The Next Steps in our RPL Journey
We saw our RE on Friday.
Some would say we have a bit of going-forward plan.
Some would say the plan has some pretty big gaps in it.
Regardless, all I know from 2 years into Recurrent Pregnancy Loss, is that the best laid plans mean nothing. But, I’ll try to explain everything we discussed with our RE. I should point out, I love our RE – he is amazing and always takes the time to answer my questions in a way that I can understand them. Every time we see him, we have some pretty awesome conversations about all of this and I do feel like he is looking out for our best interests, even if his medical advice doesn’t necessarily feel useful due to our unexplained diagnosis.
Going in we didn’t expect a miracle cure (although we always hope for one), and surprise, surprise, we didn’t get one.
Here’s the summary of the discussion:
Our RE does not believe embryo adoption is a practical route for us. First, here it is almost unheard of for people to donate or allow other people to adopt there embryos – if we want to do this within our province/country, we would have to find someone who has some left over from IVF and do some sort of private adoption agreement. Different counties have different laws, so we may be able to pursue this outside of Canada and then presumably pay big dollars for it. Second, he’s pretty confident it won’t solve our problem because our karyotyping is normal, so we should be able to produce a healthy child ourselves. So, why spend tens of thousands of dollars on something that will likely have no effect on the outcome?
If we are adamant about trying something different from a genetic perspective he suggests either turning to donor eggs and/or sperm because they are more available (although costly). He is still does not think this will solve our problem, but it’s the route he would recommend due to the lack of donor embryos. He also stressed that if we are able to create a fertilized embryo using some sort of donor product, this will not change our chances of having another miscarriage.
We also discussed doing In Virtro Fertilization (IVF) with Comprehensive Chromosomal Screening (CCS) to see if we find anything. We have discussed this before, and know that it is unlikely to provide us with an answer. And, again, this will not change the likelihood of another miscarriage. So, we could spend $30,000-$50,000+ and have the embryo’s all look perfect and end up with the embryo’s not sticking right away or just have another miscarriage. Or we could find that all our embryos are screwed up, but still be no further ahead because this can happen to anyone going through IVF. So, unless we are made of money (and we are not) and feel like going through IVF in hopes of finding something through CCS, then why would we do this?
We also spent some time talking about the fact that we are still not pregnant again.
- Our RE was just as surprised as us that we are not pregnant yet. He simply does not count the biochemical pregnancy, so for the sake of argument, today I will not either. So, this means we are now in cycle 5 of trying – 50% of all couples will be pregnant within 6 months of trying. So, he is not worried about us at this point. He believes we are falling back into the normal timeframes for people to conceive, rather than being at the head of the bell curve as per our last 4 pregnancies. I absolutely hate it, but it is nice to hear that it’s not a medical worry at this point.
- To be proactive, I will be tested this month to confirm ovulation. And, to be proactive my husband will have a semen analysis done. Our RE fully expects both to come back normal, since we have been pregnant 4 times within the last 2 years and 4 pregnancies indicates reliable ovulation and reliable sperm. But, he wants to be sure something hasn’t changed and we agree. So, I’ll get some blood work done on CD 21 – next week. My husband will go in October (when the next available appointment is).
- Broken ankles do not impact sperm quantity or quality. There goes that theory.
- If we pass the 6 month mark of trying without success, he recommends introducing either clomid or letrozole. For people our age (31), 6 months is not a concern, and would not warrant a visit to an RE in our medical system (the requirement is 12 unsuccessful consecutive cycles for couples under 35, and 6 unsuccessful consecutive cycles for couples over 35), but since we are seeing one he would not want to see us wait until the normal 12 month mark given all our RPL history. More than likely he would put us on letrozole and he suggested I research them both but focus on letrozole in the next few months (if anyone has any thoughts on clomid or letrozole, please let me know). The idea being that they should increase our chances of getting pregnant (5% risk of twins, and 1% chance of triples because I already ovulate normally). My husband and I both expressed that we are not really interested in taking these drugs because we know I ovulate, so what’s the point? But as I always like having a plan, I am happy to know what he will suggest if we still are not pregnant by November.
Immunology was one of the big topics of the appointment. As we suspected he doesn’t really buy into the whole idea. And surprise, surprise, he never received a letter from my immunologist. But, we discussed what my immunologist said (read that here). So, our RE doesn’t see a big deal with reducing my gluten intake, but he really doesn’t think it’s the answer. He agrees that there are some doctors outside of Canada who have made their profession of treating RPL and immunology together. But, he stresses that the research does not support the link, and it is his opinion that the risks associated with many of the medications they use during the first trimester outweigh the benefits of taking them. For example, we spent a lot of time discussing the idea of a low dose steroid in the first trimester. Research indicates that it doesn’t make a difference to a creating a viable pregnancy, but there is strong research indicating low birth weights and other complications for the baby if it makes it to term. Needless to say, we are at a loss right now on whether or not to pursue the expertise of someone like Dr. Braverman or not. Our big thing has been having a healthy child, not just having a child, so my initial reaction is that I would rather not introduce medications into our next pregnancy that could have long term negative effects on the child
As for trying something slightly different with our next pregnancy, our RE would rather put us on daily heparin shots then a low dose steroid, as there is more research indicating that it can help in creating successful pregnancies for RPL patients and it has no harmful effects on the baby because it does not cross the placenta. So, this may be something we do next time we are pregnant. But even then, he doesn’t see heparin as providing enough benefit to do it. Either way, if we push for the steroid or the heparin, he will work with us and treat us.
So, for now, we keep trying the old fashion way, which has proven rather successful for us. Our RE made it clear that there is no need to panic (which of course my husband loved, because he’s been saying that to me for a few months now). We will continue on our current plan* with the possibility of adding heparin into the next pregnancy.
And while we wait to see our RE again in November, at the same time we will be thinking very hard about a few things:
- Do we want to pay out of pocket to visit an RPL specialist? Possibly Dr. Braverman.
- Do we want to consider going out of country to try embryo adoption?
- Do we want to venture into using clomid or letrozole to help encourage a pregnancy, knowing that we should get pregnant on our own if we are patient? And of course, we cannot neglect to acknowledge that getting pregnant doesn’t mean we will actually maintain a pregnancy.
It is unlike us to rush into any major decisions, and we are only 31 so age is on our side, so we will take the time necessary to think through our options and make an educated decision. If we are lucky we will get pregnant before we have to make any decisions and the baby will stick (so far we have never been lucky in our attempts to have children, but a girl can hope, right?).
If anyone has any thoughts or experience with any of the above 3 options, we would love to hear them!
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