"You've got to wait till after 3 miscarriages before testing."

 After my second miscarriage I was determined to seek help and not wait for another miscarriage to happen. A lot of times in the medical community they tell you they do not do anything/begin testing until you have 3 consecutive miscarriages. Thats just crazy to me! I've got to go through 3 loses until they run a reoccurent loss panel...for which I am paying for? I wasn't okay with that. I asked my doctor to refer me to a fertility specialist. She stated she could run the reoccurent loss panel after the pregnancy hormones were out of my system and she would put a referral in but she didn't know if they would do anything since I've ONLY had two losses. My loses happened back to back with no cycle in between. We were 2 for 2. We tried 2 months and got pregnant immediately both times. Sure it could be a genetic abnormality with the embryo but I wasn't willing for that to be my only answer without further testing. 

I called around in Huntsville to the two fertility clinics but they did not accept our insurance so it would have been all out of pocket. I would have been fine paying out of pocket if I had to, we would have figured out a way to make it work but our insurance has infertility coverage so we just had to find where to go. Calling around and getting the run around we found out that UAB Reproductive Endocrinology and Infertility was where we needed to be. I called our insurance and surprisingly we actually have pretty good  fertility coverage we just have to go to UAB which is about an hour and a half from our house. When I called to schedule my appointment I was asked if I preferred a male or female provider which I preferred female but if it was going to get me in sooner I would go with a male. My appointment was scheduled for March 22 which was about 6 weeks away. At the time I thought that was so long and it was going to delay me getting pregnant again, as I didn't want to get pregnant before we got the testing done. In reality it came at a PERFECT time, which was a God thing...teaching me patience and helping me to heal not only physically but mentally as well. I literally, FINALLY, got a negative pregnancy test the weekend before my appointment and started my first period post miscarriage and first one since October, due to back to back pregnancies. 

Daniel had gotten the day off and we were headed up to Birmingham hopeful for some answers. It's pretty intimidating walking into a fertility clinic, its definitely not a place anyone chooses to go to. I always had a fear I wouldn't be able to get pregnant but the fear of miscarriage never crossed my mind. I had filled out all the paperwork prior to coming and made sure I was as accurate as possible and Daniel of course adding his little comments haha part of being married to a doctor. Everyone was super nice at the clinic. I felt very comfortable and in good hands.

The doctor was great and very thorough. We went over my history and were able to ask as many questions as we wanted. I never felt rushed or "just a number". It was great! We went over the plan and were given the okay to track ovulation and try for a pregnancy again. We got all the labs ordered including:

Hemoglobin A1C - assess for diabetes 

PRL - checks prolactin levels in blood

TSH/T4 - thyroid labs

TPO Ab - thyroid antibodies

APLS - antiphospholipid syndrome (clotting issues)

Parental karotyping - checks for balanced translocations for both Daniel and I

Urine test for mycoplasma and ureaplasma (Due to Daniel requesting...no signs I had this)

We were warned that everything could come back normal. I wasn't hopefully something would come back abnormal but at the same time I was so we would have an answer for our loses. 

We also scheduled a SIS - Saline Infusion Sonohysterography, which is where they do a transvaginal ultrasound and inject saline to look at the uterus for structural abnormalities. This was scheduled for a week later as I was currently on my cycle and it needed to be done at a specific time in my cycle. 

Our plan was to have timed intercourse and start baby aspirin as well as use vaginal progesterone suppositories in luteal phase.

I felt confident in the plan and was eager to get some answers and try again. My doctor was awesome and as soon as my results came back she communicated in the portal with me the results. Can I just say I LOVE patient portals in the medical community. They are so great and I love having access to my medical records with the click of a button! Really helps with the anxiety and having a super responsive doctor is AMAZING! Definitely feel like we made the right choice, guided by God. God placed us in the right hands! As much as it sucks to travel to Birmingham for every visit, it is completely worth it! 

One thing that came back abnormal was the APLS. It was slightly elevated and the plan is to get tested again in 12 weeks from original test to confirm it and if I get pregnant before then to start lovenox injections and aspirin.

Another thing that came back abnormal was the ureaplasma and I was given an antibiotics for it. Doctor did not think this contributed to my loses at all but since they found it they treated it.  

Everything else came back normal, well besides my thyroid but we already knew that and were working on that. Even our parental karyotyping came back normal which took FOREVER to come back and I was a ball of anxiety the entire time. I was asking for prayers from all my friends and small groups every week. 

Throughout this whole process God is teaching me patience and to let go and let God. 

Luke 12:25-26 Who of you by worrying can add a single hour to your life? Since you cannot do this very little thing, why do you worry about the rest?

Cytotec (Misoprostal) Experience

      After we found out baby number 2 had no heartbeat I had my HCG blood drawn to see what my levels were at. The results came back within the normal range of where I was suppose to be according to gestation. That gave me a little hope, maybe it was too early to see a heart beat. I was scheduled for a second HCG blood draw 48 hours later. That result came back with a decline in HCG of 2000. At that point we knew it was a miscarriage but still held out a little hope for the confirmation ultrasound one week later. God is in the business of performing miracles and I was praying this would be one. I just remember that weekend was just excruciatingly long. I had an appointment for Monday at 3pm and it couldn't come soon enough. We went in for the ultrasound and it was confirmed no heartbeat. Of course we were completely devastated. How could this happen 2x in a row! 2% chance of back to back miscarriages. We now joined the 1 in 100 statistic of reoccurring losses.

 We were given 3 options at this point.

1. Wait for a natural miscarriage to happen 

2. Take Cytotec to induce a miscarriage 

3. Have a D&C 

Waiting for the miscarriage to happen naturally wasn't really an option in my book. My HCG was dropping so slowly and it would be a long time before I may actually miscarry. I also was extremely nauseous and just wanted to feel better. Also, I just started a new job and wanted to have at least some control of the timing. 

Cytotec was highly suggested by both my doctor and my husband. I was hesitiant on taking it as I would have to go through the physical pain of the miscarriage and two it may not even work. The good thing about cytotec is it happens quickly after you start taking it and it avoids instruments in the uterus that can cause scar tissue to build up. 

The third option was a D&C which I was leaning towards. Its quick and easy and you are put under for it. You know all the tissue is taken out. Also the tissue can be tested for abnormalties. The risk is scar tissue forming in the uterus which could cause issues with implantation of another pregnancy. 

In the end we ended up choosing the cytotec. I had Friday of that week off of work due to low census so I had planned to induce the miscarriage Thursday night after work. How it worked was I was given 8 pills/tablets. I was too insert 4 pills vaginally close to the cervix and lay down for 30 minutes to and hour. The pills are suppose to start working within 6 hours. I inserted the pills around 2-230pm and anxiously awaited the pain/cramping to start. I didn't have any. It was getting close to the 6 hour mark and I still hadn't had any cramping or bleeding. Finally right at 6 hours I had some very minimal spotting but at this point it was not progressing like it should. I was frustrated. Not only was my body failing me with this pregnancy but also with cytotec now. 

So 830pm came and I had to insert 4 more pills. I laid down and put on a TV show. It was around 10-11 and still nothing was happening. I was so frustrated, why wasn't my body reacting the way it should? I finally just took an Ativan and fell asleep. Around 1-2am I woke up and I could tell I was bleeding. I went to the bathroom and as soon as I sat down I began to pass a ton of clots. I was having some minor cramping but not awful. I went to lay back down in bed and within 5 minutes the cramping got worse and worse. I then just made a bed on the bathroom floor. I continued to pass a ton of clots and BIG ones. 

Around 3am I'm laying on floor crying because I was in pain physically and mentally. Thankfully my doctor prescribed me some tramadol and I took one of those. About 10 minutes later I passed the baby and the sac entirely in one big
piece. Which was painful! We were told if I passed the baby we could save it and get it tested. I yelled for Daniel and we were able to collect it and store it properly. 

 After I passed the baby the cramping went down significantly. It was more emotional pain now. I was finally able to get some rest now too. 

The next morning I took the baby in to the doctors office to get tested. Testing would take 2-3 weeks. Now the emotionally healing began. A friend said it best, "Let's face it, you'll never be the same." I couldn't agree more. 

Would I choose the cytotec again if I had a missed miscarriage again? I'm not sure. The pain wasn't awful and the fact that I was in a little bit of control and was able to see everything be passed kinda helped. But in reality what we would learn a month in a half later is the cytotec didn't work completely and I ended up with a D&C anyways. So unfortunately it may have delayed the healing procress. I would say if my reproductive endorcrinologist recommended cytotec I would probably do it again but I would want an ultrasound done after to ensure the tissue was all cleared out. All in all it wasn't an awful experience.