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Megan M:

so very very sorry about your miscarriages!!I can totally empathize. The rest I will preface with the straight up fact, I am NOT an MD nor any other trained medical profession, however I have a technical background and studied lots on the mechanics of IVF, pregnancy etc. So I understand some basic facts really well.

THAT SAID, I am pregnant for a third time and the pregnancy (i.e fetus died) is non viable at week 8. The heartbeat went from 97 to 0 (non-existant). So am waiting for the miscarriage now. I know why I am challenged in this regard. It is simply an artifact of my age. My first m/c was a natural pregnancy at 39, #2 m/c at age 43 and now #3 at age 43---the last two with IVF and ICSI.

My (OLD) MATERNAL age means old eggs that somehow manage to fertilize correctly, implant and carry a pregnancy up to a point---THEN BAM the DNA is corrupted with a chromonsonal problem. Analysis on #2 m/c showed it was Trisonomy 22 (NOT DOWN's).

I also know I have ZERO other contributing factors such as Natural Killer Cells, etc. I had a complete blood work up done called MILLENOVA BLOODS. They do a fine job and it will tell you volumes of data and info. I'm surprised that your RE has not suggested this work-up after m/c #2..... So that's one (maybe 15% of the population has this condition) possibility. Every RE that I have spoken with in a consult (I paid them) said the same thing to me after m/c#2---get MILLENOVA BLOODS done. I have that labs address if you need it.

So I can come up with two things for your reflection: your age and/or NKC or other autoimmune things tied to NKC.
I would HIGHLY AND STRONGLY RECOMMEND A SECOND RE OPINION. If you live in the NYC metro area, I have excellent insights, if you are interested. Again, my deepest empathy to you. Jane

thanks jane,

i have had a ton of blood work done, but it seems like the blood work you are speaking about is more extensive? i am in the NYC metro area. which clinic/drs did you see?

meganm,

I am so sorry for your m/cs, I too have had several m/cs over 10, the last being Aug 06 since then DH and I were told by my RE not to get pregnant until testing was complete. I have had every test you can imagine and nothing has come back positive. I have done alot of research and have come to the conclusion I suffer from low progesterone! Have you had your progesterone checked? I was seeing an high risk ob gyn and she never checked my progesterone and I also had alot of blood work done by a Hemetologist but I was told I would have to see an RE to have my progesterone checked.

So I have been seeing an RE since Oct 06, I had my progesterone checked in January and it was 1.5, I really don't no much about the numbers but that is VERY LOW, I was suppose to have an endometrial biopsy done but since my levels were less then 5 which is still low I could'nt have it done until following month and I had to take Cloimd 100mg 2x aday for 5 days and it did boost my progesterone from 1.5 to 22.

When I left my apt with my RE yesterday I was'nt a happy camper, he went right into talking about me having IVF or using a surrogate! I was upset we DO NOT have that kind of money, we just bought our home a year ago! It was like he totally ignored that fact that I suffer from low progesterone.

Megan, have you done any research on low progesterone and miscarriages? I have done so much research and a Dr named Dr John Lee talks about any women that has had three or more miscarriages between the 6-8 week probably suffer from low progesterone! Not saying everyone women.

When I sat with my RE yesterday that was the first time that I saw it was all about the money, putting a person on progesterone is nothing, but doing IVF ranges over $20,000 and the meds are not included, it's all about the money. Don't get me wrong I no there are some women that have to do IVF and IUI's or use surrogates and I'm not knocking it but for some women it's not nessecary.

Hope this little bit of information has helped some, hope to hear back from you....Take Care...Tiffany

Hello Megan M: thanks for your bounceback. I hope you are slowly and steadily recovering from your m/c as I am....It is a stinky process both psychologically and physically....

Tiffany's right about the low progestrone. If it tests low while you are on progestrone shots while pregnant, there's a challenge. I believe it should be above 20 or 25 once you get the shots going after transfer of embryos. Progestrone shots are the only way to get it into the bloodstream and sustain a pregnancy. Progestrone suppositories don't work that way. There's a long, rationale very well written article on progestrone that I just read last night.....I'll dig for it and cut and paste it here later.

As to MILLENOVA BLOOD WORK-do it for your peace of mind, if not for the volumes of data that it gives your RE.

It is 39 different tests, hence called a panel. I can't type 6 pages of microscope print here otherwise, I'd share. But I could fax you mine if you want to see the gist of the testing.

You can probably get it done independently if you have a prescription and if you don't or can't get your RE to do the blood drawn. Any blood service (QUEST, LABCORP, etc) can draw the multi vials, but it has to be packaged and FedExed to Millenova. YOu might want to contact them: the are located in Chicago at 312-274-1918. The lab director is Dr. Carolyn Coulam, MD

The clinics I consulted with in the NYC metro area:

NYC:
Dr. Joel Batzofin of SIRM webpage: www.haveababy.com
@ CRMI: Dr. Spandorfer webpage: www.ivf.org

NJ:
Dr. Jane Miller of North Hudson IVF in Englewood Cliffs, NJ (website I have buried and can send later with progestrone article)

LI:
Dr. Pena of East Coast Fertility in Bethpage , forgot their website
Dr. Romano of Reproductive Sciences in Hicksville, don't know their website

Not sure of your criteria for a second opinion RE?? If you are below 38, any of the above REs are fine in terms of medical training, competence. If you are above 38, only CRMI and Dr. Jane Miller are worth your time (my opinion only given that I am a sufferer of ADVANCED MATERNAL AGE). They all have slightly different approaches, philospohies and practices and to the extent that they will treat you like an intelligent human rather than a routine case. Also the competence of the support staff is critical in my opinion. If you stack rank your criteria in order of importance to you, I can comment more fully and directly. I am just guessing here. Does that sound fair and helpful?

Again all my empathy and very best baby dust wishes, Jane
PS: also the book the INFERTILITY SURVIVAL HANDBOOK by Elizabeth Swire Faulker is a god-send, well worth the $15 on Amazon. I've read it three times cover to cover...

Megan M: here's some info about progestrone. It's not what I read last night, but solid. It turns out that the page I was reading last night is now under construction for some reason.....I'm sure it will come back....


Progesterone Supplementation

Progesterone Supplementation (suppositories, shots or pills)
Progesterone, a hormone that is naturally produced by your ovaries, helps to prepare and thicken the lining of your uterus for the implantation of a fertilized egg. Progesterone is necessary to support and maintain a pregnancy should conception occur. The ovaries continue to produce progesterone until the placenta has developed and is able to support the pregnancy.

In some women the ovaries do not make enough progesterone or the lining of the uterus does not respond well to normal amounts of progesterone. If this happens the lining of the uterus is not able to thicken or prepare for implantation of the fertilized egg. This may result in the failure of the fertilized egg to implant and pregnancy does not occur. There are many reasons why the ovaries might not produce enough progesterone. The different causes may be ovulation problems, endometriosis, fertility drugs, or "older eggs".

Progesterone supplementation is a medication that is taken after ovulation and it corrects the low progesterone hormone imbalance. The lining of the uterus responds to the progesterone medication, it thickens and prepares for the implantation and support of a pregnancy. A woman will continue to use progesterone until the placenta has developed and is able to support the pregnancy. (10-12 weeks after conception).

Progesterone supplementation can be given in the form of vaginal suppositories, injections (shots) or by mouth. The progesterone is usually started four days after you have had the shot that causes ovulation to occur (hCG or Profasi). You will continue the progesterone until you have had a negative pregnancy test or a normal menstrual period. If you conceive and are pregnant you will continue the medication for several weeks; the doctor will tell you when it is time to stop. Progesterone supplementation has few side effects. These may include breast tenderness, nausea, fatigue, or a 2-3 day delay in the start of your period.

The medication may be packaged with a patient information insert. The purpose of this insert is to provide information about progesterone to all patients taking it. The information in the insert pertains to all progesterone medication, both natural and synthetic. There is an increased risk of birth defects to babies exposed during pregnancy to synthetic progesterone. However, the progesterone supplementation prescribed by the physician is in a natural form and this does not increase the risks of birth defects. Please talk with your physician if you have any concerns. Not all pharmacies carry or make these medications. Your physician can tell you which pharmacies may have the drug.

Progesterone Suppositories are inserted into your vagina and are then absorbed by the body. You may notice some leakage of the medicine from your vagina when you are up and moving around. Do not worry about this because the medication is still being absorbed. You may want to wear a panty liner to protect your clothing. There are no activity restrictions while using the suppositories, including sex. It probably would be more comfortable to wait until after intercourse before inserting the suppository. Occasionally the leakage of the medicine can be irritating to the skin around your vagina; contact your physician if the vaginal irritation becomes too bothersome.

Progesterone Oral Medication comes in several different forms that are taken by mouth. Some are swallowed with water, but others (troches) are placed under your tongue until it dissolves. Ask the pharmacist to explain the correct way to use this form of progesterone.

Progesterone Injections are "shots" that are injected into your muscle (usually the buttocks or thigh) and the progesterone is absorbed by your body. You may notice soreness or tenderness at the injection site while you are taking the progesterone shots. After an injection you may apply a warm compress to the area for relief. Please contact your physician if the injections become too painful.

To make it more convenient for you, your physician can teach you, your husband, or a friend how to give these injections. The following instructions are to help guide you through the process of injections.

The following information is for descriptive purposes only and should not be used as a substitute or replacement for professional/medical instruction.

It will be helpful to lay out all of your supplies before you prepare the medication.

Progesterone-in-oil comes in a vial that contains several doses of medication. Note that the strength or dose of Progesterone 50 mg. is equal to 1 cc of this medication. (1 cc is the same as 1 ml).
A disposable 3 cc syringe
Two disposable needles - 1 1\2 inch, 22 gauge.
Alcohol pads
A plastic container to discard the used needles and syringe.

To prepare the medication follow these steps:

Wash your hands and clean your work area with an alcohol pad.
Remove the plastic cap from the vial of Progesterone and wipe the rubber stopper with an alcohol pad.
If it has not been done already, attach a needle to the syringe. Carefully twist the cover off the needle by wiggling it back and forth until it is free. Slowly remove the cover. Be careful not to touch the needle.
Draw air into the syringe by pulling the plunger to the 1 cc mark. Insert the needle through the vial's rubber stopper and inject the air into the vial. Without withdrawing the needle, then turn the vial of medicine upside down and withdrawal the progesterone into the syringe.
Please be careful to withdrawal the correct dose into the syringe.
Progesterone 50 mg = 1 cc or 1 ml.
What is the dose of Progesterone?

What amount of Progesterone do I draw up into the syringe?

50 mg 1 cc
100 mg 2 cc
150 mg 3 cc



Remove the needle from the vial and change needles before injecting the progesterone. You are now ready to administer the medication.
The middle-outer thighs and the upper outer buttock are the best areas to give a progesterone injection. The injection sites need a chance to rest between shots. It will help to rotate or alternate the injection sites.




Administering medication: You may choose either the buttocks or thighs as injection sites. If you choose to give yourself a shot in the thigh, be certain the leg is relaxed and in a resting position. For injections into the buttocks - it is necessary to have a second person administer the medication with you laying face down or leaning against a surface with your toes pointing inward. (This helps to relax the muscles).

Carefully clean the injection site with an alcohol pad, then let the area dry.
To inject the needle, firmly spread the skin surrounding the injection site. Position the needle at a right angle to the skin, and quickly insert the needle straight through the skin and deep into the muscle. Release the skin.
Gently pull back the plunger 0.1 - 0.2 cc to check for blood. If no blood appears in the syringe, it is safe to inject the medication. Push in the plunger with a slow, steady motion until the syringe is empty. Gently withdraw the needle and cover the injection site with the alcohol pad applying a small amount of pressure. The used needle and syringe can be discarded in the plastic container.

Some Suggestions:

When you pull back on the plunger in Step 3 to check for blood and blood does appear in the syringe, this means the needle has entered a vein. Do not be concerned. Withdraw the needle/syringe completely and discard them in the plastic container. Start over again.
Needles should be discarded immediately if someone is accidentally punctured or injected, or if it touches unclean surfaces.
Never re-use needles or syringes. Use it for one injection only and then discard them. Your physician will provide these supplies to you at your request.
Discard the used needles and syringes in a plastic container. The purpose of the container is to protect you and others from being accidentally punctured.
Date last updated: January 6, 2003

Megan: As promised, here's the webpage for Dr. Jane Miller:
http://north-hudsonivf.com/

in North Jersey, Englewood Cliffs

Joining the team

I am 34 and married for 4 years. Two years before I had a D&C followed by no H/b in 8wks. just after 3 months I had an ecotopic pregnancy and the right fallopian tube was removed. The other tube is identified having blocks thro' a lapro . So i did my first IVF cycle last month and after a wait for 2w, the bhSG level was 200 and was optimistically waiting. but the further tests showed a very low bhSG level (<1.2 at the 7th week) and the scan shows there is no fetal growth after 5wks. Now I started bleeding. No idea what next, any ways planning for the next embryo transfer asap. Through out the mishaps my darling husband stands by me through my emotional outrage.
How a PGD will help me in checking a chromosomal anomaly?

Hi Jane,

I read your post. Did you ask your RE for an order on Immunologic testing through Millenova Immunology Laboratories? I have always wanted to get myself tested after I had failed implantation in Feb 07 with 3 DE plus miscarriage at 12 wks in 2005. I did asked RE about it but he felt it wasn't necessary. I don't want to continue onto 3rd IVF w/o knowing if I have immune problems. I was thinking if doctor order is needed, can I ask my primary dr instead?

How much did you pay out of your pocket for the tests?

Which testing panel did you use?

Thanks!



[quote author=JANE ALLERTON link=board=17;threadid=3874;start=0#33085 date=1173307252]
Megan M:

so very very sorry about your miscarriages!!I can totally empathize. The rest I will preface with the straight up fact, I am NOT an MD nor any other trained medical profession, however I have a technical background and studied lots on the mechanics of IVF, pregnancy etc. So I understand some basic facts really well.

THAT SAID, I am pregnant for a third time and the pregnancy (i.e fetus died) is non viable at week 8. The heartbeat went from 97 to 0 (non-existant). So am waiting for the miscarriage now. I know why I am challenged in this regard. It is simply an artifact of my age. My first m/c was a natural pregnancy at 39, #2 m/c at age 43 and now #3 at age 43---the last two with IVF and ICSI.

My (OLD) MATERNAL age means old eggs that somehow manage to fertilize correctly, implant and carry a pregnancy up to a point---THEN BAM the DNA is corrupted with a chromonsonal problem. Analysis on #2 m/c showed it was Trisonomy 22 (NOT DOWN's).

I also know I have ZERO other contributing factors such as Natural Killer Cells, etc. I had a complete blood work up done called MILLENOVA BLOODS. They do a fine job and it will tell you volumes of data and info. I'm surprised that your RE has not suggested this work-up after m/c #2..... So that's one (maybe 15% of the population has this condition) possibility. Every RE that I have spoken with in a consult (I paid them) said the same thing to me after m/c#2---get MILLENOVA BLOODS done. I have that labs address if you need it.

So I can come up with two things for your reflection: your age and/or NKC or other autoimmune things tied to NKC.
I would HIGHLY AND STRONGLY RECOMMEND A SECOND RE OPINION. If you live in the NYC metro area, I have excellent insights, if you are interested. Again, my deepest empathy to you. Jane





[/quote]

I'm sorry about your miscarriages! I've had one miscarriage as well and still am not all emotionally there yet. I have had a laproscopy for my endometriosis by my RE as well sometime ago years back, but did your dr even talk to you about taking metformin (glucophage) to help maintain a pregnancy? Not sure if you have PCOS or not, but usually they gice glucophage(diabetes medication) even though you may not be diabetic, to help sustain a pregnancy until you are 3 months, that's when the placenta takes over making the hormones itself in stead of relying on your ovaries to make the hormones. Please ask the Dr if you have PCOS and even if you don't, if you are insulin resistant, the metformin (generic for glucophage) helps a great deal as well.

I am an RN, but not a Dr, but moreso I am a patient that lost a baby(I hate the word embryo!) and I can only imagine how you are feeling! I had to take progesterone and get HCG injections, but that did not help. Everyone is different, but I will tell you- you cannot be a nurse and a patient at the same time, when you're pregnant, you forget so much and don't think the same! I've moved so I was not able to see my RE so I put myself in the hands of a Dr I should not have seen, but I called my old RE and he said to take the metformin as he told me way before-but i forgot.

Even if you get an IVF, it's the sustaining of the pregnancy that's the concern. You cen get pregnant no problem, I believe. Also, when you have so many MC's, they increase your folic acid to about 4 mg's or 4000 mcgs same thing, each day.

My wish for you is that you have your baby soon one day, but right now even moreso, that you find an RE that can diagnose you and check you for possible PCOS. They do a trans vaginal ultrasound to diagnose this.

God bless you..... [email protected] Silvia

"God did not give me a baby this time, because he gave me an angel instead."


Some books to read:


When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility by Sandra Glahn and William Cutrer

Moments for Couples Who Long for Children (New Life Devotional) by Ginger Garrett


Keep us posted on how you're doing and if you want to talk please email me. I'm here for you.
-Silvia