Recurrent Miscarriage & the Question of Infertility Treatment

We talk about miscarriage as if it is a moment in time, a crossing back from a state of pregnancy to some state of baseline, a return to normalcy. However, going through it is something else entirely.

First and foremost, it is a process rather than an event. When someone says, “I had a miscarriage,” it sounds as if it quickly took place and is now concluded. However, losing a pregnancy is often a process that happens over days, even weeks. Every person’s body responds differently, but often there are physical signs that something was awry.* This was the case with both my second and third miscarriages, my pregnancy symptoms seemed to lessen over a few days, then I started to experience spotting. With my third miscarriage, after a trip to the doctor for blood work and an ultrasound, the results were inconclusive. There was clearly a gestational sac, but the pregnancy was measuring behind. The doctor wasn’t too worried about a miscarriage so she scheduled me for another ultrasound in a week’s time to see if the baby continued to grow. The next day my blood work came back indicating a decrease in my progesterone indicative of an impending miscarriage. Within 48 hours of that ultrasound, the spotting turned to severe cramping and bleeding. The cramping came on gradually and roared to a crescendo that lasted a few hours, causing me to alternate between kicking my feet in pain and curling into the fetal position. In four days time, the little life I imagined joining our family was gone, and I was left only with a heavy period to show for it. There would not be a need for a second ultrasound. Another pregnancy ended without hearing a heartbeat.

The physical nature of miscarriage is often long, confusing and uncomfortable, if not painful. However, the most challenging part of miscarriage is not the physical symptoms, but the emotional toll it takes. From the moment I woke that first morning that my pregnancy symptoms started to subside, I was filled with anxiety, dreading what my body already knew to be true. After two previous miscarriages, I was guarded about this one, but after a few weeks of apparent normalcy, I begin to believe this was going to be the pregnancy that stuck. It’s such a balance of cautious optimism and protecting yourself emotionally against the very real chance that this pregnancy will end in heartache too. It’s hard not to go to the worst case scenario in your mind when the only outcome you know is loss. I wanted to remain positive. I wanted to believe my doctor when she said she wasn’t convinced this pregnancy would end in miscarriage, but deep down I knew something wasn’t right. After this miscarriage as with each of our others I was left with so many questions, but mostly, “will we ever be able to stay pregnant long enough to meet our baby?”

And to think that we were told in health class that if we had sex we would get pregnant and have a baby nine months later! How I wish it were that simple. All the pregnancy resources will tell you that the chance of having recurrent miscarriages is very slim, less than 1%. So when you find yourself among that minority, it is a disorienting feeling because the cause is often unknown. You may never know why this is happening during your pregnancies, unless you are willing to seek out a doctor who specializes in infertility.

After three miscarriages you fit into a new category: “recurrent miscarriage.”

In this new category of recurrent miscarriage, we now qualify to see a reproductive endocrinologist. The process is very involved and follows a strict timeline. These initial appointments are cycle dependent and for us have meant many early morning appointments and time away from work. The initial baseline appointments include:

• Day 2-3 of your cycle: blood work and ultrasound
• Day 6-12 of your cycle: saline ultrasound to determine health of fallopian tubes,
• Day 9 through Ovulation Day: track Luteinizing hormone (LH) to determine ovulation,
• Ovulation Day: ultrasound and bloodwork to test Estrogen level,
• 8 Days Post-Ovulation: blood work to test Progesterone level,
• 2 days later: Endometrial biopsy
• Then the conversation of next steps and treatment planning begins

Our doctor has affirmed our experience and given us confidence that we will get the answers we need to make the best decision for starting our family. I feel so fortunate to have a job that allows me to take time off to go to these appointments, great insurance benefits, and the financial means to pursue infertility treatments. I am grateful this technology exists and that we have the options informed by tests specific to both Jeff and me. I am grateful for all of it, and yet I am so disappointed that we are in this position at all. I never imagined loss, disappointment and fear being a part of starting a family. I could not have anticipated all of the tears and loneliness and self-doubt that has accompanied the last few years.

We are in the process of completing all of the aforementioned tests and waiting for a consultation with the doctor to determine any potential causes of our recurrent miscarriages and whether or not we will go ahead with infertility treatments in one form or another. Based on our conversations and test results so far, the doctor will likely recommend IVF because they determined that I have low ovarian reserve. I find myself resistant to IVF, but with the ovarian reserve of a woman in her 40s, I am racing an accelerated biological clock. I feel let down by my body, a body I have come to deeply care for and respect. A body that had previously proven to be capable of overcoming so much now seems to reject the one thing I thought was guaranteed. I have always imagined having biological children and conceiving those children naturally. At this moment, it feels a little like failure and a lot like I’ve given up on myself to go the route of IVF (I mean no disrespect to any who have chosen this route for their family — any way you chose to start or expand your family is sacred and honorable). I just didn’t think all hope was lost for a natural pregnancy. I didn’t think we were in a place to need infertility treatments because we’ve been able to get pregnant three times.

The question now becomes, do we risk another miscarriage or further diminishing my already limited ovarian reserve to try to conceive naturally or do we go ahead with IVF, but pay a hefty price? This process is physically demanding on your body and equally demanding on your checkbook. All that money just to conceive? And what if it doesn’t work — try again? All the while trying to avoid getting pregnant naturally during tests and treatments adds an extra layer of complication to the emotional load. This process isn’t for the faint of heart.

The unknowns have been the heaviest burdens – not knowing how long it will take to get answers, to get pregnant, to hold our baby in our arms. I long for a healthy pregnancy and to watch my husband become a dad, and yet have had to face the fact that our chances are slimmer with every passing cycle. While we watch more friends and family members get pregnant, we continue to get blood draws and medical bills. This process quickly consumes your every thought and dictates how you live your daily life.

To date, I’m more acquainted with heartache than hope, but we will continue to forge ahead. We are doing what we can to give ourselves the best chance at success — all in the name of hope. We are seeking good medical treatment, cleaning up our diet, taking every fertility supplement known to man, working on incorporating more self care habits, and asking others to pray for us when I don’t feel like I have any more prayers to pray. When despair starts to set in, Jeff regularly reminds me to trust what has already been true – we can conceive. Now we just have to figure out how to stay pregnant.

More to come when we have a treatment plan. Until then, we appreciate your prayers.

* I am not a medical professional and my blog should not be construed as medical advice. If you suspect you are experiencing a miscarriage, consult your doctor right away.