Dr. Practical

I loved him. Well, he is my only choice with Kaiser so I bet there was something inside me reminding me of this so I was focused on all of his strengths throughout the consult. He was great, got down to business and helped me feel much more in control of this process. We met with the nurse first for like 20 minutes and went over my detailed menstrual charts, miscarriage details, surgery dates, background family medical info, our environment, habits, etc. She put everything into the computer and got Dr. Practical.

He was great. He suggested three main things to do for recurrent pregnancy loss. He did keep saying that miscarrying twice is SO common. He would order the three main things right away if we miscarried 3 times but with 2, he let us decide how aggressive we want to be. I will be doing all three of them, which will all be completed by my next ovulation so, yes ladies...he told us to try again as soon as we want. I am freaked beyond belief. The last 3 months have flown by and the time between trying and losing pregnancies has been a nice security blanket so I am a little hesitant to try again.

1. Hysterosalpinogram (HSG)- This will look at my uterus for any abnormalities. I think this is going to be the only uncomfortable piece to this puzzle. I will call the office on the first day of my next period and schedule with radiology for sometime between day 6 and 14 of my cycle (between the end of menstrual bleeding and ovulation). This now sits around the second week of February.

2. Lots of freaking bloodwork for immune, coagulation, etc. I had 8 vials of blood taken a few weeks ago which was the beginning of this process. I had 9 more vials taken today. Most of the previous tests and the ones taken today are all immune stuff and coagulation panels. I will gather a total list of all of the tests and post them when I can figure out what the hell he tested today.

3. DNA/Chromosome analysis- One of the biggies today was a chromosome analysis of both hubby and I. Hubby hopes his results come back indicating he is a "superhuman". We both gave a vial and the results take 6-8 weeks. There is absolutely nothing my doc can do to my genetic makeup if the results come back abnormal. If abnormal on my part, I will then assume 2/3 of my eggs are duds and 1/3 are okay or balanced. If I get pregnant right now before results are back, I could very likely have an unaffected or "normal" egg, which he strongly thinks is the case. If I miscarry a third time, at least this bloodwork is already done and we know the results. If I do have an abnormality....I will be put on Clomid to up my eggs, increasing the chances that more normal eggs will release. So with a 3-5% chance of an abnormality in couples with RPL and a 33% chance that, even within that 3-5%, I would have a normal egg released, I am going to take my chances...does this make sense?

He did say that my analysis of the last pregnancy is essentially useless. Because it came back 46XX, it can be one of two things. Either it was a genetically normal girl or it was my tissue and he is not able to tell which. That is why this can still be considered a fluke. If it came back 46XY, it would most likely be the embryo because I am in fact not a male ;). So he really gained nothing from the normal results from the karyotyping I did.

Beginning the month I want to start trying again, I will begin progesterone 3 days after ovulation, right before implantation could happen. He does not routinely test for luteal phase defect and does not test for progesterone at all. He is part of a huge scientific community that sees the research indicating that progesterone level drops are never the CAUSE of a pregnancy loss, rather the RESULT of a non-viable pregnancy to begin with. He did say that because it is relatively cheap and safe and easy, I can absolutely do it if I want (see, he's practical). He said the same for baby aspirin. If I need some crutches during the next pregnancy, he understands.

Once I get pregnant, I will be under his watchful eye for 10 weeks. I will have blood draws each week early on and a few ultrasounds to see how things are progressing. If at 10 weeks all is growing nicely, I will graduate to my OB.

So I will wait for more bloodwork results, my DNA workup will be back in March and I will have my HSG done in a few weeks. Today felt pretty good.