doctor has repeated the statistic that 55-70% of women with recurrent miscarriage do have a successful pregnancy. (I understand this statistic covered both primary and secondary recurrent miscarriage with more of the secondarys - those who already have a child - having more success. But statistics apply to populations, not an individual. This statistic doesn't affect my likelihood of success. There's also the other statistic about recurrent miscarriage - that it affects less than 1% of the US population. Since I already missed out in being one of the 99% that doesn't have this problem, it doesn't seem unlikely that I would fall into the 30-45% who never have a successful pregnancy.
While that's sad, its not really the hardest part. The hardest part is knowing when to stop trying. When do you stop paying money, taking drugs, being a basket case, hurting your marriage, your friendships and your job? If you stop too early, how do you live with the thought, "if only .... (we had done one more test, undergone one more cycle, took more drugs, changed doctors, I had left my job.)"
For now, we're in the middle part. Its been a lot, but not too much. We have an also (not instead) plan of starting on adoption when I turn 39. The point of this all being to bring a child into our family.
Dr. Chicago met with us and reviewed our history and discussed where to go from here. She was strongely against IVF with PGD on the basis of two recent Belgian studies published in the December 2004 volume of Human Reproduction and the March 2005 volume of Fertility Sterility (I haven't actually read them) which did not show any increased likelihood of successful pregnancies for women with unexplained recurrent miscarriage who underwent IVF with PGD. Instead, she recommended additional auto-immune testing and an endometrial biopsy with endometrial function test. The endometrial function test is apparently something new performed at Yale. I can have the endometrial biopsy performed locally. The tissue sample is then sent to Yale. Dr. Chicago has worked with the doctor heading this up at Yale and believes that his work is aiding in the identification of uterine lining issues not discoverable through the endometrial biopsy alone. We've decided to take Dr. Chicago's recommendations (although I haven't have the endometrial biopsy).
Dr. Chicago was very big on the role that stress plays in early recurrent miscarriage. I appreciate, but hate this fact. The chance of me staying calm during any future pregnancy seem virtually nill. But, I've started my first foray into alternative medicine. I started at our local naturopathic teaching clinic. I'm on supplements, am eating more often and have hugely increased the amount of water I drink a day. I also started acupuncture. I'm going to a yoga class tonight. I have roughly a month and a half before I return to work.
I had the auto-immune blood work done two weeks ago. I just spoke to a nurse who said that all of the results look normal, but that Dr. Chicago will be calling to discuss them with me in the next few days.
One of the hardest parts of this has been the unexplained nature of the miscarriages. Because its unexplained, there is nothing we can fix. There is nothing we can work on or work toward. My local doctor has repeated the statistic that 55-70% of women with recurrent miscarriage do have a successful pregnancy. (I understand this statistic covered both primary and secondary recurrent miscarriage with more of the secondarys - those who already have a child - having more success. But statistics apply to populations, not an individual. This statistic doesn't affect my likelihood of success. There's also the other statistic about recurrent miscarriage - that it affects less than 1% of the US population. Since I already missed out in being one of the 99% that doesn't have this problem, it doesn't seem unlikely that I would fall into the 30-45% who never have a successful pregnancy.
While that's sad, its not really the hardest part. The hardest part is knowing when to stop trying. When do you stop paying money, taking drugs, being a basket case, hurting your marriage, your friendships and your job? If you stop too early, how do you live with the thought, "if only .... (we had done one more test, undergone one more cycle, took more drugs, changed doctors, I had left my job.)"
For now, we're in the middle part. Its been a lot, but not too much. We have an also (not instead) plan of starting on adoption when I turn 39. The point of this all being to bring a child into our family.
