Adam and I had our first appointment at the new fertility clinic a couple of weeks ago and we were very pleased with the entire organization, and especially with our doctor. Of course, I often seem to like each doctor I try early on, only to discover the problems later, but a good first impression is at least a good start.
We met with our Reproductive Endocrinologist for about an hour, and he explained the results of the testing we did with the previous doctor. We needed this review because the old R.E.'s entire explanation of the results so far was, "You are homozygous for C677T and need to take folic acid." Everything else that I wrote here on the blog came from my research on the Internet. My research was generally correct, except that I had an inflated idea of how relevant my MTHFR issue is. Our new doctor (Dr. U.) said he would not even test for this gene except that it comes automatically with the battery of genetic tests. He claims that the science does not show any correlation between the mutation and pregnancy loss. He does look at homocystiene levels, which can cause clotting problems, and mine are normal. Even if he is wrong on this issue, the folic acid would still be the only treatment. I am doing that, and there are no side effects, so the whole thing is just a non-issue. I was close to that same conclusion based on my research, but I had some lingering doubts until I heard his explanation.
Dr. U. then explained what had been ruled out, which the previous doctor never did. I won't bore you with the details, but any identifiable genetic issues that could be the problem have been ruled out, and that was my main concern. Just about every other common issue has been ruled out as well, but we have two more easy, safe tests that we can do. I have to wait for my next cycle to perform the tests, and this time we are being more careful!
However, before Dr. U. explained the additional testing, he gave us a lecture about accepting the unknown. He didn't realize that he was preaching to the choir! Using statistics and citing results of controlled studies, he told us that, especially after the testing we have already done, we will probably never know why I have had recurrent miscarriages, beyond the guess that it is an egg-quality problem (which is normal at my age). He talked about how there are dozens of "treatments" for this or that, but that most of the things people try either have no evidence for improved outcomes, or have positive evidence for worse outcomes. He was obviously warning us against something I'm sure he sees all the time: people's desperate grasping for some action to take - something that they can do and control. I'm sure you can imagine the wacky things people will try in order to make a baby, and the thing is, sometimes they are actually making it harder on themselves.
(This is an issue that I've been thinking about a lot lately: the seeming human need to eliminate the unknowns and deal with uncertainty. Personally, I have great trouble with uncertainty, but I tend not to cling to fantasies to solve the problem, and instead build up psychological defense-mechanisms that cause me great anxiety. That's a mistake that I'm working on.)
After we agreed on the tests, Dr. U. told us that based on my history so far, I still have a 60-65% chance of having a successful next pregnancy. I asked him about IVF with PGD and he said (despite the fact that he himself is a pioneer in this area) that PGD will not give us better odds than that, and it might even worsen the odds. If you know anything about genetics, the reasons are, 1) mosaicism (in PGD, they test only one of less than ten existing cells), and, 2) the limited number of problems they can test for in the short time available before they have to implant the embryo. Dr. U. said there have been at least seven controlled studies on this and that they show a slightly worse outcome for PGD patients in circumstances similar to mine. (The best uses of PGD are for weeding out known genetic problems or for gender selection.) The doctors might be able to somewhat increase the likelihood of a healthy embryo with the testing, but that is outweighed by the problems inherent in harvesting the eggs, fertilizing them outside the womb, and then reimplanting them. Since we have no trouble conceiving, we'd be lowering our odds overall.
One of the additional tests we are doing will tell us if I have a bigger egg-quality problem than would be expected for my age. If that is the case, then we will reconsider our options, but otherwise, we're going forward naturally.
So, believe it or not, it looks like three miscarriages at my age really is quite normal - maybe a little unlucky, but not unbelievably, shockingly, devastatingly unlucky. I want to scream to all my young friends to start trying NOW, but I think it's a bit tacky so I'll just do it here on my blog instead of in person. Did you hear me, young friends?