Friday, January 4, 2013

What Causes Miscarriages?

John and I had an amazing visit this week with my new doctor. He was so kind, and patient, and hopeful. We talked about my history, and he helped me understand something a bit more.

Statistically, I most likely had three miscarriages. However, because I did not have an early ultrasound with any of them, it's possible that one or more could have been ectopic pregnancies. Those occur when the egg implants somewhere else other than the uterus. It's possible that, especially since I have one blocked Fallopian tube, that the egg was fertilized but didn't make it down to the uterus. But, since we don't know for sure, we are assuming they were all implanted in the uterus, and would be miscarriages.

Besides having really, really bad luck (by luck alone, the chance of a woman having three consecutive miscarriages is 0.8%), there are five main reasons for a woman to suffer from multiple (three or more) miscarriages.

  1. Low progesterone. I have already discussed this a bit in the past. If there isn't enough progesterone produced, the egg will be vacated from the body because it's not being supported. He said my level was good in a sense that it showed I ovulated, but doesn't know much more than that. Every body is different, and perhaps that level was low for me specifically. We are not doing any tests for this, and I'm just going to be put on progesterone supplements. He said it's cheaper and easier to just prescribe it than to test the levels every month. Thank you!
  2. Cysts, polyps, and fibroids.  Sometimes there are little growths growing on the uterus or ovaries. These make it hard for embryos to implant and grow. Next month I will be going back for a water ultrasound. They will inflate my uterus with water and do an ultrasound to look for any of these growths. If there are some, usually a simple outpatient surgery will get rid of them. Sometimes it's a chronic condition, like polycystic ovary syndrome, or PCOS, that we'd have to work around with hormone drugs. 
  3.  Autoimmune disorders. Some women have a disorder which forms antibodies that think fetuses are foreign invaders in the body, and don't belong there. So these antibodies will attack the tissue until it leaves the body. The solution for this is simply taking an immune suppressor so the antibodies won't attack and leave the baby in peace. 
  4. Blood clotting disorders. This also has to do with the immune system. Some women have immune systems with antibodies that attack anticoagulants in the blood, causing the blood to clot more easily. The blood can clot in the placenta, not allowing proper blood flow to the growing fetus. There is a drug that a woman can take that will prevent the blood clotting so easily and allow blood flow to the fetus.
  5. Genetic disorders. I have not studied genetics passed what I learned in high school biology (this would be more of John's area of expertise), so this is my very, very basic understanding. If anyone has more info, please comment! Sometimes two people's genes just won't mix right. Without proper genetic information and instructions, a healthy fetus can't grow. There is a really cool test they can do on each person to get a map of all their genes. They would take a sample from me and a sample from John to see if our genes are compatible. If there is some problem, the solution is to do in vitro fertilization. They would fertilize the eggs and do testing on those embryos to see which ones are viable, then place the viable ones into the uterus and hope they implant.
After the doctor explained each of those to me, the first thing that went through my mind is that there is a solution for each one of those problems. I'm just so relieved that a solution is right in front of me. Before, my problem seemed endless. Now, we just have to test and play around with the first few options to see if we can diagnose what it is. As for numbers three and five, we are going to wait on those. The tests are really expensive, and it's a lower probability that those are the cause. We are on a tight budget, so we're just going to test for the affordable ones. So, if after working on the other three I get pregnant and miscarry again, we'll do tests for the last two and see if those are the culprit. We're just hoping it's not number five, because in vitro is expensive!

In addition to taking progesterone, I will also be going back on 100 mg of Clomid. I thought I was done with it because I have been ovulating on my own, but at my ultrasound this week, we saw that I did not this month. Clomid can have a brief lasting effect after you stop taking it, but that effect wore off on me. 

It's all so close now that I can almost see it!


Jules said...

I love helpful doctors who actually EXPLAIN things. Do you have any inklings about which issue might be causing the trouble? Just curious! I hope it's the first, since that sounds like the easiest to resolve.

Allie said...

I actually don't have any idea which it could be! If I did pure speculation, I would rule out number two, because I have had two doctors palpitate around my ovaries and neither of them felt cysts or anything. But that doesn't mean that there isn't something hiding inside the uterus. All of the above (and possibly more than one) could be the cause. I'm also hoping it's the first!

Jessie and Curtis said...

Wow, sounds like a great and understanding doctor! So glad you found him - you deserve it! We are always praying and cheering for you!