There have been many days and nights that i had silently made curses to... actually... myself!! Curse my previous lives karma that contributed to the many months failed TTC.
Becoming parents is not going to be easy for us, and we have to face that, and give in. The informations gathered below are my research on just the way the medical world thinks. Fertility specialists think that when a baby was lost, there'd probably never been a quick and easy testing that would tell us what went wrong, then we could do something simple that would totally prevent it from happening again. Sometimes, the only way to know there is a problem for sure is to lose another baby. I hate that, and am troubled by the practice, but the medical world goes by statistics, and here is why you may not be as aggressively tested as you would like following your first miscarriage:
After one miscarriage, your odds of another one are very small. Less than 20% of women who have miscarried will have repeated losses, so most doctors will assume that if you are healthy and had only one loss, particularly in the first trimester, that you will never have another one. This is pretty much true.
There are very few treatments to help you prevent a miscarriage. Most testing will not uncover a reason for a loss anyway, as early testing is just a shot in the dark. Even if testing showed a problem, there might not be anything more you can do than to assess the amount of risk you face for another one. The biggest bulk of miscarriages are caused by a random genetic error, which cannot be predicted or avoided. Because fetuses can JUST DIE! Don't play play.
Signing up for further tests, which often yields no conclusive answers, can be very expensive, especially done in Malaysia, time consuming, very stressful, and make you wait longer to try again sometimes can be as long as 6 months. Often by the time you do any of the more involved testing, such as endometrial biopsy, HSG, or laparoscopy, all of which require you to wait until a certain time in your cycle, of which unknowingly you could be pregnant again with a healthy baby. Let's hope no one is that bad luck ridden to have such coincidence.
Medical research also said that for would-be-parents who are over 35 and had one or two first trimester losses, they will be even less likely to get testing since the odds that the loss was a chromosomal problem with the egg are very high. There is nothing to do in this case but to keep trying for a better egg. Huh! easy to say. Some doctors, however, acknowledge that older moms might have undiagnosed health problems, and will test for the more common thyroid or lupus causes. True enough; i was diagnosed with hypothyroidsm on January 2008.
After three miscarriages in a row, it is best advised to stop trying on your own. Clearly, there's problem, and it must be found so to be treated. This, of course, if only true if the parent wannabes have never had a healthy baby. If there are born healthy children between the losses, the choice to test is becomes optional.
The Testing Process
A number of tests are easy to perform (blood test or vaginal culture only.) All but a few require that you not yet be pregnant again. If you are comfortable with your doctor and willing to fight for some testing, you can usually ask for and get the early testing ones done even after one loss:
Early Testing:
0 Progesterone monitoring by blood test (prior to pregnancy to check for luteal phase defect, and during early pregnancy to watch for deficiencies.)
0 Mycoplasma bacteria culture from cervix
0 Antinuclear and antiphospholipid antibodies in blood
0 Lupus Anticoagulant in blood
0 Underactive or overactive thyroid by blood
0 Exposure to German Measles, toxoplasmosis, Group B Streptococcus, or sexually transmitted diseases even if you tested negative prior to or early in pregnancy
More Extensive Testing
0 Progesterone Endometrial Biopsy (a bit of lining is scraped and checked)
0 Hysterosalpingogram (HSG) or "dye test" (dye is shot into the uterus and fallopian tubes and then x-rayed to look for malformations, fibroids, or blocked tubes)
0 Karyotyping of Baby or Pregnancy Tissue (tissue is grown in a dish to watch for cell division, which will reveal the chromosomal make up of the baby)
0 High Level Ultrasound of Reproductive Organs
Most Extensive Testing (some are limited to specialized centers and not available to regular OB/Gyns)
0 Laparoscopy or Hysteroscopy (minor surgical procedures where interior of reproduction organs are inspected with a lighted scope via a belly button incision (lap) or up through the dilated cervix)
0 Karyotyping Parents (blood cells are cultured and grown)
0 Genetic Counseling
0 Immune Factors
0 Antipaternal Leukocyte Antibodies
0 Antithyroid Antibodies
0 DQ Alpha & DQ Beta
0 Immunophenotype
0 Natural Killer Cell Assay
0 Tumor Nerosis Factor
0 Factor II (prothrombin) Mutation
0 Factor V Leiden Mutation
0 Methylene Tetrahydrofolate Reductase Mutation
Special Situation Testing
Parvovirus, or Fifth Disease (a recently active virus can be looked for if you work with small children, were exposed to the illness, or had symptoms. Most adults are already immune, but this test can see if you were not and perhaps were infected during pregnancy.)
Mercury blood levels (if exposure seemed high, usually through job function)
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