Well, I opted for medical management of this miscarriage, and it’s proceeding slowly. I took the first round of medication Friday night, and not much happened, so I took another round Sunday morning, and finally things are moving. I don’t think I’ve passed the main pregnancy tissue yet, but hopefully soon (I was so afraid it was going to happen in the middle of my lecture yesterday!). I’ve got another week before they’ll start pushing a D&C on me, which I’d like to avoid if possible since I have adhesions from my first pregnancy.
In the meantime, I’ve started to do some research on causes of recurrent pregnancy loss. I’ve already been tested for clotting factors and some of the immunological stuff, and other than being heterozygous for Factor V Leiden it all came back normal. But it’s hard for me to believe that FVL is the only culprit, since it’s not associated with an increased risk of 1st trimester loss. The main thing I haven’t really been evaluated for is heritable chromosomal issues, like a balanced translocation in my husband and me — but I find it hard to believe that that could be the source of our woes, since we know that two of our four pregnancies at least have been chromosomally normal, including the daughter we lost in the 2nd trimester. It’s also not particularly associated with 2nd trimester loss.
There are actually very few issues that are associated with increased risk of both 1st and 2nd trimester loss. But one thing that I read about immediately clicked for me, and now I am anxious to talk about it with my doctor on Tuesday. You’d think that with everyone looking at my uterus in every which way over the past four years someone would have brought it up before now, but I’m about 95% certain that on one of my recent ultrasounds the tech noted a slight septum that she didn’t think was clinically relevant. But anatomical abnormalities like a uterine septum are one of the most common — and most treatable — causes of recurrent pregnancy loss. They are also one of the few etiologies that causes both 1st and 2nd trimester loss. The ASRM guidelines on recurrent pregnancy loss note that the likely mediating factor causing 2nd trimester loss is abnormal placentation, which was the leading hypothesis for our daughter’s death. It just all makes so much sense! If I have a slight septum that isn’t bad enough to cause total infertility, but is enough to cause poor blood flow to the embryo/fetus, it would explain why I keep getting pregnant but keep losing the pregnancy, sometimes early and sometimes late, even in the absence of chromosomal issues. It at least seems worth asking about, since the prognosis for treatment is really, really good — there are some studies where the live birth rate jumps up to like 85% (normal!!!) after surgery to correct a septum. I would love to have an 85% chance of a live birth, instead of the 75% chance of miscarriage that I seem to have had in my pregnancies so far. Maybe my doctor will tell me I’m nuts and that this slight septum can’t possibly be causing my problems… but I feel like I have to at least bring it up. And if my regular OB doesn’t listen, I have an appointment with the RE on the 28th and will bring it up again then. And again and again until someone listens and has a real conversation with me about it.
I’m just ready for someone to take this problem seriously and stop telling me it’s just bad luck — it seems so clear that whatever is going on, it’s more than just bad luck. One 2nd trimester loss… maybe? But that’s already really bad luck, since it happens in only ~1% of pregnancies. Two losses? OK, fine, a single first-trimester loss out of three pregnancies does seem within the realm of normal. But three losses out of four pregnancies, including a loss in the middle of the 2nd trimester? How can people keep attributing this stuff to bad luck? I mean, I know it’s not always possible to find a cause, but it would be so much more helpful if someone would say, “Look, your history is crappy and indicates a problem. We don’t always know what the problem is or how to solve it, but here are the things we can check for and here’s why I do or don’t think that each of them might be a problem for you specifically.” That’s what I want. Why is it so hard for doctors to talk to patients that way?
Anyway, that’s where I am now. Waiting to finish miscarrying this pregnancy, walking around, acting like everything’s normal in the meantime, diving back into the literature on pregnancy loss to try to find some answers about what’s happening to me. This semester has just been so hard, with my dad dying the first week of the semester and my third miscarriage happening in the middle of the semester. I’m kind of amazed that I’m still functioning, but at the same time I really don’t think I can take any more, and I’m having to bite back yelling at people or bursting into tears all the time. I have very little patience for anything even a little bit trivial right now, which is really not the frame of mind I should be in during advising week for our freshmen, who are freaking out about their schedules for next semester. I also can’t handle any kid-related stress, and when my toddler was clinging to me at daycare dropoff yesterday I actually started crying right in the middle of the toddler room. I don’t think the teachers noticed, and I got myself out and to the car before I really let loose, but I wanted to cling to my son as much as he wanted to cling to me! You’d think I’d be used to pregnancy loss by now, but I don’t think you really ever get used to it. Having a living child makes it easier, for sure, but it’s still awfully hard.