I wrote a post concerning my follow-up appointment with my RE, post D&C. Turns out that appointment was simply to check my uterus and hCG levels (389 at 9 days past D&C). We finally met with my RE just this morning to review the results of the genetic testing and to discuss the next steps in getting (and staying) pregnant.
The genetic test revealed that there was an extra chromosome 22, resulting in trisomy 22. My hCG levels are now at 16. Also, we were expecting a baby boy.
I wanted to return to the initial questions I posted for anyone that may be interested in her responses.
Given my medical history, do you think this miscarriage was a result of my specific fertility situation, or do you think it is a matter of “shit, happens?”
Definitely, shit happens. The literature does show that women with PCOS are at higher risk for miscarriage, but this, in particular, pertains to women who are overweight. (I am not overweight.) In addition, the genetic results reveal a chromosomal abnormality that “is generally incompatible with fetal survival.” This is more likely related to my age (32) and subsequent egg health rather than PCOS.
Does the literature demonstrate a higher miscarriage rate in the PCOS population due specifically to chromosomal abnormalities?
No. Nothing has been or can be confirmed, nor is it a theory that has credibility in the infertility research world.
Do low levels of estrogen during the follicular phase, such as the case with Lucky Cycle #10, decrease egg health?
No. It is more likely that the low level of estrogen during Lucky Cycle #10 was a result of poor egg quality, not a chronic condition.
Do you have any suggestions for improving egg health?
Yes. Eat a plant-based diet. This does not include processed vegan foods. Research shows that a plant-based diet, similar to what our ancestors ate is, by far, much healthier than what the typical American diet looks like, especially in regards to meat consumption. This is particularly true in the US where the quality of our meat and dairy products is compromised by hormones, antibiotics, and other practices found in mass production of meat and dairy. A plant-based diet has been shown to reduce inflammation, which is common in PCOS, as well as many other chronic illnesses and many different types of cancer. Buy a juicer.
Do you have any suggestions for reducing the chance of a second miscarriage?
This miscarriage was a matter of chance, and there wasn’t much we could have done to change the outcomes.
Do you think it is time to run another round of hormone tests?
Not yet. Given the fact that I just got pregnant, the need for another round of tests is not necessary. If, after three months of medicated cycles, I am not pregnant, it will be time to reevaluate my hormone levels.
What about the HSG? How long can I expect both tubes to stay open?
A while. My blockage was probably due to mucus, typical in women with PCOS. In her experience, she has not found that her patients’ tubes fill up again after a period of time. If we are not pregnant after a three medicated cycles we can reevaluate.
Given my low levels of estrogen, do you still think Clomid is the appropriate next step? If so, do you supplement with estradiol?
Again, the low levels of estrogen may have been due to the quality of the egg in that particular cycle. She recommends Clomid for the first cycle because it is FDA approved for fertility use. Femara is used off-label. Tracking of my lining and estradiol levels will give an idea of how I react to the Clomid. If it kills my lining we will switch to Femara. She does not like to supplement with estradiol in women with PCOS because we are already at high risk for endometrial hyperplasion (aka cancer). Estrogen promotes cancerous growth.
Can we just skip the Clomid and go to Femara?
Yes, if that is what I choose to do.
Can we try an unmedicated cycle supplemented with estradiol?
No. See above.
Magic Eight Ball when will I get pregnant?
Three to six months.
Glad you got some answers! If my RE had been one-quarter as useful, I might still be his patient. I am sorry about your little boy.
But I am glad that your miscarriage was caused by something that is a very common cause of miscarriage in all women, not something particularly PCOS/IF related. It really does sound like one of those bad-luck things that shouldn’t happen again next time.
Thanks! PCOS carries so many risks for pregnancy and I’ve been worried about egg health from the beginning. It was good to have someone that actively reads the literature to reassure me that my eggs aren’t junk! Another question that I asked, which has bounced around on the MDC board, was if longer cycles result in poorer quality eggs and increased chance of miscarriage. My RE emphatically said NO, but I know that doctors certainly vary on their opinions on this one. She said that there isn’t any research out there to corroborate this claim. I haven’t looked at the literature, so I can’t say if this is true.
Wow! Sounds like a very informative appointment. How are you feeling about the news of the cause of your miscarriage and all of you options?
You know, I feel pretty good. One really important point that I failed to mention on the post about Lucky Cycle #10 is that my right tube was blocked for the 5 of the seven “healthy” cycles. So, although it took 13 months, it really was only a matter of three or four cycles to pregnancy. That puts a rosy glow on things, for sure. My partner and I still have to decide on whether or not we want to pursue a medicated cycle. I’m not sure yet. It probably depends on how long this cycle lasts, immediately post-D&C. I no longer have any patience. And, as my doctor has told me, I’m not getting younger.
Sounds like you got some good answers. I’m glad it was “just” a matter of chance and that your risks of a future miscarriage aren’t affected. And three to six months … well, that’s not so long. Except it is.
I know. It feels like an eternity.
This “plant-based” diet for PCOS is very similar to what I’m doing! It’s a 28 day “cleanse”, but it’s really about eating a lot of healthy plant foods and minimal fish and chicken. I have very low estradiol levels due to the PCOS, and I have asked my gyno the same question: should I go on Clomid knowing this and knowing what it could do to my lining? He says “yes” for now, which seems like what your RE is saying. Keep us posted!
One thing she did say, which I didn’t include because I really couldn’t remember the details, is that the average number for estradiol (during, or near, or somewhere around ovulation) is 100-200, but these are estimates and they don’t really know what constitutes a low or high number, or what really is even okay for a “normal” cycle. I thought that was also really interesting. You see the 100-200 per follicle number everywhere. I thought it was standard, not simply a guess or a loose range…Do you have a juicer? I’ve been thinking about a juicer for over a year now. I even have a juicer cookbook. You know, in case I want to squeeze the juice out of the beets by hand.
Something my husband is doing, which I think has the potential to be more healthy than juicing, is blending. As in, putting fruits and vegetables (and typically a little bit of liquid, like coconut water, soy milk, etc.) in the blender and just pureeing it all. That way, he gets all of the fiber along with the nutrients. I’m actually pretty impressed with how well our cheap-o blender has done with this. Just a thought!
Thanks, Monkey! Do you guys just make it up as you go, or do you follow any recipes? I’m a recipe type of person…
I must confess I refuse to partake of the smoothies myself. Partly because I’m already nauseous in the morning, partly because I have… issues… with fruits. dh has tried both recipes and making it up, and he seems to prefer recipes. Making it up himself has not always gone well.
That is a rosy glow, three or four cycles is nothing! Though I know the 13 months probably felt like forever. Hopefully you will be pregnant again soon.
I’m with you on the having no patience thing. I’m currently going back and forth on whether I want to continue using TCM for treatment or try a few more Clomid cycles with IUI. I know I’m getting healthier with TCM but it is taking what seems like forever for results.
Seriously. Its so hard to stick to the “natural” alternatives when the results are often so subtle and slow to emerge. I followed a super strict PCOS diet for almost four months and didn’t see any kind of change in my cycles, so I said screw it! I still follow a low GI diet, but I eat gluten, corn, dairy, and caffeine in moderation. I do this despite the evidence that I shouldn’t.