Sunday, July 31, 2011

On RPL

First and Foremost: I apologize for all the blank posts. If anybody is having issues with posting, try changing your browser. I kept posting with Firefox, only the title of my post could be published (Lots of hair got yanked out!!). Changing to Internet Explorer fixed it. Blogger deserves to be abandoned for Wordpress or something else that does not mess up like this.

After my second loss, my Indian RE strongly suggested I read the book 'Coming to Term'.  The author and his wife had 4 pregnancy losses (2 chemical, 2 more advanced), and he decided to do a careful study on the subject of recurrent pregnancy loss. His book covers the scientific spectrum of causes of pregnancy loss, and he has the most heartrending case studies. Its horrifying and uplifting all together to read those stories. The average women in there had about 4 losses, but many of them has as many as 6 or more. Almost ALL of them went on to have healthy children. Almost all.  Tears and joy aside, reading that book gave me a good idea of the scope of the monster that is RPL, an invaluable thing in itself.

The book also highlights that science does not have all the answers and that miscarriage is the murkiest of pools. One story in particular stood out. This woman had 4 first trimester losses. She was finally diagnosed with Factor V Leiden, which predisposes to blood clots that end the pregnancy.  At that time, heparin had not been established as the treatment for this issue. Her fifth pregnancy, with no medical intervention whatsoever, went completely smoothly. She had a healthy baby. She got pregnant again, and this time, took heparin, and that pregnancy also went just fine. What amazes me was her 5th pregnancy. If clotting was what had ended 4 of the pregnancies, what saved the 5th?  Science definately does not have the answers.

Still- there are times when it can help. I stumbled across the most amazing website. It is an archive of all the research done on the myriad causes of pregnancy loss.

https://sites.google.com/site/miscarriageresearch/

I did a lot of reading up on the the two that have been implicated for me, Vitamin D and Thyroid autoimmunity.  There is PLENTY of evidence linking the two to pregnancy loss, and even more gratifyingly, vitamin D to glucose metabolism. The parts about Selenium and anti-thyroid antibodies I also found useful. This website is a treasure trove, I'm not done going through it yet.

However linked something is to either infertility or pregnancy loss, the converse also applies, there have to have been women who have many of these issues, and have gone on to have perfect pregnancies.Nothing is absolute and almost all the iceberg is still below water. 

The statistic is that one in 5 pregnancies end in loss. I have 4 friends currently pregnant. I'm the only person they know who has had pregnancy losses.  When I listened to my friend, who had just started trying and who is now 15 weeks along, a sense of failure came upon me. How could I have been the one to fail not just once, but twice? A stupid, immature feeling, but its not one that is going to go away anytime soon.

What I've learned along this painful road: tell nobody. I've made a few new friends in NYC who I'm getting closer and closer to as time goes by. One year ago, I would have happily told them what I intend to do. Now, I'm going to keep my mouth firmly shut. Nobody is going to get to know the next time around, whenever that blessed event occurs. 

11 comments:

  1. Port of IndecisionJuly 31, 2011 at 10:07 PM

    I assume you mean 15 weeks along? 15 months along would be one hell of a pregnancy!

    It can be both comforting and isolating to tell people. Comforting because you find out how many other women you know have had a miscarriage, isolating when you find out that almost none of them have had more than one - and that most of them have at least one kid by now too. Since I get pregnant easily, I'm always seesawing back and forth on whether to tell close friends early or just tell them I'm on antibiotics and can't drink. One day I feel like, "Ehh, what's it matter at this point? Who cares about waiting to tell people?" and the next day I realize what an ass I'll feel like for telling them, "Never mind. Not pregnant anymore. Again."

    I've been meaning to tell you also, just as a data point for your intellectual curiosity. I have a friend whose AMH tested around a 2 last year. She does not have a baseline Vitamin D reading from back then, but when she had her AMH re-tested a couple months ago, it was a 0.8. And her D was 17 (!!). She's not interested in following up on it because she's had her tubes removed and had already started her last IVF cycle, so it doesn't really matter to her. I just thought you might be interested to hear of another person with a possible correlation.

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  2. haha, yes, I meant weeks, thanks for pointing it out:))

    Among one of the many reasons I don't want to tell people is this sense of embarrassment - baby making is so easy for them, and I just feel like they are all wondering what the heck is wrong with me that it is not so for me. This is uncharitable of me, I'm *mostly* sure they have no such thoughts, I'm projecting what I feel onto them,  but yet,  keeping my mouth firmly shut is the way to go.

    I can do it because I have this community, and I thank god for that:))

    About your friend, thanks for sharing.  It is interesting, 17 was my level too. But yes, without a baseline, it is inconclusive. She should most definately have her vitamin D levels up nice and high- low vitamin D levels in blood correlate to low vitamin D level i follicles corellates to poor egg quality and  a much reduced chance of sucess in IVF. Multiple studies have shown this. A good blood level is between 35-45 IMO.

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  3. Raining-Sunshine.blogspot.comAugust 1, 2011 at 2:06 AM

    Intriguing post. I have never had a loss because NOTHING even IVF with ICSI and assisted hatching has worked. I blogged today about being high risk x8. My mom has Factor V Leiden and nearly died from a traveling clot at age 16. She lost her first baby at 8.5mo and managed me with no blood thinners but never any more kids. Science is just science but it is disheartening to be the one always coming up short. Wishing you a healthy baby soon!

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  4. I'm sorry for everything you have been through. In a way, all the factors that cause pregnancy loss are also the ones that apply for general infertility. A BFN could be because of an extremely early loss- if one assumes that a 'pregnancy' begins the moment that the sperm injects its DNA into the egg, I read somewhere that the % of miscarriage rises from 15 % to about 70 or 80%.

    Thanks for stopping by, I'm going to go check your blog out now :)

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  5. raining-sunshine.blogspot.comAugust 1, 2011 at 6:55 AM

    Thanks. :)  It has been an ordeal.  Considering 33 and nada - zilch - zero, the doctor thought perhaps the endo made eggs tough to penetrate since I do ovulate on my own each month.  The ICSI did result in all mature ones fertilizing (only 3 because over suppressed since I am not as awesome of a responder as we thought).  Day 3 transfer, did all three since 2 were at the same point (6 cell) and one slightly behind.  BFN.  The IUI before on injectibles we really chanced it with 2 IUIs and SIX mature follicles released.  BFN.  If those things don't do it, no wonder nothing happened before then.  I guess Thursday at my followup I will learn more...  Fingers crossed for you and your info gathering.

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  6. I've read that book - it's very good, in a horrifying and calming way.  The message I got out of it is we don't know anything, just keep trying!  Exhausting...

    I like Google Chrome for internet use too - it gets rid of all my blogging problems...

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  7. Thanks for commenting on my post, Jay.  I don't think that I am braver than you at all.  I haven't experience the loss that you have.  Quite frankly, I'm certain that I'd make the same choice as you if I had a similar history.  I can afford my optimism because I haven't tried and met with heart crushing disappointment.  It's quite alarming to think that 1 out 5 pregnancies end in miscarriage, but I know two women in my life who had miscarriages.  It was interesting to read the research on miscarriages.  I was interested to read the research pertaining to soy.  In many Asian countries (Korea, Japan), soy is a significant staple in their diet---more so than meat.  I'm curious to know what the miscarriage rates in those countries compares to the U.S. and how or if ethnic backgrounds might factor in.  I was also interested in what research had to say about N-Acetyl Cysteine.  My RE has me taking it, but I couldn't figure out why until I head the synopsis on the studies form the web site.  Thanks for sharing!

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  8. Well, if the levels turn out to be no different, it is still inconclusive.  You can always wonder if the women there, who have been consuming bucketloads of this stuff for time immemorial, have actually evolutionarily adapted to it- decreased the receptors for phytoestrogen or something. Every permutation and combination is possible with biology!

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  9. Yeah, exhausting is the word.  Its bloody hard to keep on at it. I wonder how many women he interviewed actually gave up after a few losses, and whether he left out those cases.

    But yep, that book did help calm me down, for exactly the reasons you state.

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  10. I'm of a similar opinion... I don't share my fertility plans with my family or with most of my friends. I just don't know how to share such news after two miscarriages.

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  11. Jay...thank you for your comment on my blog! I published it & will be answering it shortly (got called away just as I was about to catch up on my replies yesterday). Sorry & thanks again. EJR, MD

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