Wednesday, June 16, 2010

Baby Making Update

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?


  1. Thank you for sharing your story, Amy. Even at my age (I'm not quite 27), I hear all the time from friends who are struggling with miscarriages and fertility problems--it's definitely far more common than most people think, even at a younger age. Although we've come so far in gaining control over one of the most important facets of life, thanks to modern medicine, it's difficult to realize how much of it is still out of our hands at this point. Thank you (from all of the future stubborn mothers) for your courage in not giving up!

  2. This was a pleasure to read! I'm so glad you had a positive outcome with this new doctor. It sounds like night and day from the last one, and I hope your initial good impression turns out to be accurate.

    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.

    This paragraph really jumped out at me. I have the very same issue with building up defense mechanisms. I know we don't have much opportunity to talk to each other, but I'd love to chat about this sometime or just hear how you are working on the mistake via your blog, as I make the same one and am working on it myself.

    Last summer when we were debating taking the "trying to conceive" plunge, we interviewed several sets of young parents and found that people either said "wait and enjoy your lives alone together as long as possible" or "begin trying right away while you're young; you never know what problems might crop up with age." It was an interesting dichotomy between opinions, and I suspect there's no right or wrong, as baby-making is that one wholly irreversible and unpredictable (in terms of both process and outcome) change that humans can make in their lives. It's hard to know which side of the fence you'll fall on. We ultimately decided that since all of our ducks were in a row, we'd start trying, assuming there would always be a longing for "just one more vacation with just the two of us," etc. whether we had our first child at 29 (which I will) or 35 or 39. We were extremely lucky to have an easy time getting and staying pregnant, but I agree with your last paragraph--I am very glad we chose to err on the side of trying as soon as we were ready vs. squeezing in those few extra years sans kids.

  3. Hi Amy! I'm glad you are finding answers to this, and that you both like this new practice. That's great! :D

  4. I hear you lady! Loud and clear!