Plan #1 - Assess

Thanks everyone for your thoughts, we appreciate it very much.



We met Dr. Gehlbach today and his PA Lindsay. They were both very nice and informative. The plan at this point is to assess the situation and what could be causing the miscarriages to occur. Dr. Gehlbach does not believe that the MTHFR mutation is what is causing the miscarriages to occur. He did agree that I should continue at this point taking the aspirin, folic acid, and B vitamins. His words were "they probably won't help a pregnancy, but they won't hurt. The MTHFR puts you at higher risk for clots and it will definantely help with that."



We went over our medical histories and what has occured this past year with the previous pregnancies. He came in and talked to us about things that cause recurrent miscarriages. This is the list and what we do to test for each specific cause:



1) Anatomic (meaning a anatomical issue with my uterus that the baby would not be able to attach or survive correctly) ~ for this I will have a what is called a Saline Infusion Sonohysterography the first week of my next cycle (which will be the 1st week in August). This test is done by doing a sonogram and at the same time inserting sterile saline into the uterine cavity. This will show us any abnormalities of the uterus and/or endometrial cavity.

2) Antibodies ~ these are caused by blood disorders (factor issues, lupus, etc), I have already completed these blood tests at my OB office. All look normal.

3) Chromosomes ~ This is done by Karyotyping (which is a blood test). Dustin and I will both have this test done to ensure that both of our choromosomes that we would be passing to a baby are correct and balanced. This will be before Aug 1st.

4) Hormonal ~ these would show a luteal phase defect. I have chosen not to do this test just yet. It consists of doing an endometrial biopsy during the luteal phase. I have nothing against this test, just want to see what the others show first. Instead of doing the biopsy I will began taking a progesterone supplement starting with my next cycle on Day 18 and then continue if I indeed become pregnant or stop it when I began my next period and start it again on the next day 18.

5) Insulin Resistance ~ apparently there is some corilation with having a higher glucose/insulin level on a consistant basis and miscarriage (who knew?). So for this I will have that lovely 3 hour glucose/insulin test done. This will be before Aug 1st.

6) Ovarian Reserve ~ This is to see how many follicals I am producing. For this with my next cycle on Day 3 I will go back to Dr. G's office and have a blood test and a sonogram. They will count and measure my follicals to see how many likely develope into eggs to be fertilized. The blood test will determine my FSH and Estradol level (hormones that produce the follicals).

Dr. Gehlbach also encouraged us not to lose hope. Sometimes we never find a specific cause of miscarriages. But reality is this in 50-60% of cases similar to yours a cause is found and we go on with that, 40-50% of cases we find no cause, all comes back normal. But if we do not find anything there is still a 70% chance that you will still have a healthy pregnancy and baby. It is just going to be based on how much you can endure before it happens.

So these is where we sit for now. All of these tests will be completed within the next 3 weeks and then maybe we will have an answer. I was hoping for some further guidance yesterday, but at the same time I am so glad that someone is finally going forward with testing.

Thanks again for all your thoughts and support. I will keep you updated as I learn new things!