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.