Last week I wrote my first post-miscarriage post. It was difficult to write, but it also felt cathartic to share what happened. I had a few people email me some questions, which motivated me to write a follow up post. In this post I am sharing what I have learned about miscarriages from a medical perspective. Please know that I have no medical training. I am not attempting to give any type of medical advice. This is just my experience.
Some people have asked if I considered having any testing done after the miscarriage. We did in fact do a lot of testing. Most of the time doctors do not do this after one miscarriage. This is because often times, a miscarriage is due to random genetic issues. While this does not make a miscarriage any easier, random genetic issues do not increase the chance of miscarriage in the future. We had two reasons for testing. First, we are as certain as we can be that my baby had no genetic issues. Our microarray results found nothing. Microarrays are so comprehensive that they sometimes find genetic issues which turn out to be nothing. Ours found absolutely nothing. We also did PGS on our embryos, which tests for several genetic issues.
The second reason is because my miscarriage happened later than usual which can be more problematic. Most miscarriages happen before 12 weeks. Of course there is still the possibility that the CVS caused the miscarriage, but there is no way to know this for sure.
These are the tests I had: Factor V Leiden Mutation, D-Dimer, Lupus Anticoagulant Reflex (this is for APS), MTHFR ( A1298C and C677T), Anticardiolipin IgG/M, (quantitative), Factor II (DNA Analysis), Protein S-Functional, Antithrombin Activity, and Protein C-Functional.
Before my miscarriage, we learned that I had low papp-a, which some doctors have linked to thrombosis. There are several different types of thrombosis. My tests covered the main ones. Doctors who believe that thrombosis is an issue would say we are likely to have the same problem again if I get pregnant. Others doctors say it is random and we are at no increased risk of it again. My doctor and MFM specialist believe the latter. They do not think I am at an increased risk.
All tests came back normal except one. I found out that I am heterozygous for MTHFR C677T. This means I have one normal and one variant copy of the gene. Being homozygous (2 variant copies is worse). This is exactly what my test results said:
This individual is heterozygous for the MTHFR C677T variant (one copy). The MTHFR A1298C variant was not identified. This combination of results is not associated with an increased risk of hyperhomocysteinemia, venous thrombosis, coronary artery disease, or recurrent pregnancy loss.
If you do an internet search on MTHFR, you can find all kinds of people who think it’s a major issue. My doctor told me that even though a lot has been written about MTHFR mutations, most experts believe it has little if any health consequences. If may impact folate metabolism so it could help to take an active form of folate which is more absorbable than folic acid.
I did my own research on MTHFR and came to similar conclusions. By research I mean reading peer reviewed journals and not the first thing that comes up on a google search. One benefit of being a grad student is I have access to pretty much all published academic journals. I have also gotten pretty good at synthesizing information from journal articles (sometimes I feel like that is all I ever do). I do not think MTHFR is an issue for me but if I ever get pregnant again, I will take active folate just to be safe.
My biggest concern is that if I ever get pregnant again, I am going to have low papp-a again and the same thing will happen. Some doctors preemptively treat this with Heparin or Lovenox in the first trimester. Until recently, these medications used to be heavily prescribed to prevent thrombosis, which may impact papp-a. Recent research suggests that these medications may not be as effective as previously thought. The exception may be with individuals who have Antiphospholipid syndrome (APS), which I know I do not have.
My doctor sees no reason to use Heparin or Lovenox unless an individual has a history of blood clots . I am curious to see what people think of this. The rational part of me agrees with this. Another part of me does not see the harm in taking it. He did suggest taking baby aspirin which I take now.
Another question people asked me is what went wrong with the D&E. I had mentioned that I had some complications from it. The procedure itself actually went well. Physically, I felt less discomfort than I did with my IVF retrievals. What is happening now is that I am having trouble with my lining. When we did my first transfer, my lining was as good as I could ever expect. Also, when I did my IUIs, my lining was also very good. This month, I was on estradiol and Lupron. My lining got better but it was not nearly as good as it was when we did my first transfer. Because I have always had good lining pre-D&E, my RE think that my now thin lining is the result of this procedure.
Apparently after a D&C or D&E, it can sometimes take a while for lining to come back. In rare cases, they can lead to Asherman’s syndrome, which is characterized by uterine scar tissue. This is a more permanent issue that usually requires surgery to fix. It is more likely to happen with multiple D&C or D&Es (I have only had one). Even so, all I can do now is wait. My RE suggested waiting at least 2 cycles. I have gotten really good at waiting. I have been doing it for the last six years.
If anyone has any insight on any of these issues, I would greatly appreciate it. As I said, I am not a doctor so I am not sure what to make of all this.