What Testing Can be Done for RPL? #2

Moving onto homronal imbalances, such as FSH, LH, Estradiol, Progesterone, TSH, T4, Prolactin, (Fasting) Glucose and Insulin and Inhibin B.

FSH stands for Follicle-Stimulating Hormone. FSH is secreted from the pituitary gland and is responsible for stimulating the production of eggs and producing a hormone called Estradiol (E2), better known as estrogen, during the pre-ovulatory phase of the menstrual cycle. FSH & E2 are tested on cycle day 3 because typically this is when FSH peaks. If the FSH is below 12 and E2 is below 35 a fertile cycle is likely to occur. However, if the levels of FSH are above 12 and E2 is above 35 an unsuccessful cycle most likely will occur. This can be a good indicator antibodies are at play too.

LH or lutenizing hormone is responsible for giving us positive OPK's. This is because E2 reaches its peak around the day of ovulation which sends a signal to the pituitary gland to secrete LH. LH is responsible for triggering the ovary to release an egg. Normal results vary between 6-30 U/L. Typically LH tests are performed when a woman is going through IVF to determine when ovulation would occur but this could also determine: anovulation, ovarian failure, PCOS (polycystic ovarian syndrome), pituitary disorders and chromosomal abnormalities.

Progesterone (P4) should be low during preovulatory phase and increase post-ovulation. The corpus luteum is responsible for the progesterone after ovulation. The production of progesterone helps in aiding a blastocyte to implant to the uterine wall. Normal P4 values at cycle day 3 should be < 1.5 ng/ml and at 7 dpo should be > then 10-15. Low progesterone may indicate a luteal phase defect, meaning there are too few days between ovulation and menstruation.

Prolactin as many of us know is the milk secreting hormone. Elevated levels when not breastfeeding may interfere with ovulation and conception. Hyperprolactinemia is commonly associated with PCOS. Normal levels at cycle day 3 are <24 ng/ml.

Another important hormone test is thyroid testing which includes TSH (thyroid stimulating hormone) and T4 (thyroxine). TSH & T4 will help determine if hypothyroid (lack TSH &/or T4) or hyperthyroid (produce too much TSH &/or T4) conditions are present. TSH is produced by the pituitary gland and signals the thyroid to make hormones.

Symptoms of Hypothyroidism:

- Fatigue
- Weakness
- Weight gain or increased difficulty losing weight
- Coarse, dry hair
- Dry, rough pale skin
- Hair loss
- Cold intolerance (you can't tolerate cold temperatures like those around you)
- Muscle cramps and frequent muscle aches
- Constipation
- Depression
- Irritability
- Memory loss
- Abnormal menstrual cycles
- Decreased libido

Symptoms of Hyperthyroidism:

- Palpitations
- Heat intolerance
- Nervousness
- Insomnia
- Breathlessness
- Increased bowel movements
- Light or absent menstrual periods
- Fatigue
- Fast heart rate
- Trembling hands
- Weight loss
- Muscle weakness
- Warm moist skin
- Hair loss
- Staring gaze


Signs and symptoms vary due to severity and are different for everyone.

- 10 million AMERICANS have hypothyroidism.

- Approximately 10% of women suffer from some type of thyroid hormone deficiency.


A great resource I found while researching thyroid conditions; www.endocrineweb.com.

The fasting insulin and glucose is a test for diabetes. There are 2 types; Type 1 & Type 2. Type 1 Diabetes typically comes on gradually but symptoms develop quickly. With Type 1 Diabetes your body loses its ability to produce insulin. This increases glucose levels.

Signs & Symptoms of Diabetes Type 1 include:

- Extreme weakness and/or tiredness
- Extreme thirst—dehydration
- Increased urination
- Abdominal pain
- Nausea and/or vomiting
- Blurry vision
- Wounds that don’t heal well
- Irritability or quick mood changes
- Changes to (or loss of) menstruation
- Weight loss—despite eating more
- Rapid heart rate
- Reduced blood pressure (falling below 90/60)
- Low body temperature (below 97º F)

There are actually two types of Type 2 Diabetes; insulin resistant and not insulin resistant. Insulin resistant means your body does not use insulin properly. If you are not insulin resistant it means your body does not produce enough insulin to break down glucose.


Signs & Symptoms of Diabetes Type 2 include:

- Fatigue
- Extreme thirst
- Frequent urination
- Extreme hunger
- Weight loss
- Infections
- Slow wound healing
- Blurry vision

Inhibin B is a protein hormone that is secreted by your follicles once FSH has worked hard to develop those follicles. Inhibin B inhibits the pituitary from secreting FSH and will reach a peak in early-mid follicle phase and then a second peak at ovulation. The test is performed on cycle day 3 as well. This test is a newer test for predicting ovarian reserve or quantity and quality of eggs. This seems to be a more reliable for predicting ovarian reserve over FSH.

The mean value of Inhibin B for normal women on day 3 of the menstrual cycle is 40 pg/ml and the 95% confidence interval of the mean is 33 to 45 pg/ml. Women undergoing IVF with day 3 Inhibin B concentrations less than 45 pg/ml have a pregnancy rate 70% less than women with day 3 Inhibin B concentrations greater that 45 pg/ml.

- Millenova Lab

Stay tuned for more tests.

Seriously?!

I'm beyond fed up at this point! Why do things continue to go downhill when I thought I was seeing a light at the end of the tunnel?

As the time gets nearer for me to change jobs, I'm becoming more and more anxious. I HATE that we cannot move forward with any type of testing until August. And this puts TTC off until fall. I am, however, waiting for the results of my blood work that I had done after I came back from Holland. These include my Thrombophilia labs: Antithrombin III, Protein C &C activity, MTHFR, Homocysteine, Factor II and TSH, T4, Antithyroid antibodies, Prolactin, (Fasting) Glucose and Insulin. I'm hoping to have the results this week.

Once my insurance kicks in we will proceed with the immune testing & the cycle day #3 labs: FSH, LH, Estradiol. We may pursue the immune testing while on Cobra since this will probably be an OOP expense either way. The other testing that is on hold is the SHG and semen analysis.

On top of this we are still dealing with DH's endocrine issues. I don't think I've mentioned this before. The short story on that is DH was diagnosed about 6-8 months ago with hypothyroid and low testosterone (Low T) by his PCP. He has since gone to an endocrinologist. Despite being on Synthroid he was still not feeling all that better. The endocrinologist, Dr. P (I'll call him), was not happy with his hormone levels and wants to increase his synthroid as well as put him on Androgel to increase his testosterone. Dr. P seemed certain that these issues have nothing to due with my RPL. However, Dr. Corley was pretty adamant that this is not the case unless a semen analysis was performed to determine this. Why is no one ever on the same page?

So the WTF news of the week, is DH called Dr. P because we are having trouble getting the Androgel approved by insurance. Dr. P mentioned we may want to consider freezing DH's sperm because Androgel may decrease his sperm count. Excuse me? Why was this not mentioned before?! He damn well knows our history of RPL and wanting to conceive. DH thinks its just to cover his tail, which I understand but this is a HUGE deal in my book. And I'm disgusted that he hasn't ordered a sperm analysis at least a comparative one before and after Androgel to see if this does affect his count.

So at this point I have emailed Dr. Corley and his nurse Lisa to let them know where we stand and to acquire his opinion on whether we should do a sperm analysis before starting the Androgel.

It is important to DH that we do something and soon. His symptoms continue to get worse and both the hypothyroid and Low T are most likely related. The hypothyroid and Low T have affected his sleeping, increased fatigue, inability to lose weight, loss of hair, mood swings, weakness, occasional ED, and muscle cramping.

Any other monkey wrenches?

What Testing Can be Done for RPL?

Doctors have many different opinions on what types of testing are necessary for RPL. This post is for those who are unsure if they are being "cheated" by their RE or Ob/Gyn and not getting the care that they deserve. I've been there and want to make you aware of what is available. I am NOT a doctor and I am not a know it all. I do this in my free time, reading & researching RPL. Researching the possibilities of why I lost my 4 angels. If no one else is going to give me answers I have to research to hold on to my hope, faith and sanity. This is what I have found and there very well could be more out there. If something is incorrect please leave me a message. If you are looking for more about a particular diagnosis leave me a message and I'll be glad to try and help you.

Let's start with thrombophilia for this post. Approximately 40% of those who have thrombophilia have inherited it. Thrombophilia means a person is prone to develop blood clots due to defect in the process of coagulation. Some interesting facts about thrombophilia related to RPL:

"Inherited thrombophilias have been associated with early and late recurrent pregnancy loss as a result of uteroplacental microvascular thrombosis and hypoperfusion. Obstetrical complications such as intrauterine growth retardation, placental abruption as well as preeclampsia have also been related to abnormal placental vasculature. Genetic thrombophilia are suspected to account for about 30% of these obstetrical complications. Poor pregnancy outcomes are associated with maternal thrombophilia but may also be associated with fetal thrombophilia by inheritance of maternal and paternal thrombophilic genes."

~ Found on the Millenova Lab website

Thrombophilia labs include Antithrombin III, Protein C & S activity, MTHFR, Homocysteine, Factor II and Factor V Leiden.

So what are these tests and what are the tests testing for?

Antithrombin III test is to determine how the amount of AT III in the blood, a protein that assists in blood clotting. When you have an AT III deficiency often times these things may appear:
1) Increased risk of venous thrombosis and pulmonary embolism. Venous thrombosis occurs most frequently in the deep veins of the lower extremities.
2) Thrombotic events begin in mid-late teenage years.
3) Mesenteric veins, inferior vena cava, renal veins are all susceptible.
4) Cerebral vein thrombosis can occur.
5) Events occur with AT activity at 40-60% of normal. Homozygosity is fatal in utero.
6) May be precipitated by provocations such as surgery, trauma, pregnancy, oral contraceptive (OCP) use, or infection.

Protein C & S activity is another blood test that examines the function (activity) or quantity (antigen) of both proteins. The lack of one or the other protein or possibly both (highly unlikely) indicates that you do not produce this substance to help prevent blood clots.

- 1 out of every 300 people has one normal gene and one faulty gene for protein C deficiency.

- Protein S deficiency is less likely and only occurs in about 1 in 20,000 people.

- 20-40% of women who have had two or more consecutive m/c have an incidence of Protein C deficiency.

Next, MTHFR. The full name Methylenetetrahydrofolate reductase. From my understanding a blood test helps to identify a mutated gene. This can be heterozygous (inherited by one parent) or homozygous (inherited by both parents). A defective MTHFR gene cannot process folic acid and B12 properly. As we all know folic acid is very important for a developing fetus.

- The incidence of a heterozygous MTHFR condition in women with RPL is about 25-30%.

- Where as the homozygous MTHFR condition is found in 14% of women with RPL.

- MTHFR is the most common abnormality in women with thrombophilia.

High homocysteine levels are usually found in those who are carriers of a MTHFR mutation. Not all the time is there a connection. People who are deficient in folic acid, B6 & B12 may have high homocysteine levels as well.

Factor II deficiency is is present when there is a lack of Prothrombin in the blood, this creates a blood clotting/coagulation problem. Both parents must be carriers of Factor II to pass it along to their children. Factor II deficiency is most commonly caused by lack of Vitamin K. Some babies are born with a Vitamin K deficiency which explains why a Vitamin K shot is given shortly after birth.

- 8% of women who experience fetal loss have this mutation.

People with Factor V Leiden not only have a higher chance of developing blood clots but have a high chance of the blood clot breaking away from the original site. Some history about Factor V Leiden, it was named after a Dutch professor who discovered it in 1994. I find that interesting since I'm half Dutch. ;-)

"The factor V Leiden mutation is associated with a slightly increased risk of pregnancy loss (miscarriage). Women with this mutation are two to three times more likely to have multiple (recurrent) miscarriages or a pregnancy loss during the second or third trimester. Some research suggests that the factor V Leiden mutation may also increase the risk of other complications during pregnancy, including pregnancy-induced high blood pressure (preeclampsia), slow fetal growth, and early separation of the placenta from the uterine wall (placental abruption). However, the association between the factor V Leiden mutation and these complications has not been confirmed. Most women with factor V Leiden thrombophilia have normal pregnancies."

- Between 3% and 10% of Caucasian people are heterozygous for Factor V Leiden, and a much smaller percentage are homozygous.

- In Sweden the rate of heterozygous mutation may be as high as 15%.

- Approximately 1 in 100 women who have FVL will have a serious deep vein thrombosis (DVT) during pregnancy.

While researching Factor V Leiden, I came across an informative website for those who have been diagnosed with Factor V Leiden. I also came across this article, "Pregnancy, Clotting, and Factor V Leiden: An Overview"

Stay tuned! More info to follow on immune and hormonal blood tests.

NaPro - Private Session

I had my first NaPro private session last night with Erin. I have to admit that I was a bad student and did not read the book/manual that was included. I just haven't had the time between Easter, Holland trip, accepting a new job, etc. I do consider this to be a downfall of the NaPro system. In all honesty a private session should be first, instead of being handed a book IMO (in my opinion). It turns out its quite different then how I'm use to checking for CM. So I learned a lot from our $50 private session.

With the Creighton Model you do not temp or do internal exams as other systems have you do. Its based solely on your CM; sensation (when you wipe with flat layers of tissue), observation (on the tissue) and finger testing (between thumb and forefinger). Acronym: SOFT

So let's start with sensation: When you wipe is it dry, damp, wet or lubricative?

Observation: Is there a discharge present? If so, you finger test.

Finger Testing: Is it sticky, tacky or stretchy? Is it shiny, brown, cloudy, cloudy/clear, gummy, clear, lubricative, pasty (creamy) or yellow?

Now you may ask, when do I check for this? Well, before and after urinating or BM (including in the middle of the night), before bathing or showering, before and after swimming and before bedtime. NaPro definitely changes your bathroom habits.

Here are some pictures I took of my chart for those who are curious.






This is a picture of my chart so far this month.



One thing Erin pointed out is a I had 3 days of brown spotting at the end of my period which I can't say is normal for me. Maybe two but she said this can indicate low progesterone the prior cycle. Hmm...interesting! I'm looking forward to our next session in two or so weeks to see if there are any other indicators.

"To Full Term"

I've almost completed reading this book, "To Full Term: A Mother's Triumph Over Miscarriage" by Darci Klein, that I want to rave about. This book is geared towards those who have experienced RPL, stillbirth and pregnancy complications. This woman spent nearly 30+ weeks on bed rest, fighting to save her child's life and maintain her sanity. In this book, she encourages women to take part in their own health care, to trust their instincts and not let doctors dictate their care. In fact, this is the best book I've read that is a story telling book, supportive, inspiring and combines factual information.

As I mentioned before, having Landon this time around has greatly distracted me. Whether this is a good or bad thing, I'm unsure. I'm not convinced I have grieved entirely over this last loss. Maybe, I have come to accept this as the norm and deal with it by throwing myself into research and books over RPL. Don't get me wrong I think about my latest lost on a daily basis. It pains me that I'm not 15 weeks pg, that I'm not a month away from finding out if I'm carrying a girl or boy in my newly protruding baby belly. I would be close to feeling little drum like taps as my developing baby stretches his or her arms or legs. I am use to this disappointment. Should anyone be use to this?

These days I'm having difficulty facing the sea of PGR (pg related) posts on my private board. It stings, it stings a lot. There was a huge bfp (big fat positive) explosion on the board the time of my bfp. I'm finding it harder this time around to be happy for those who are due in the fall. As October approaches I'm sure it won't get any easier. It's funny how different I am reacting this time around. It has definitely flip flopped. I don't find myself being bitter as women walk by with big baby bellies. I actually find myself smiling at them and yearning to be pregnant once again with a healthy baby. Prior to Landon I was not happy for these people that I didn't "know". These people who were naive to the fact that 1 in 4 pg end in m/c. I never went through a pg not worrying, I have no concept of this feeling--it was stolen a week after I found out I was pregnant the first time.

Now I know what pregnancy feels like. I can appreciate being a mother to a happy & healthy little boy. I'm not that girl any more who just yearned to be pregnant to experience the joys (as well as the uncomfortable times). And because I know this; I know how easy it is to get caught in the joy of pregnancy and forget. I know my sisters have been through the same tragedy of m/c but only a hand full have gone through RPL. In fact, only 5% will go on to have a 2nd consecutive miscarriage and 1% will have 3 or more consecutive miscarriages. I can't say ever forgot the pain that my m/c caused but the joy of pregnancy triumphs that pain and pushes the devastating memories far away as you reach new milestones. Week by week that fear dissipates and turns into appreciation, love and joy.

SIRM

I recently found the Sher Institute for Reproductive Medicine also known as SIRM. I first came across SIRM after my 2nd m/c. I read a book named "Is Your Body Baby Friendly?" that mentioned SIRM briefly. I never further investigated them at the time. Shortly there after I became pg for the 3rd time and then for the 4th time.

A dear "sister" of mine kindly returned some books that she had borrowed from me, right before my 4th m/c. Little did I know that I would yet again turn to "Is Your Body Baby Friendly?". It was one of my favorite m/c books that I've read. It explores all medical avenues. Now I do have to worn that it can be a bit over the top especially if you do not have any medical knowledge. I remember reading it the first time and skipping over parts because I had a hard time following it and I'm in the medical field. With that being said, it provides excellent material. The author, Dr. Beer was certainly ahead of his time in his field.

Anyways, my "sister" Amy and I met on a public chat board and later we became part of a private chat board. I believe I talked about her and shared her blog in a previous entry. I call her my "sister" because we are part of a family and consider all of the 150 posters on there to be my sisters. This has become a huge support system in my life. These women have helped me to grieve, listened to me when I needed an ear, reassured me that my feelings were/are normal, swapped information, talked about IRL (in real life) issues other then pregnancy loss and so forth. They have allowed me to vent and most importantly they understood me when the closest people (DH, family, co-workers) to me could not.

Getting back on track...I'm not quite sure how it came about. I don't think I really realized at the time Amy was going to SIRM. I recall asking her questions about what she thought of the books, etc and then she shared her story about going to SIRM. Shortly after I started investigating SIRM myself and what they were all about. I decided that this was something I wanted to pursue.

I filled out a Request a Consultation with a SIRM Physician. I also filled out a Patient Questionnaire. The very next day I got a call from SIRM and scheduled a FREE phone consultation with Dr. Corley. I faxed over my questionnaire and records. I couldn't believe how quick they were able to get me in and accommodate me.

I had my appt with Dr. Corley on April 21. The appt lasted about 45 minutes and was a little overwhelming with all the information he had given me. The nice thing is the next day he emailed me and reiterated all the information that he had covered the day before. He was very nice and the things that stick out in my mind is he was just as unhappy with the lack testing that my RE & Ob have performed (including NOT testing the tissue from my last D&E). He almost sounded shocked that no one has followed up with very simple blood tests.

In 2008, my RE, Dr. Dodson ordered some Coagulation panels; Factor V Leiden, Lupus Anticoagulant & DRVV. He ordered Homocysteine levels which were inconclusive and never repeated (most likely the lab messed up and never drew my blood for this particular test). He ordered some endocine testing; HbA1c, TSH and Free T4. He also ordered some rheumatology labs; AnticardA, CardiolipIgG, CardiolipIgM & B2Microglb. We also had a chromosome analysis of DH & I. All the tests at the time came back within normal limits, WNL.

Dr. Corley has ordered the following:

1) Cycle day #3 labs FSH, LH, Estradiol, TSH, T4, Antithyroid antibodies, Prolactin, (Fasting) Glucose and Insulin.

2) Immune testing APA and NKa. If Nka is positive we will check DQalpha when you are pregnant.

3) The rest of the Thrombophilia labs: Antithrombin III, Protein C &C activity, MTHFR, Homocysteine, Factor II.

After my quick trip to Holland recently, I came back and was able to complete most of the labs except the cycle day #3 FSH, LH, Estradiol & I did not have the immune testing done yet.

The immune testing, I have to call MILabs tomorrow and they should send me a kit. The kit will include everything I need including the tubes. All I have to do is find a phlebotomist and then fed-ex over night to MILabs, located in Chicago. These two tests will most likely be out of pocket (OOP) expenses (around $400 to be exact) because most insurance companies consider these "experimental tests". :::flicking off insurance company::: :-D What do you guys know anyway?! ;-)These immune tests are only performed at special laboratories across the US.

We also have a new issue. I am taking a new job for a few different reasons that I won't bore you with. Less then a month ago I found out at my current job that we would be going to a new insurance plan and have a family deductible of $4k. Did I stutter?! Yes I said...$4000! So this is one of the reasons I wanted to find a new job. We don't have the option of taking Mike's insurance because its over $1k OOP and $5k deductible. :::choke me::: So I took a new job and my insurance will not kick in until after 90 days. So cobra we go to. :::sigh::: But I will only have a $500 deductible with the new insurance plane. Remember there are many reasons I took this new job but it just throws a monkey wrench into the whole thing and puts many things on hold, including TTC any time soon.

So overall I am very pleased with where things are going except for the new monkey wrench. I have an appt schedule with Center for Women's Health, June 28th. I'm looking forward to hearing from Dr. Corley soon regarding my labs. Hopefully we will get some answers.

What is NaPro?

I have to say I've been very hopeful about the two avenues that I've researched, NaPro & SIRM. I'm only going to talk about NaPro today.

"NaProTECHNOLOGY works cooperatively with the procreative and gynecologic systems. When these systems function abnormally, NaProTECHNOLOGY identifies the problems and cooperates with the menstrual and fertility cycles that correct the condition, maintain the human ecology, and sustain the procreative potential.."

To me? Its natural family planning and charting based soley on cervical mucous (CM). So you can use it to avoid pregnancy or achieve a pregnancy. Another great website to visit is Pope Paul VI to learn more about FertilityCare & NaPro.

So I signed up for a group session (for free) at Holy Spirit Hospital in Camp Hill, PA. Mike and I went Tuesday evening. The session was put on by Erin, a CRNP from a local Ob/Gyn office, Center for Women's Health. It turned out to be informative for the average Joe who doesn't know a whole lot about charting, getting pregnant, CM, etc. A lot of it was reviewed in our natural family planning class before we got married. However, what I did really really like about the session was we got to ask Erin individual questions at the end and in private. She was super helpful. She listened to my story and said she could understand how frustrated I must be that no one is listening to me. :::DING DING DING::: WE GOT A WINNER!!! She told me that their practice would be willing to work with SIRM and try to get to the bottom of this, unlike my current RE & Ob/Gyn. Needless to say, my current Ob/Gyn & RE have been fired! She also told me that she really thinks the NaPro could help me figure things out and if not that SIRM would be very thourogh.

So I'm charting now based on my CM which should be fun since I always have a discharge. I know already that my luteal phase (LP) is shorter then average but I've never put it down on paper. I've already made an appt but unfortantly they will not see me until after 2 months of charting which is frustrating as well.

So at least, I have hopefully found a new Ob/Gyn. Check one. Complete.