Sunday, November 7, 2010


I woke up at 6:45 am on a Sunday. It would be entirely horrifying but for the fact that its a pregnancy symptom, hence it makes me ecstatic. Yes, pregnancy brain is a very weird thing indeed.

This next bit is a rant.

My  perinatologist flatly refused to get me tested for any of the thromobophilias (factor V leiden/ MTHFR) saying a) that the test results are hard to interpret and b) I've only miscarried once. Its like saying, lets wait till you do it once or twice more (because each time is so much fun) before we test you further. Its the same attitude my old OB had when she refused to order any more tests after they got the normal fetal karyotype result back. She assured me that in 99% of the cases (even the repeat miscarriers) they *never* find a cause, despite running all these oh-so-expensive tests.  Then I come back positive for the anti-TPO antibodies which are found in 10 % of the population AND are linked to miscarriage. Even more damning are the facts that a ) I do have an incredibly strong family history of hypothyroidism and b) TPO antibodies are found in  a lot of women with TSH levels in the normal range! If they had ordered those tests and stated treating me, I think there would have been the slight possibility that my first baby would have made it. Still, that is water under the bridge now, but when I think of all this, its only natural when I feel like I SHOULD be now second guessing my doctors.  Still, I think the possibility of me testing positive for the thrombophilias are really, really low, so I'll let this one go.

But still, I think this is a topic that strikes close to home to a lot of people- how much do you have to go through before your doctors 'waste' some of your insurance's money and decide to test you? Are series of wasted tests worth it for even the slightest possibility that one might actually find something?


  1. Given that it doesn't cost them squat to test you - I mean they could just send you to a lab instead of do bloodwork in their office - it seems nuts that they'd be so opposed to sending you for the test.

    Thinking of you and the bean :)

  2. With the cost of healthcare going up every day, doctors are getting judged for practicing cost effective medicine (which is BS, if you ask me, until tort reform is passed...but that's another story), and in training we are taught and encouraged to practice cost effective medicine.

    Unfortunately, what's cost effective for a population might not be too comfortable for an individual.

    That's not a very comforting answer, but that's the way it works - if you find this uncomfortable, wait until we get socialized medicine! I understand your perspective, and relate to it completely, but I also understand your doctor's perspective as well.

  3. Jay, I would try to order every test for your reassurance and peace of mind. If your perinatologist won't do it, ask your regular OB, RE, or primary care doctor. You really have to be proactive with your medical care. I have ordered tons of tests on myself-- it doesn't change the management of my TTC, but it makes me feel better.

  4. Sometimes it sounds as though Doctors don't always know the value of piece of mind...having a test done to put your mind at ease is important.

    Take care.

  5. "Are series of wasted tests worth it for even the slightest possibility that one might actually find something?"

    Hell, yes! Found you through Mo's blog. I'm an SMC in NYC (would love to get together once you move here), and after reading that REs generally don't believe in all this testing, took it in my own hands. BEFORE starting to cycle (at the insane advanced age of 44), without discussing it with my RE, I got a recommendation for a hematologist from an IVF message board and booked an appt. I said to him, "I'm 44 and about to start IVF. I want you to run all the bloodwork you would run on a woman who'd had repeated miscarriages or failed IVFs." He agreed, did a thorough exam, took a thorough history, and had his phlebotomist draw about 1/3 of my blood. Everything came back basically fine, except I have a single heterozygous MTHFR and mild Reynauds (which is pretty inconsequential), and he had me come back to recheck all the bloodwork in my first trimester. (I did inject Lovenox from transfer day to 8 wks.) Totally worth it for my peace of mind.

    Congrats on your pregnancy. Hope it's boring. :-)

  6. Hey Dora, thanks for stopping by, yes, would love that! There are some silver linings from having to relocate from San Diego to NYC in the dead of winter, meeting you and Mo and all the other people in this process will be a very big one!