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Pregnancy after RPL is incredibly scary as some of you know...
I don't really know what to do now. I'm open to opinions, advice, whatever
In my past pregnancies I was told to take baby aspirin, progesterone, and prednisolone. Mind you, nothing actually, clearly wrong with me was ever found. I have taken to reading medical journal articles on pubmed (I have access to some full-text journals with work). Apparantly there is no evidence of any benefit to taking baby aspirin without a diagnosed clotting disorder. I honestly do not believe I have a clotting disorder. Clearly, I bruise easily and my circulation is great ever since I have gone from sedentary to active.
Progesterone is a "it can't hurt" thing, and I have had a documented LP defect in the past so although I believe my healthy lifestyle has improved my ovulation quality and my past few LP were textbook length, I am taking progesterone.
As for prednisolone, I'm a bit afraid to take it, especially as a doctor specialized in auto-immune diseases believes there is no reason for me to take it while pregnant, and my RE (who I haven't seen in nearly a year) seems to think it's a good idea.
Here are the doctors I can call at this point:
a) My RE. I don't really wanna, she doesn't do early pregnancy followup and the only thing she would do for me is maybe a consult, maybe give me a script to get an early ultrasound and some betas. I don't wanna because I'm not ready to go down the TTCWMA road again if this fails and I don't want to have to explain why. Just awkward. Plus I'm not sure she even remembers me. I did ONE IUI with her last March. And I really don't want to get in an argument about which meds to take or not. I want to take progesterone, period. Get retested for a bunch of stuff, if there's evidence I need something more sure I'll take it but I don't feel at this point that I should. It didn't work for me before in the other pregnancies. (I tried her treatment in a total of 3 pregnancies)
b) My regular gynecologist. She is nice enough, but last time I saw her I asked for info about the contraceptive implant, got my pap smear, and she gave me a script for the BCP with the same hormone as in the implant. I chickened out and never did it. Am I flakey? I guess so. Do I change my mind? Obviously. I am still embarrassed to have changed my mind and to be pregnant after so recently being adamantly against ever trying again and adopting. I doubt she'd judge me, but I'm still afraid of it. Plus, her copay is out of this world. But she has a TVU in her office, which is a perk. However, she outsources all ultrasounds past 10 weeks. And she can only follow me til 6 months along then I need a new doctor.
c) My regular neighborhood doctor. Perks: he is nice. He is the nicest doctor I know. He can do my pregnancy followup until 6 months if I so choose. His office is literally 5 minute walk away. What I'm not so sure about is that any and all ultrasounds will be outsourced, and during my 2d pregnancy/miscarriage he didn't order betas for me when I started spotting, he just told me to wait it out and I'd get my answer sooner than the betas would come back, and of course to call him back if I experienced pain or insane bleeding. He is kind, compassionate and a good doctor and I don't think he'd judge (my gyn is soooo judgy, I can't stand it. Nice, but judgy). In retrospect, he was right about the betas. I was less than 5 weeks along. I was already on progesterone and there was nothing to do at that point. But I'm afraid he won't be aggressive enough in treating me. Also, a $2 copay per visit, and any prescribed ultrasounds would be copay-free and done in a seperate office.
d) Look for a new doctor or midwife.
My time constraints: I only have enough progesterone left in my box until Friday. That stuff is prescription-strength. I need to have a prescription by Thursday at the latest.
Things I am not entirely sure of:
1) Do I want betas? Pros: they can be reassuring and exciting and something positive to hold onto while waiting. Cons: they can be bad for me if they are borderline. Obsession city! Maybe I prefer to be blissfully ignorant until I'm... not.
2) Do I want an early ultrasound? Yes, I want to have an ultrasound before the low-risk pregnancy standard of 11-13 weeks. A 5 week ultrasound won't show much and will reassure me for maybe a week. A 6 week ultrasound could go either way. I've already done the "no heartbeat at 6w4d dance -- but heartbeat at 7w2d". Most stressful, awful, horrible, no good week of my life. Worse than any of my miscarriages in and of themselves. I think maybe a 7 or 8 week TVU is the way to go. My missed miscarriage ended at 8 weeks and I found out in the ER at almost 10 weeks. Blissful ignorance that lasts too long sucks too, so I think 8 weeks then 11-12weeks is a good compromise with an ER visit or an emergency ultrasound at the doctor's if I have spotting in between.
3) Should I just take the stupid meds, side-effects be ******?
4) Exercise. I believe a healthy diet and exercise is what fixed my wacky cycles. So it clearly has a beneficial effect on my stress levels and on my health, including reproductive health. I think that is a clear indication to continue. But clearly I cannot continue my routine of heavy weightlifting 3x week, running 2-4 miles 3x week, HIIT 1-2x week, rock climbing 1x week and yoga 1x week. Clearly that is too much for a pregnant woman with a history of repeat miscarriage. Indeed, my doctor agreed that I was at the upper limit of what I could do without overtraining, and to be careful not to overtrain. But I am struggling to figure out how much is too much, and how little is too little.
What do you think of yoga 1-2x week, walking 45+ minutes nearly daily (no more running - my dog will be happy with this change), some water aerobics (a class designed for old ladies, pregnant women and people recovering from injuries in my gym) or swimming, and taking it really easy on my indoor wallclimbing: top rope only or traversing just barely off the ground with a thick mat under me, and some upper-body strength moves (heavy squats and deadlifts just don't SOUND like a good idea, lat pulldowns and bench press can't really hurt though I guess).
Props to you if you read that whole rant, even better if you have any clarity on the best move for me.
Last edited by Lex&angels; February 26th, 2012 at 01:09 PM.
Ok so I definitely think you need to go see either your regular gyno or your family doc since you definitely need more progesterone. Personally I wouldn't go to the RE since you are unsure about continuing with them if that road happens. From my experience I went to my gyno who could only see me until 6 months and actually switched to my midwives at the 11wk mark. I had a loss before having Megan and my gyno had all the records and I knew they would do the betas for me and the early u/s. This place had an in medical office lab for me to do my betas but I did have to go to a separate place for my u/s which I was ok with.
Cay wife to David mom to Megan 10/01/2010 and April 7/14/2013
Ditto what everyone else about going to your family doc.
As for excercising - my OBGYN highly suggested I stop rockclimbing and jogging at 12 weeks. He said I could swim, walk or do anything that was not high impact / or could result in a fall. This time around I plan on continuing my weight lifting (not adding additional weights) and walking on the treadmill - hoping it will help with the problems I had my last pregnancy and avoid the 70lb weight gain.
In regards to ultrasounds, standard practice here is one at 8 weeks (just a quicky in the dr's office), and another at 12-14 weeks. Then 20 weeks and possibly 30-32.
Thanks girls! Some of my TTC buddies have also weighed in so this is what I'll do: I'll call my family doctor today and see what can be done, I'm guessing he'll refer me to a high-risk OB who can follow me to the end, and I'm guessing he'll give me a script for more progesterone.
As for exercise, I'm going to play it by ear I guess, consult my doctors in detail etc. I'm thinking for strength training to mostly do upper body because squats and deadlifts really, really wipe me out and I'm afraid. I guess I'll quit rock climbing, the risk isn't worth it. Most people are probably fine doing it til 12 weeks -- same for jogging -- but I'm high risk. I'll of course let the instructors at the gym know I'm pregnant so they can suggest modifications. I might even ask for PT sessions with one, she is very nice, I know she has a great degree and she seems knowledgable about strength training and modifications. I wanna be a strong mama!