Infertility Evaluation Advice

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Hi, everybody. I passed state boards last Thursday (yay), and now that school and boards are over, I am moving on to my next endeavor, which brings me to my question.

I am familiar with the concept that women under 35 should seek medical advice after one unsuccessful year of trying to get pregnant. I'm 33. Should I seek help sooner? I have a ten-year-old son from my first marriage, and my husband of two years and I have been trying for the past fourteen months to get pregnant. We did, exactly twice, and lost both babies -- one at six weeks gestation, the other at eight. We lost our last baby officially on January 31 of this year. I do monthly BBT charting and LH surge testing, beginning on Day 10 of my cycle until a surge is detected. We time conception attempts accordingly, even in the middle of Med-Surg II (sorry if that is TMI). So far, no go.

The first pregnancy was lost when I started bleeding profusely right before a Psychiatric Nursing lecture. The second wasn't as dramatic; routine u/s revealed absent cardiac activity in a deceased embryo of 8 week size, resulting in a D&C Jan. 31.

We have a fabulous support system, none of whom have experienced the pain of pregnancy or infant loss. Many well-meaning friends and family, in attempts to say the "right" thing, bestow platitude upon platitude upon us: "It was God's way of stopping you from having a deformed/retarded/defective baby," "When it's the right time, it will happen," "Quit worrying about it and you'll have a healthy baby," "You should be happy with the one you have," etc., etc. I have heard them all.

I try to have heart, but it's tough, to say the least.

I am coming to you for compassionate, evidence-based advice: At what point timewise should our problems be investigated/evaluated? I have read many thoughtful, diverse posts from most of you, and respect the knowledge and wisdom you bring with you from your many combined years of nursing practice. Some of you may have experienced situations similar to mine. I welcome input from both angles.

Live, laugh, love,

Jenny

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I'd go ahead and have the evaluation, to see if there's any medical problems.

Plus, also take into consideration that the stress of nursing school can make your cycle out of whack, making it a little mroe difficult.

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Have you read Taking Charge of Your Fertility by Toni Weschsler? I recommend it highly, along with Garden of Fertility, by Sara Singer (I think). In any case, before you begin all the hormones and stuff, you might consider charting more than just your temps. Check your cervical mucus and position as well - this can yield very helpful information, both for you and your care provider. Make sure you're optimally healthy, too - take a good multi vitamin, get good sleep, etc. Consider meditation, and creating a positive mind/body connection. Might sound like weirdo advice, but it can help instill a sense of peace and confidence during this difficult time.

I'm sorry to hear about the insensitive comments people have made. That really hurts, I know. I can tell you that I had 2 miscarriages after my son was born. I wsa really concerned about my bodies' ability to hold onto a pregnancy. But the body is wise, too .... trust in it. It is really common to miscarry, and I'm told that docs don't really get concerned about habitual aborting until after the third miscarriage.

I am now 8 months pregnant, and can tell you that using my fertility signals (mucus mostly, and some temps) really worked. I got pregnant the first month we tried. It was really empowering. And even if you need a little extra medical intervention, just knowing where to pinpoint the problem is SO helpful!!!

Good luck to you!

Alison :balloons:

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I sympathise with you.

I would advise you to get to a reproductive endocrinologist asap. You may have something odd going on with your hormone levels that is not sustaining your pregnancies. A R.E. is much better equipped to deal with complex problems like this rather than a regular gynecologist.

Also, there was a study done about people undergoing infertility treatment. A greater percentage of those who were *prayed for* got pregnant. Get your friends and family to pray for you. I do hope you get your wish. :)

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I sympathise with you.

I would advise you to get to a reproductive endocrinologist asap. You may have something odd going on with your hormone levels that is not sustaining your pregnancies. A R.E. is much better equipped to deal with complex problems like this rather than a regular gynecologist.

Why do you think she has a hormone problem, though? Unless she was habitually miscarrying (and medically speaking, it's not until after 3 miscarriages), it's a non-issue, medically speaking. It may just be fetal anomalies as opposed to hormonal problems. (And does anyone else here HATE the term "habitual aborter" the way I do? That and "incompetent cervix". Bugs me!!!!)

One other thing my midwife gave me was wild yam cream, which is a natural form of progesterone. I rubbed it into my skin. Apparently, it can help sustain a pregnancy. (Interestingly enough, it can also help to prevent postpartum depression.) Or you can use prescription progesterone cream from the Doc.

I like the advice about prayer and pregnancy a lot! :) I know of one lady in my community (and you should never, ever know from this!) who had 10 miscarriages and then was blessed with twins. Imagine ....

Among Orthodox Jews, there is a tradition that in her 9th month, a woman visits the mikvah (the ritual immersion bath generally used by menstruant women after the completion of their period before resuming relations with their husbands). During her 9th month, some ladies will visit it in order to immerse and pray for a safe birth and baby. It is also a custom that ladies who have had trouble conceiving will immerse after her. If you happen to be Jewish, this might be a minhag (custom) you could check out. It's an absolutely WONDERFUL experience.

Alison

(Who's sending you lots of positive pregnancy vibes!)

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First, I'm so sorry for your losses. Big (((hugs))) to you!

I can't offer advice, but I think it wouldn't hurt to visit your OB/GYN now to discuss your concerns.

good luck to you, both in nursing (congrats on passing the boards) and in expanding your family!

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I am not saying that there are hormonal problems, but a trip to a RE would be able to rule this out faster than wasting precious months trying to figure out the problem. At this age, you need to work fast.....while the oocytes are still good.

Many gyn's who are RE's are fertility specialists. Why waste time?

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Specializes in Med-surg; OB/Well baby; pulmonology; RTS.

I think now would be a good time to see your ob/gyn for an appointment. You need to have a work-up done-bloodwork, possible HSG (to make sure there are no structural abnormalities in your uterus causing you to miscarry) and ultrasound.

I'm so sorry about your losses. I have had 2 losses (one miscarriage and one neonatal death) and it just amazes me the things people say....sometimes they do try to help, but others can be downright cruel. If people would just think for a moment before they spoke to someone who has had a loss, try to put themselves in our shoes....the world might be a better place. :stone

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Specializes in NICU.

(((HUGS))) for you Jenny. Sorry I don't have any good advice to give you, I have no children, but I want to wish you all the best .... I'm sending good thoughts and prayers your way :)

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I am not saying that there are hormonal problems, but a trip to a RE would be able to rule this out faster than wasting precious months trying to figure out the problem. At this age, you need to work fast.....while the oocytes are still good.

Many gyn's who are RE's are fertility specialists. Why waste time?

Having gone through miscarriages myself, my experience with my OB-GYN was that they wouldn't run any lab work or other tests until after 3 miscarriages. He said that this was the standard of care among OB's and RE's, although practice may have changed since my last miss in 2002. Two is considered within "normal" range. (Though something so painful and heartwrenching should hardly be considered normal!)

Just another $0.02! :)

Alison :balloons:

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
I think now would be a good time to see your ob/gyn for an appointment. You need to have a work-up done-bloodwork, possible HSG (to make sure there are no structural abnormalities in your uterus causing you to miscarry) and ultrasound.

I'm so sorry about your losses. I have had 2 losses (one miscarriage and one neonatal death) and it just amazes me the things people say....sometimes they do try to help, but others can be downright cruel. If people would just think for a moment before they spoke to someone who has had a loss, try to put themselves in our shoes....the world might be a better place. :stone

I like this advice. You ARE 35, so don't wait too long to be sure all is ok. The standard often is 6 months and then evaluation for infertility.

I have suffered 5 losses myself, so I know the pain there. Often, when a patient is over 35 and has miscarriages, they can do an eval to see if there was any obvious anomaly with the pregnancy; they did that for mine. None was ever found, however, and the answers eluded us. The only possibility was a lot of scarring around my uterus, causing it to tip severely. But no one knows for sure. It sure sucks not knowing "why" but sometimes we don't get the answers and have to make peace with it.

So I would say, go for a basic checkup to see all is "ok", and go from there. Over 35, there is no need to wait too long to get further evaluation ----my sister was having trouble getting pg. Turned out, she had ovarian cysts on both sides and severe cervical dysplasia. She was instructed to STOP TTC and got the LEEP to treat the dysplasia. Once cleared, they used art. insem and got pregnant after numerous tries. She is now a mom of 2, fortunately. But if she had not followed my advice to get a good evaluation (her original doctor blew off her concerns), she would be in dire straits today and probably childless.

Anyhow, not trying to scare you. But if it has been more than a 6 months since a thorough GYN checkup and workup, do that FIRST before even THINKING of TTC. You may be saving yourself lots more heartache and medical problems. Good luck and I hope you get your dream.

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I like this advice. You ARE 35, so don't wait too long to be sure all is ok. The standard often is 6 months and then evaluation for infertility.

SBE - I normally hate to contradict you, since you usually agree with me. ;)

But the OP said she was 33, didn't she? Does this make a difference to an infertility specialist?

Alison

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