Subject: misc.kids FAQ on Miscarriage, Part 3/3
Supersedes: <misc-kids/miscarriage/part3_825451240@rtfm.mit.edu>
Date: 28 Mar 1996 22:02:37 GMT
References: <misc-kids/miscarriage/part1_828050394@rtfm.mit.edu>
Summary: The miscarriage FAQ is a compilation of people's
         experiences, words of sympathy, and some technical
         information.
X-Last-Updated: 1995/03/25

Posting-Frequency: monthly

                    Misc.kids Frequently Asked Questions
                            Miscarriage

                            Part 3 of 3

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Collection maintained by: Laura Brooks (brook006@mc.duke.edu)
Last updated: March 23, 1994

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=====================================================================
The FAQ continues with people's experiences...
=====================================================================

Hi, the following is a SMALL subset of the answers I got to my original
posting on having two miscarriages in a row.  To make it shorter and
to preserve people's privacy, I tried to delete all the sympathetic
messages, personal histories and duplication of fact and limit it to
scientific explanation.  But let me stress that I appreciated EVERY
message.  The support I got from a lot of you guys REALLY made a
difference, and made a very hard time for me a little easier.

Thank you VERY, VERY much.

Laura Brooks
brook006@mc.duke.edu

First, my experience:

My first miscarriage happened at 7.5 weeks (after LMP).  I hadn't had any
morning sickness at all, but this didn't worry me because my mom said she felt
great when she was pregnant (just sleepy all the time).  It was a pretty big
shock.  I had just sort of assumed that everything would be fine.  I had to go
to the ER, and I got sick so fast (almost fainted, started pouring sweat, etc)
they thought it was ectopic.  They couldn't find anything in the ultrasound, so
they did an emergency laparoscopy.  The tubes were clean, however, so they sent
me home the next morning, and told me come back in a few days so that they could
check my hormone levels.

I passed some tissue the next day, so I took it in to show them.  They tested it
for chorionic villi and luckily found what they were looking for (until then
they were convinced it was outside the uterus somewhere).  I overheard my doctor
talking to a resident in the hallway that if they didn't find anything they
would do another laparoscopy and "look behind her liver."  The resident said,
"but we already looked there - we looked EVERYWHERE."  This struck me as sort of
morbidly funny, even at the time, but I was pretty relieved when they confirmed
that it was just your everyday, garden-variety miscarriage.  They did a D&C
later that evening.

That was in the beginning of August.  In December I got pregnant again.  I tried
to convince myself that the last time was just a fluke and very normal, but I
kept feeling that something bad would happen this time, too.  I tried to tell
myself that I was just being morbid.  I did feel some sickness this time, though
not too bad.  My breast were really sore, too.

They did an ultrasound at 9.5 weeks (after LMP) and were able to see the heart
beating, so that reassured me a bit.  However, they did tell me that conception
must have happened late, because the baby was only big enough to be 6.5 weeks
old.  This disheartened me a little, because I had thought I was almost out of
the first trimester, only to find out I had weeks to go before the baby would
actually be 12 weeks old.  After that I never knew what to tell people when they
asked me how far along I was - weeks after LMP or fetal age.

About the time of the ultrasound (actually a day or two before), my husband made
a comment that my breasts didn't seem as big as before.  This scared me, because
I know that they're not supposed to shrink.  They also didn't seem very sore.  I
started noticing, too, that my appetite wasn't nearly as strong as it had been,
and I wasn't sick anymore.  But I was still really tired, so I thought
everything was still OK.  Last Sunday I started to bleed, just a little.  On
Monday I went in to the doctor for another ultrasound, and the baby was dead.
They couldn't detect any movement and the fetus had actually shrunk as it
started to be reabsorbed.  They did a D&C the next day.  I was at about 11.5
weeks (after LMP).

This one wasn't quite as bad as the first.  Physically it was way better - I
never really had any bad cramping, and only the scheduled D&C.  Also, I was
almost expecting it.  The thing that's worse, though, is thinking maybe I'll
never be able to do it.  That's why the need to know WHY is so strong, and the
hope that it's something PREVENTABLE in future pregnancies.

>I would like to find out more about what the chromosomal test
>actually involves, and what they might be able to find out
>from it.

They will count the chromosomes to see if there is the right number
(46).  They will look to see if the chromosomes are complete, with
no missing parts.  They will look to see if part of one chromosome
has broken off and rejoined another chromosome.  They will look
for any kind of abnormality they can find.  Chromosomes in eggs and
sperm are at a somewhat higher risk for getting things screwed up
because they undergo a process called "crossing over" where, for
instance, chromosome 1 from your father and chromosome 1 from your
mother may swap equivalent parts, leading to a new combination of
genes on the resultant chromosome 1's.  This is good for the species,
but when things don't go quite right, it's bad for the individual
that will inherit those chromosomes.  Most of the time when this
happens, the conceptus or zygote is completely incapable of normal
development, and either never implants or dies within a few days of
doing so, and you never know about it.  But some limp along until
some critical gene that has been damaged is needed, and then they
die in a first trimester miscarriage.  Because the chromosomes can
be seen with an ordinary microscope, any large rearrangements or
duplications/omissions can be easily detected, and the cause for
the miscarriage known.

>  Also I would like to talk to other people who've had
>tests run on themselves and/or their spouses.  I would also like
>to hear from people who's progesterone levels were too low to
>support a pregnancy (my OBGYN doesn't think it was that but hasn't
>ruled it out - I keep wondering about it because it happened to
>my sister-in-law).

It would be helpful to know when your miscarriages occured.  Through
most of the first trimester, progesterone is produced by the corpus
luteum---the "scar" left behind when the egg popped out of the ovary.
It produces progesterone because it detects chorionic gonadotropin (HCG)
in your blood.  The HCG is produced by the part of the embryo that
later becomes the placenta---the trophoblast, in scientist-speak.
For the first 10 or 11 weeks, a progesterone insufficiency would be
due to either the trophoblast not producing enough HCG, or the corpus
luteum not responding with enough progesterone.  For instance, my
mother miscarried all three times between 8 and 11 weeks, and never
had any morning sickness with any of those pregnancies, but she did
get it when she had her four children.  My personal opinion of this
is that the first 3 embryos were not producing enough HCG to sustain
the pregnancy for whatever reason, since the first trimester nausea
is often correlated with HCG levels.  It's difficult to use morning
sickness as an indicator though, because women vary enormously in their
sensitivity to it.  Some women can have raging levels, and have no
morning sickness, and some will still be vomiting from the low maintenance
levels in the 2nd and 3rd trimesters.  Anyhow, getting back to
established fact, HCG levels in a normal pregnancy rise dramatically
until about 2 months (this does vary though), and then begins to
drop off as the corpus luteum ages and becomes incapable of producing
hormones anymore.  The placenta by this time has become mature enough
and large enough to produce its own progesterone, and it ramps up
production as the corpus luteum is winding down.  If these two events
are not quite in sync, you can experience a slight dip in progesterone
levels, and since rising progesterone levels (absolute level doesn't
matter, it is the rate of change of levels, which is why progesterone
levels continue to rise throughout pregnancy) keep the uterus relaxed,
contractions that expel the fetus can result, just like at birth.
Rates of miscarriage decline the further along in pregnancy you get,
except that there is a slight spike right at the end of the first
trimester, when this switcheroo maneuver is underway.

>  And finally, I would appreciate hearing from
>anyone with any information about women developing antibodies to
>their fetuses, and how common (or rare) this is.  And basically,
>just anyone else who has anything to tell me at all that might be
>helpful.

It's very rare.  It's not precisely known why all pregnant women
don't develop antibodies to their fetuses, since they are, after all,
foreign tissue.  The theory is that the placental interaction between
the cells derived from the baby (placenta) and the mother's cells in
the uterine wall induces the fetus to produce an enzyme that damps
the immune response at the interface.  Theoretically, certain "markers"
are used to determine where the immune response is supposed to be
dampened, and the cells do a little comparison between themselves
and their neighbors on these markers and if they are different, then
they produce the enzyme.  The difficulty (again, theoretically) is
when the father coincidentally has the same set of markers as the
mother, then the fetus' cells look just like the mother's cells when
the comparison is done, and no enzyme is produced.  The mother's
immune system could care less about these markers, however, and the
other differences between mother and fetus trigger an immune reaction
and antibodies are produced.  Again, this is all theory, nobody knows
what the markers are even if they exist, but what is known is that a
woman who consistently has an immune reaction against fetuses fathered
by one man will be able to carry a fetus fathered by another man (say
by artificial insemination) to term quite nicely.  The man will also
be quite capable of having children with another woman.

Your practitioner probably did a blood test that included a white cell
count, and possibly other measures of immune system function.  If you
are rejecting the fetuses, you may experience similar symptoms to an
immune reaction to just about anything else---a fever, feeling sick
(not necessarily nausea, but the same feelings you get whenver you're
battling the flu, a cold, or other infection---being very tired, loss
of appetite or a ravenous appetite, etc.), and the evidence of your
immune system fighting an invader may show up on your blood test.  But
it also may not unless it is being explicitly looked for---if some of
the theoretical enzyme is being produced because at least one of the
markers is different, then the immune response may be weak enough not
to show any symptoms, but still strong enough to kill the fetus.

I hope this hasn't been too dry and technical for you, and I hope it's
been helpful.  Myself, I cling to the example of my mother, who had
so much heartbreak and then was rewarded with four wonderful kids (if
I may say so myself :).
---------------------------------------------------------------------------------

Ok, so, if we're going to try to look for an answer to why these miscarriages
occured, we'll consider the facts.  On a gestational age basis, the first
embryo died somewhere around 5 weeks old (LMP is approx. 2 weeks longer
than gestational age).  At this age, the embryo is about 1 centimeter or
4 tenths of an inch long.  The second embryo died at about 6 weeks old,
and is a little over half an inch long at this age.  Important to note is
that the embryos died well in advance of being expelled.  If there were
a hormonal problem, the embryos would have been alive and well, but the
uterus would have expelled them anyway.  Usually (though not always) in
cases of the mother's immune system attacking the fetus, the placenta
suffers the most damage, because it is the part directly connected to
her.  Bleeding from the damaged placenta almost always precedes such a
miscarriage.  So this is unlikely to be the cause.

When the embryo just up and dies like this, it is usually because something
has gone wrong (either chromosomally or developmentally), and the embryo
is simply incapable of continuing on.  It's pretty amazing that development
ever goes totally right.  The first weeks are an incredibly fast and furious
process of cells dividing, migrating, bending, making seams, all having to
be highly orchestrated to happen at just the right time.  If something
doesn't happen quite right, the embryo may die or be born with profound
defects later on.

However, it's quite unusual to have 2 miscarriages in a row with this cause.
There's about a 1 in 20 or 25 chance of this happening in any given
pregnancy, and to have it happen twice is like drawing a ball from each
of two bags of 25 numbered balls and having both balls be number 25.
It's a very low chance, but somebody has to be the unlucky one, I suppose.
______________________________________________________________________

I sent eMail to someone on the net whom I knew from earlier postings to
be a geneticist, asking him about the chromosomal test - his answer:

    I am really sorry to hear about this situation with you and I hope that my
notes can expand your information base so you can ask better questions to your
doctor.  To begin with, I would double-check my statements with your
doctor/genetic counselor in regards to the SPECIFICS of your INDIVIDUAL case.
    When a miscarriage occurs, a cell tissue is taken for this test and grows
for a period of several days which can vary according to cell type: blood, bone
marrow, amniotic fluid.  This is called "growing a culture" which will take a
number of days.  For example, I am learning the procedure this week and last
Friday, I took my own blood and let it grow until Tuesday.  On tuesday, I
activated the cells to grow at the same rate by adding certain chemicals.
After that I blew up the Red Blood cells and removed the waste to leave behind
only the White Blood Cells.  This is done because Reds do not contain any DNA
while White do.  Thursday, I will take this purified blood sample and fix it
onto a slide where I can analyze it.  By using a microscope with a computer
screen, I cut apart the chromosomes and sort them according to type.  This
results in creating my 'karyotype' which I will print out & in the case of
other people return this data to their doctor.
    WHAT CAN THEY TELL?
    Good question.  I do not know your age but most expecting mothers over 35
take this to find out if their child has Downs.  This is detected by an extra
21 chromosome in the cells fixed to the slide which reflects the baby/patient
depending on source.  Other errors are able to be detected are extra
chromosomal numbers such as 69 or 92 but this is VERY unlikely and I highly
doubt this is your situation.  I suspect you can not help but suspect the worst
but well..wait for the results.
    In regard to why, they may test you and the father?  Well, sometimes about
1 in 200 people have balanced translocated chromsomes which in simple english
means that no genetic info was lost but people have a chunk of their
chromosome 3, for example, attached to chromosome 5, for example.  This looks
odd compared to others in a 'karyotype' but the cells do not care so long as
all the genes are present.  If the baby has a balanced translocation in the
test, they will want to know if it was new for the baby or you have it as well.
 I won't be that surprised if I have this myself so don't panic.
    But most likely, their is no genetic reason for this miscarriage but a
result of other reproduction factors. I MUST STATE THAT I AM ONLY A
BIOCHEMISTRY SENIOR AND AM LEARNING THIS PRODEDURE but I hope that this info
makes you feel more informed with your situation.

--------------------------------------------------------------------------------

The hardest thing is finding that there is often no one or no thing to be
blamed--it just happens and nobody knows why. Give yourself lots of time,
as recovering emotionally is not unlike recovering physically--just because
wounds are felt rather than seen doesn't mean that there hasn't been damage
that will take a while to recover from. In a real sense, this is a death,
so you may need to mourn and grieve for a while. Take lots of time with
yourself emotionally as well as physically. And, by all means, if you are
uncomfortable with your OB-GYN--you're not getting answers to your
questions, etc.--find another one immediately.

> Also I would like to talk to other people who've had
> tests run on themselves and/or their spouses.  I would also like
> to hear from people who's progesterone levels were too low to
> support a pregnancy (my OBGYN doesn't think it was that but hasn't
> ruled it out - I keep wondering about it because it happened to
> my sister-in-law).

If this turns out to be an issue, progesterone supplements are easily
available. Several years back, they were only available via injection or
suppository, but they are now out in capsule form. In fact, my wife is
taking them now, as we're trying again.

> And finally, I would appreciate hearing from
> anyone with any information about women developing antibodies to
> their fetuses, and how common (or rare) this is.

This is all very new stuff, so there isn't a whole lot of data around. As I
understand it,  in order to strengthen the blocking response of the
placenta, white blood cells (a half unit) from the (prospective) father are
administered to the mother, and then they try to conceive again. While some
reports of the succes rate are as high as 70%, I don't know that the sample
is large enough yet to be significant. There are, for example, other
studies that have shown that psychological counselling was also
effective--again, the data sample is small, so it's hard to tell how
significant a result this might be.

My wife and I had the white cell stuff done in Richmond VA and we now have
an 18 month old son. Clearly, *something* worked--even though we didn't
have the full course of treatment that the Richmond people wanted. But now,
we're having troubles even conceiving again--which wasn't the slightest
problem before.

> And basically,
> just anyone else who has anything to tell me at all that might be
> helpful.

It's not your fault. Even though it happens in your body and to you, it's
not your fault. It hurts like hell, but these things just happen, the way
asteroids sometimes slam into the Earth. Boom. Stuff flies. Things get
killed. It's nobody's fault. It just happens. We pick up and try to go on...

--------------------------------------------------------------------------------
I suffered two miscarriages in a row a couple of years ago.

I was super careful to eat all the right things and avoid caffiene &
nutrasweet the first time.  I miscarried at 11 weeks, which was a major
disappointment because I thought I was almost far enough along to quit
having to worry about miscarriage.  The second time I was less careful
with caffiene and still miscarried at 6 1/2 weeks.  This was in some
ways harder than the first because I had so much morning sickness,
which the Dr. said was a good sign.  In other ways, I guess that I
was more prepared for the possibility and it was much earlier in the
pregnancy.

The pregnancy that resulted in my son, I was even less careful about
caffiene & nutrasweet (though I didn't pig out on it).

----------------------------------------------------------------------------------------

Well, I don't know if this will be helpful.  There is an organization
called Pen Parents, who provide resources and support for all kinds of
pregnancy and subsequent loss.  Their address is as follows

Pen Parents
P.O. Box 8738
Reno, NV  89507-8738
1-800-484-1033 code 7332

In thier "synopsis" that I recieved, there is a brief description of
several other groups that also provide resource and support.  One of
them is called HOPE (Helping Other Parents Endure)  and the address is
listed as...

C/O Pauline Montague
4833 Straume Ave.
Terrace, BC
V8G 2C8
Canada

The description of HOPE that follows is..." A newsletter by and for
parents who have lost a child through miscarriage, stillbirth or
neonatal death...."

Another one...

Pregnancy and Infant Loss Center
1421 E. Wayzata Blvd. #30
Wayzata, MN  55391
(612) 473-9372

"The PILC is a non-profit organization offering support, resources, and
education on miscarriage, stillbirth and infant death..."

There are more listed, if you would like me to post them.  Am sorry to
hear of your situation.  Please keep me posted...I'd like to know if
you've found any help through these sources.

-------------------------------------------------------------------------------

Laura -

I read your post to misc.kids about having 2 miscarriages in a row, and
really feel for you.  Unfortunately, I had 3 miscarriages in a row (after
having a previous normal pregnancy, which made it all the more puzzling).  I
will be glad to share my experiences with you, but I want to relate a some
things first:  You said you realized there is not always a reason.  Not
true!  I said the same thing, and our doctor (a specialist in recurrent
miscarriages) said there is always a reason, the problem comes in finding the
reason.  Also, it may be helpful for you to contact RESOLVE.  RESOLVE is a
support/education/advocacy group for infertile couples.  I'm not saying you
are infertile, but someone like me (after 3 in a row, I am considered
infertile - unable to carry a pregancy to term) is.  They have lots of good
information on miscarriages, and there are lots of opportunities to get in
contact with people you have or are going through similar experiences.  I
don't have their phone number with me right now, but will get it to you if
you want it.

Now to our situation.  We have a little boy who will be 4 at the end of May.
I got pregnant in April of 1992, and everything seemed to be going fine.
The ultrasound we had at the time of the amnio showed a beautiful, normal
miniature baby.  Then, inexplicability, the baby died in utero.  I began to
get nervous after a while, because a friend at work was pregnant at the
same time (we were due 2 weeks apart), and she was feeling lots of movement.
I was actually standing in front of the mirror in the mornings, looking at
my breasts, asking myself - "Are they getting smaller?"  I didn't say
anything to anyone, thinking I was exhibiting hysterical pregnancy fears.
Well, the water broke at 19 weeks, and I aborted.  Thankfully we got to the
hospital in time, and it happened there.  The pathology showed nothing
abnormal, and all my OB could tell me was a guess - a cord accident.  A
rare, random event.  That reasured us somewhat, so we tried again.  We lost
that pregnancy at about 8 weeks, and lost the third at 10 weeks (that was
May of 1993).  Well, by that time we said "Enough is enough!" and we found
an excellent doctor in Boston who specializes in recurrent miscarriages.  My
mother in law sent me a newspaper article after the second miscarriage in
which the reporter interviewed this particular doctor.  I hauled it out and
read it after the 3rd loss, and that gave us a name.  I then talked to
people at RESOLVE, and he was highly spoken of.  He is Dr. Joseph X, a
reproductive endocrinologist at Brigham and Womens Hospital.

Here is a description of the tests he ordered for us:

1.  Chromosomal analysis of my husband and myself.  He said that a
chromosomal abnormality in one or both of us could result in recurrent
losses, but that this was not too common.  This involved drawing a blood
sample from both of us.  Everything was normal.

2.  Endometrial biopsy.  This involved removing a sample of the lining of
the uterus just before my period started.  The development of the lining was
assessed to determine if I had a leutal phase defect (ie levels of hormones
not right to support a pregancy).  By the way - I am not a medical person,
and do not have my reference materials with me as I write this, so my
explanations my be off somewhat!  This was uncomfortable, but not overly so.
Some women feel more discomfort than I did.  I believe they told me to take
motrin before the procedure to minimize discomfort.  This was normal.

3.  Hysterosalpinogram (spelling?) also called a 'Tubogram' - during this
procedure, a dye is injected into the uterus, and the radiologist takes
photos to assess the condition of the fallopian tubes (open, closed) and the
uterus.  Abnormalitites in the shape of the uterus can cause recurrent
miscarriages.  This was normal.  Some women have quite a bit of discomfort
with this, but it was not too bad for me.  They had me take antibiotics
prior to and after the test.  This was done to prevent infection.

4.  Blood tests for anticardiolipid antibodies and lupus anticougulant
antibodies.  This was also normal!

Tests 1-4 are the standard tests that are performed during an assessment of
recurrent miscarriages.  During our initial visit, Dr. X said that a large
proportion of couples are not diagnosed by these tests.  He then proceeded
to say that he has developed a theory of recurrent pregnancy loss, in which
the women's body views the early placental tissue and/or the early fetal
tissue as foreign objects.  The white blood cells then attack and cause a
miscarriage.  He has developed a blood test that detects what he calls
'embryotoxic factors'.  It is my understanding that these 'embryotoxic
factors' are proteins given off as part of the process of attack by the
white blood cells.  Please remember my previous disclaimer!  He said that of
the couples who test negative during the standard tests, 80% test positive
for the embryotoxic factors.  Well, I tested postive for the embryotoxic
factors, followed his treatment, and am now beginning the third trimester of
a healthy, normal pregnancy.  I will be glad to send you details
of the treatment, but it is basically rather high doses of progesterone during the
first 20 weeks of pregnancy.  There is no danger to the fetus.  Doctor X
said that physcians have been prescribing progesterone for recurrent
miscarrianges for years, without really knowing if it would work.  The
thinking was that it couldn't hurt.  Well, they may have been treating this
condition without realizing it.

We naturally asked him about our normal first pregnancy, and the fetal
demise.  His theory on this is that when the baby died and stayed in the
uterus (for as long as 2 weeks, maybe) that my body became sensitized to
pregnancies and attacked the subsequent two.  He said a normal pregnancy
changes the women's immune system to keep itself from being attacked as a
foreign object (which it is, being composed of half your partner's genes).

Doctor X said his treatment has not had
the benefit of a double - blind, placebo controlled study because he has not
been able to get the funding for such a study.  He does believe there is
"something to it", though.  The women at RESOLVE said he has a high success
rate, and that 4 or 5 years ago, when he was just getting started with this,
that his waiting room would be clogged with frantic women looking for help.
He has modified his office procedures a lot since then, and the situation is
busy, but much more orderly.  Another empirical verification came from a
doctor at the same hospital who is using a special ultrasound technique to
study blood flow around the fetus and placenta of women who suffer recurrent
losses.  Her subjects come from Dr. X, and are under his treatment, and she
said a problem (for her, not for me) is that there are very few failures
(miscarriages) so she doesn't have much data!  That was reassuring.

I don't know how much reading you have done on the subject of recurrent
miscarriages, but a recent theory says that the woman and man can be too
close to each other genetically, and that some sort of injection into the
woman can help (I don't know too much about this theory).  Anyway, Dr. X
said that has recently been debunked.  This theory was promoted by a doctor in
Philadelphia.

Another thing - Dr. X has said that if a couple is in their 30's and has
had 2 miscarriages that they should consider having a workup.  I don't know
your situation, but it is something to keep in mind.

Yet something else - Don't hesitate to go to a specialist!  You may like your
OB/GYN just fine (like I do), but don't feel you are being disloyal by going
to a specialist.  After the 3rd loss, by OB/GYN said "I can't help you with
this".  So off we went, and are we glad!

Please pursue this with as much vigor as you can muster, and don't give up
hope!  I have just dealt with the medical aspects of my experience here, not
the emotional.  Please let me know if you care to exchange notes on the
latter.  Best of luck and let me know how you are doing!

----------------------------------------------------------------------------------

Got your message.  I'm glad you are seeing a doctor who wants to start
testing soon.  The tests on me took 1 cycle to complete, which was much
faster than I had thought.  I should think that your body has to readjust a
bit before the more invasive procedures are done, though.

In the newspaper article on Dr. X, he said progesterone was described in
the '70's as 'nature's immune supressor', and that is why they looked at
it as a possible treatment for this condition.  We asked him why he chose
the dosage he did (50 mg progesterone twice a day via vaginal suppositories
(ugh)).  He said that in the lab they added progesterone equivalant to that
dosage to the blood of women who tested positive for the toxic factors, and
they (the factors) disappeared.  He said there is no guarantee that the
levels of progesterone in the women's blood would be the same, however,
because each women's body is different.  He said if the woman miscarries
under his treatment they increase the dose of progesterone in hopes that
will deactivate the toxic factors.

The blood test he uses is, to my knowledge, different from the usual tests
for antibodies (I *think* the usual tests are for the anticardiolipid and
lupus anticougulant antibodies - may want to ask your doctor on this).  I
think he is the only person doing this test, and do not know if he does it
'long distance'.  Dr. X and another doctor co-authored a chapter of a
book, and it deals with miscarriages (causes, treatments).  He gave us a
copy to read, and I his theory is described there.  I'll try to get the
reference for you (and your doctor?) if you want.

----------------------------------------------------------------------------------

Here is the information on the book:

Kistner's Textbook of Gynecology.  1990.

It will be updated this year.  Hill's secretary got the information for me,
and when I asked her if she had the publisher, she just laughed.  I guess
she considered herself lucky to get that information from him (he's busy!).

It has been good to correspond with you.  Please keep me updated on how you
are doing, and how the results of the tests come out.  You are doing the
right thing by being an active participant, because you and your partner
have the most to gain and the most to lose.

=====================================================================

After all the wondering, when I got my fetal tissue test results back, they
indicated a trisomy-16.  I posted the following to the infertility group:

>I joined the group a few weeks ago after having my second miscarriage in a row.
>I saw the doctor today, and the results from the fetal tissue testing were back.
>It seems the problem was a trisomy-16.  I THINK this means an extra
>chromosome, sort of like Down's but in a different position.  It is always
>fatal, and apparently is the most common flaw that they find.  Of course, they
>can't be sure what happened the first time, since that tissue was not tested.

>I suppose that this ought to make me feel better, but at the moment, it doesn't.
>It scares me, because now I'll probably just have to try again without knowing
>any more than I did before.  It SEEMS that we have just had really bad luck, but
>I find that so hard to believe.  I want to CHANGE something, do something
>DIFFERENTLY next time, and it seems like there won't be anything TO change.

My doctor also told me that neither my husband nor I could personally have
an abnormality in chromosome 16 or we wouldn't be alive ourselves.

I also got some more responses:

----------------------------------------------------------------------------------

I wanted to write to you after your first post but you were more
interested in genetic specifics that I'm not familiar with.  Now you
asked about the odds involved.  I think its an important question.

We had a miscarriage in our 1st pregnancy after 13 weeks.  We had
conceieved in our first month trying and were terribly naive about the
statistics of miscarriage frequencies.  We called our families and
some friends right after the home test and before we had even been to
the HMO.  At 11 or so weeks, even having learned more, we thought we
had gone beyond the risky stage.  We went in for an ultrasound "just
to make sure things were OK" after my wife had a little brown
staining.  It was the most painful shock of my life to look at the
ultrasound and see nothing there, just a mostly-empty 6-week sized
sac.  My wife couldn't see the screen but found out with the
technician saying "good luck next time".  The actually miscarriage
came a week or so later on a Sunday morning (when I was originally
scheduled to be attending a conference in Washington).  The experience
was like a bad nightmare.  Suddenly TV seemed to be filled with ads
and sitcoms about childbirth and babies.

Well, I know you are aware of the pain involved.  I think what made it
the hardest for us was not having a sense of the risks we were facing
from the start. We had pictured the risk of miscarriage as being the
same as the risk of various birth defects.  It seemed like a possibly
concern, but something perhaps less than 1% of the people would have
to face.

We've since learned that the odds of misscarraige are something like
5-20%.  The 20% figure, which I haven't seen backed up that often, refers
to recognized and unrecognized pregnancies.

10% seems to be the more often quoted figure.   Of the 10%, I believe
about 80% are due to random non-reoccuring causes -- primarily the miracle
of the dna from both parents coming together correctly to create a new
life.

After a first miscarriage, odds of having a second are a little worse,
only because of the possibility the 1st misscarriage was due to a
non-random cause. Otherwise, you are just rolling the dice again.
Since the miscarriage we have talked to many women about it and nearly
every one has had one or more.  One had 4 miscarraiges before having
two healthy bosy.  Most people only share there experiences with other
people who have had a loss and as a result many people aren't aware of
the risks.

 Using the 20% figure, the odds of having 3 children without
experiencing a miscarriage are 0.8*0.8*0.8=50%.  It is much more
painful to begin with a miscarriage.  There are no children to provide
comfort and the worry about whether it will be possible.

For your situation, in retrospect the odds of having 2 in a row are
0.2*0.2=4%, but like I said, you are just rolling the dice, each time
you try you have the same odds to face.  Since the problem was found
to be random, you are facing the same odds of sucess next time as well
(80%).  Some people believe the odds actually improve since your body
has had some experience with the process (hormones,etc.).

After the waiting period, it took us 6 or 7 months to conceive again.
During that time we may have had one undetected miscarriage.  We
finally conceived on my birthday last July and are expecting the baby
a week from tomorrow.  In retrospect, the experience has played an
important part in preparing us to be parents.  So don't give up hope,
and don't feel cursed, these things are a real part of the parenting
process. We wish you the best of luck.

----------------------------------------------------------------------------------

Hi!
        Best of luck! We also had two miscarriages
right in a row - and it was very scarey for us. My
doctor assured us, as did other sources, that it
really was not signicant. He was right - and we
are now the parents of a very happy 6 month old
boy.  Keep hanging in there - things will be fine.

----------------------------------------------------------------------------------
Hi Laura,

Just thought I'd let you know that my sister-in-law had
two miscarriages in a row, and did the same as you, had
the fetal tissue tested.  For her, it was also the trisomy-16
problem.  The doctors told her the same thing your doctors told
you.  Her third pregnancy was just fine (yea!), and she now has
a 9-month old daughter.

Hope this makes you feel a little better!

                        anne

(it DID!!!)

=====================================================================

Another reader posted a message to the net asking for advice on how long to wait
after a miscarriage before trying again.  The following is a compilation of her
responses.  Please remember that this is only opionion, and that you should
first and foremost follow your doctor's advice...

--------------------------------------------------------------------------------
In reading misc.kids during the year since my wife's miscarriage, I've
decided there just isn't any consistency in the advice.

My wife was 34 last year when she miscarried.  Our doctor told us to wait
until she had had one period before trying to conceive again.  We did
exactly that.  That was her only period.  She got pregnant again right
away.  That baby boy, our second, was born January 21, 1994, and appears
to be perfectly healthy.  More healthy than our first, in fact, who is
missing a kidney.
--------------------------------------------------------------------------------
I want to tell you, that I had 3 miscarriages since 1992, and I had to
have 4 D&C's since then. I had a appointment with an endocrinologist, and
he told me to wait at least 1/2 a year before the next try. First I
couldn't understand and I started as soon as possible with all the
testing.  Now I feel that this 1/2 year is not too long to get the emotional
healing that I needed so much.
-------------------------------------------------------------------------------
The "three month wait" is sometimes suggested because it can take your
body a little while to get back on a regular menstrual cycle.  If you
wait three months your physician has a better chance of coming up with
a reasonable due date.  But it isn't always necessary, and if there's
any doubt about the due date now they can clear it up with ultrasound.
So if you were told you didn't have to wait three months, it's
perfectly all right to start trying again as soon as you're ready.
(This was what my doctor told me.)

I got pregnant again the first month after, and despite a difficult
pregnancy, there was never any threat of another miscarriage.  And my
baby is six weeks old now, a healthy beautiful little boy.  There
didn't seem to be any problem caused by getting another baby started
so quick.
-------------------------------------------------------------------------
The standard waiting period of three months (for the first
miscarriage--if you've miscarried before, the waiting period goes
down--I'll explain later) was designed mostly, IMO, for the
expectant parents to deal with their emotional grief.  Waiting for
one cycle makes very good sense medically in terms of waiting for
the uterine lining to completely heal, etc., and so that if you get
pregnant, it's easier to "date" the fetus from LMP.  If you jump
right in, generally, ultrasounds, etc. need to be performed in order
to get a correct dating for the fetus.

I have miscarried twice.  The first time, my OB said "wait three
months."  (I was 29 at the time.)  The second time, just this past
summer, at the age of 33, I was told to wait 2 cycles, though 1
cycle would suffice.  Friends of mine who have infertility problems
are told not to wait at all (that is, not to wait for a complete
cycle; they should at least wait until the physical cramping, etc.
is gone) because it's so difficult for them to conceive anyway that
waiting just prolongs the agony.

I hope this helps.  You have my complete sympathies on your
miscarriage.  It's never easy, especially after you've daydreamed
about life with baby, etc.  I do know, from my experience, that the
second one was easier emotionally (though tougher physically,
because it required a D&C) because we have a healthy son.
------------------------------------------------------------------------
As far as I know it's all folklore.  It's one of those "might help, can't
hurt" things.  Different doctors, different suggested waiting periords...
my gyn suggested two months.
------------------------------------------------------------------------
Ah, yes, confusion.  I know it well.  Here's one example for you:

    I lost a pregnancy at 8 weeks while on vacation; the older OB at the
hospital there said to wait for three normal periods before trying again.
Since I wanted to time the next baby so that I'd be home in the summer
when my older kids are out of school, that would have meant waiting a
whole year -- and at 33 I didn't like that idea.  So I asked my regular
doctor when I got home.  She said that the wait wouldn't make much
difference, except for trying to estimate the due date!  So we did try
again, and lost another just 8.5 weeks after the first.  That ended hopes
for a maternity leave the next summer.  Now aiming for the following
spring/early-summer, we waited 10 months, conceived in August, lost again
in September, and conceived in October.  Ultrasound done in December
resulted in an estimated due date in early July, suggesting the conception
had occurred just 3 weeks after the spontaneous abortion.  Another
ultrasound in June revealed a very low lying placenta which would have
made a normal delivery dangerous, so a c-section was scheduled.  The
result - a healthy baby girl, quite well developed for the estimated
gestational age.

------------------------------------------------------------------------
I have had two miscarriages.  The first was at 11 wks LMP and then I was
told to wait until after two menstrual periods.  The Dr said that this
helped in knowing when conception occured because I would know how long
my cycle was and when my LMP happened.  I had the same Dr. after the
second miscarriage (3 months after the 1st), and he gave me the same
advice.  Due to selling the house and moving, we didn't try for about
6 months.  The third pregnancy carried to term and now Kenneth will be
two in June.
------------------------------------------------------------------------
I had a friend, mid-thirties, miscarry her first baby.  The doctor told
her to wait a few months to give her body a rest.  She wanted to wait
because it had been traumatic emotionally, and she wasn't ready to risk
that just yet.

Well, she and her husband are not good at birthcontrol.  She didn't get
her next period, and she delivered a beautful baby girl nine months later.

Every woman is different.  I think (as a mechanical engineer and general
busybody) that the correct time to wait is as long as you need.  If you
are ready to try again and your body is healthy, I say go for it.
------------------------------------------------------------------------
In response to your posting about how long to wait after
a miscarriage... I had miscarriage 10/1/93 at about 9 weeks.
I did have a D&C though.  My doctor advised waiting 2 periods.
Luckily, my period started exactly 4 weeks after.  The dr. had
said it could be 4 to 10 weeks! So I waited 2 cycles and started
trying  again.  Some people I spoke with thought 2 months wasn't
enough, but my Dr. did so I took his advice.  I am now 9 weeks
pregnant and  am pretty nervous, but I'm taking it one day
at a time and hoping for the best!  Good Luck, I know how difficult
it is.
------------------------------------------------------------------------
I am sorry about your miscarriage.  I too miscarried at about 6.5 weeks (in
September, 1991) & was concerned about how long to wait before trying
again.  I was 32 at the time I miscarried.  Like you, we received various
recommendations, even from different doctors.  After reading up on it and
talking to my brother (who is a general practitioner & does a fair amount of
OB-GYN work), I concluded that the recommendations to wait are based more on
the need for time to recover PSYCHOLOGICALLY than the body's need to recover
physically.  I had suffered from infertility & it had taken me over a year
to get pregnant, so I didn't want to wait any longer than necessary.  I did
wait until I had one period (which was 7 weeks after the miscarriage) to
try.  But then, much to our surprise, I became pregnant again right away.
Our healthy son was born a little less than 11 months after my miscarriage.
------------------------------------------------------------------------
One addition of my own - I was told two periods.  When I asked the
doctor if I could move that up, he said it probably wouldn't hurt anything
but recommended that I take multivitamins or better yet prenatal vitamins
(and to eat healthily) right away to make sure that my blood had enough
time to recover.

.

