misc.kids FAQ on Miscarriage, Part 3/3
broo...@mc.duke.edu
Posting-Frequency: monthly
Misc.kids Frequently Asked Questions
Miscarriage
Part 3 of 3
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Molar Pregnancies
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This is what I know, for starters:
Most miscarriages are of the types "fetal demise" (where the fetus dies) or
"blighted ovum" (an egg is fertilized, and a placenta starts growing, but
the fetus fails to grow, so there is only a placenta and an amniotic sac).
Much rarer are molar pregnancies, which are a type of blighted ovum where
an abnormal spongy mass grows on the placenta. Partial moles much rarer
than full moles.
When a molar pregnancy has been diagnosed (the tissue extracted during the
D&C is sent to a pathology lab), the first course of action is to make sure
all the growth has been removed. This is done by doing weekly, then monthly
pregnancy blood tests. This is cruel test to do to a woman who is dealing
with the aftermath of a miscarriage (personal opinion). Three negative
weeks in a row means going to monthly tests. Three negative months is a row
means the patient is "cured". If the test do not go to negative, this
indicates that the growth mastesised (spelling?) and that there is tissue
growing elsewhere in the body. According to my doctor, the usual course of
treatment is then chemotherapy. It is therefore imperative that the patient
not become pregnant again until declared "cured" (since obviously a
subsequent pregnancy would make it impossible to determine if there was any
other growth). It is usually recommended that you wait at least a year
before attempting another pregnancy.
I am hoping that someone out there has gone on to have a successful
pregnancy after a molar pregnancy, since I could use some encourage- ment
when we get around to trying again.
Thanks for your sympathy. As many people are aware, a miscarriage is
certainly a painful loss. Dealing with a non-viable pregnancy is hard, too
(I often felt like I had no right to cry over a baby that never was).
Dealing with the additional issue of whether chemo will become necessary
while dealing with the other parts is hard, too. Especially when a lab
technician just knows you need a pregnancy test and starts making small
talk on the assumtion that you are hoping for a positive.
Later Addendum:
Since the time that i wrote the original letter to Tracy, i have completed
a successful pregnancy (and she'll be 2 on Sunday!) So, I really don't need
encouragement at this point, but if anyone reading the FAQ has had a molar
preg. and would like to correspond, I would be glad to be the moral support
end of an exchange.
Maureen Busch m...@world.std.com
Mom to Jody(7/27/86), Sean(11/1/88), and Rachel(8/6/93)
misc.kidding since '87; '95 PA pg 25, '94 PA pg 18, also in '93 PA
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How Long to Wait Before Trying Again
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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...
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Other Resources
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The three best books I had were "The Well Pregnancy Book," "A midwifes
Guide to Pregnancy and Childbirth," and "Preventing Miscarriage: the Good
News."
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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 their "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.
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Add to your list of books
``Coping with Miscarriage''
Unfortunately, I don't have the author's name, and it was a library book,
but I found it very reassuring after my miscarriage.
Lynn l...@ai.mit.edu
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The best book I found on pregnancy loss was "Ended Beginnings". There are 2
authors, one of which is Cathy Romeo, the other I can't remember now. It
was stronger in terms of positive possabilities for emothional healing than
other books I read.
Jan Stetson mailto:jste...@bbn.com
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I have a book on preventing miscarriage that tells stories of women who had
up to 8 miscarriages before giving birth to healthy babies. In case you
care, the name of the book is "Preventing Miscarriage: the Good News." It
details all sorts of things. One thing the book mentioned that I had never
thought of was that sometimes the same problems that make it hard for a
couple to conceive also make it hard for the mother to carry to term. I
found it interesting reading, but sometimes the words that were meant to be
encouraging did not encourage me.
broo...@mc.duke.edu
Posting-Frequency: monthly
Misc.kids Frequently Asked Questions
Miscarriage
Part 2 of 3
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Causes and Technical Information (cont.)
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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 Hill, 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. Hill 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 Hill
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 Hill 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. Hill, 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. Hill
said that has recently been debunked. This theory was promoted by a doctor
in Philadelphia.
Another thing - Dr. Hill 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!
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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. Hill, 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. Hill 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.
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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.
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Dreams and Realities
by Nancy P. Hemenway
Reflecting back on a hot morning in early August, I distinctly remember the
eager anticipation of the long awaited culmination of my hopes and dreams
in my marriage to David. I was 38 and I had kissed a lot of frogs before my
prince came along. Hearing the loud ticking of the biological clock was
enough to throw caution to wind (along with our birth control) a whole 2
months into our marriage! My only concern at this point was that I might
get pregnant too fast and our "honeymoon" would be cut short! When nothing
happened the first year I became concerned but realizing we were both
healthy, active individuals, I pushed that thought as far away as possible
attributing it to works schedules and bad timing. Another two birthdays and
no pregnancy.
Then in July while on vacation in Florida I realized my period was late.
David and I rushed to a local drug store for our first of many home
pregnancy tests. Postive! ! I couldn't believe it! We were finally going to
have a baby. Unfortuanately, we were both a little naive and innocent about
pregnancy. At about 7 weeks I started spotting so we rushed to the Dr. and
had an ultrasound. The results were alright and everything looked fine. He
told us 20% of pregnant woman bleed. The spotting continued and the
cramping began. The next sono revealed a problem with the sac and the
doctor told us I was "threatening a miscarriage". My heart was in my knees
but I managed to pull myself together and push these negative thoughts out
of my head. At almost 10 weeks we had another ultrasound. The doctor told
us the baby was growing again and the sac looked ok. We lost the baby the
next day in the hospital emergency room. Having come from a background in
nursing, I asked for genetic testing of the fetus. I was told because it
was only my first pregnancy they would not do this. I also believe they
attributed the loss to my age (41). The genetic testing I never had could
have been a major diagnostic link with the problems we have now been
diagnosed as having.
Several months after my first miscarriage I referred myself to a
reproductive endocrinologist who tested both of us for every disease know
to man (and woman). Over the next two years, we went through ovulation
induction with all the drugs, had numerous IUI's (intrauterine
insemination) and finally three cycles of IVF. We were again, overjoyed,
when I got pregnant on the second cycle. This pregnancy ended at about 6
weeks.
The Quest For a Diagnosis
Through all the testing I never had a diagnosis. The doctors never found
anything wrong with either my husband or me. "Unexplained Infertility",
that's what they call us. We're healthy, active people, "the perfect
couple" except we can't do what 90% of the rest of the couples can do. I am
not the kind of person to settle for "unexplained", so I set out on my own
personal quest to, at least, explain why I couldn't get pregnant or stay
that way once I achieved a pregnancy. I searched the internet for articles
and read everything I could on infertility. I commiserated with my
"sisterhood of infertility" on the medical support bulletin board of
Prodigy. One of the women on the bulletin board had a similar history to us
and sent me some research studies. I couldn't believe what I was reading.
Dr. Alan Beer of the Chicago Medical School in North Chicago Illinois had
been studying the immune system as it relates to reproduction for about 20
years. I read about women (just like me) in many parts of the studies. I
gathered up the information and took it to my doctor. He told me this was
rare and he didn't think I had these problems. I decided to refer myself to
Dr. Beer.
After a review of my chart, he told us we were indeed candidates for
problems in this area and ordered blood tests to be done. Not only did we
have these problems but Dr. Beer told us they were about as "bad as he
knows they can get!" My new diagnosis was : Habitual Aborter. Dr. Beer had
discovered we have three major problem areas: Blocking Factor Problem,
Antiphospholipid Antibodies, and Natural Killer Cells.
Blocking Antibodies
One out of every 200 - 300 couples who marry and start a family will share
similar tissue types to their spouse. Basically this is a white blood cell
(WBC) problem. In the WBC system symbols relate to different types of
cells. The last 4 symbols are called the DR / DQ numbers . these DR/DQ
numbers are inherited . Couples who lose every pregnancy are matched for 3
out of 4 of these number (symbols). David and I found out that we are an
"unlucky match". Our DR / DQ numbers are 1.1, 1.2, 1.3 and a 4 . There is
little more than one amino acid's difference between us. This means we are
75% alike.
As you know the WBC system is our defense against disease. Each of the
above numbers within the WBC system have little antennae which when touched
by a certain virus or bacteria sends signals to make antibodies. These
antibodies take care of any foreign interlopers (bacteria) entering the
body. The man has all the genes (in his sperm) to blueprint out the
placenta. He starts to build the placenta . This sends a message from
outside of the woman's body (from the genes within the sperm) to alert the
mother's body to prepare for a baby. The message sent from the man is
called "g". All the cells of the placenta that line up around the egg have
the genes that will be needed to construct the placenta and the message
sent is also "g". The mom and dad are now in a partnership together
building the placenta. The dad's "g" should be different from the mom's
"g". The mom is responsible for making antibodies to dad's "g". This will
provide a camoflage for the baby making it a sort of "wolf in sheep's
clothing". The "g" of the husband acts liks a fertilizer, a growth molecule
telling the placenta to grow and divide. When a couple is similar (as we
are) there are too few antibodies to "cloak" the fetus. The placenta
doesn't grow and divide like it should, beta tests don't double,
ultrasounds may be "up and down" , the sac may disappear and the pregnancy
is pretty much doomed.
There is hope for this problem. Dr. Beer extracts the WBC from the husband
(or a donor if the couple is too similar). The lab takes the WBCs and feeds
them wheatgerm . After a couple of hours of breakfast the cells grow and
divide. Dr. Beer theorizes at this point the "g" comes out of hiding. A
concentrated serum is made (10,000 times stronger than what would be found
in the placenta) and it is injected under the skin of the forearm (of the
wife) much like a skin test for allergies. After two lymphocyte
immuniztions (two sets of injections) the couple ought to be capable of
producing the blocking antibodies necessary to take the pregnancy to term.
Antiphospholipid Antibodies
There are consequences for every action. Pregnancy is no different. Each
time a pregnancy doesn't make it inside your body, there are conseguences.
This includes even the act of fertilizing an egg. A 20% chance exists with
each pregnancy and/or pregnancy loss that one problem make create another.
In all probability, this is why we now have the antiphospholipid antibody
problem. The phospholipids are a sort of glue necessary in every pregnancy.
They look like little snowfalkes (of fat) which have a sticky end to hold
the cells together. They fuse into other cells and act like a membrane .
Think of them like a swimming pool filter. The phospholipids filter the
nourishment from your blood and than in turn filter the baby's waste back
through the placenta which feeds the baby and produces the BHCG throughout
pregnancy.
Phosphlioids necessary in pregnancy are: cardiolipin, ethanolamine,
phosphatidic acid, glycerol and serine . In our particular case I have
developed an immunity to ethanolamine (this is the "glue" which also sticks
the sperm to the egg). Just like being immune to chicken pox and measles (I
no longer get them) I now am immune ethanolamine so I no longer get
pregnant. Ethanolamine and serine are also the "glues" which are necessary
to build the placenta, so even if I were to get pregnant I still wouldn't
be capable of building the placenta. Couples with this problem are good
candidates for multiple failures at IVF / GIFT / ZIFT cycles. Once you have
developed an immunity to one of the phospholipids there will be an attack
on the baby even in a donor cycle! This problem is 97% efficient in the end
to a pregnancy.
However the key which locks this glue in place is your own body's natural
heparin. Most people think of heparin as a blood thinner but in the case of
combating the phospholipids, heparin acts in a way to lock the glue in
place and keep the organs attached. The heparin must be taken preconception
because the cells are already functioning as they are lining up around the
egg. If there is a pregnancy 86% of the woman will become mothers. If they
wait until after a postive pregnancy test 75% will lose their babies again.
After the immunizations, treatment with heparin and baby asprin
preconception 30% of Dr. Beer's patients have been successful without the
use of ART.
Natural Killer Cells and "Unexplained Infertility"
It seems like years since we sat in Dr. Beer's office on a very cold, snowy
Chicago morning in December. The consultation lasted almost two hours and
Dr. Beer saved the "best" until last. The problem with my natural killer
cells was the "icing on the cake" and probably the most difficult thing for
me (us) to deal with. Everyone has (circulating) in their body something
called natural killer cells. They secrete a substance called TNF (tumor
necrosis factor) and lately the "powers that be" have been looking at the
body's own immune system (these NK cells) as a way to fight cancer. The
overactivity of these cells producing their TNF is deadly to a pregnancy.
Unfortunately for us, I have an overactive immune system. Remember the DR
/DQ numbers? I inherited a "4" from my father which puts me on the "Olympic
Team of Immune Responses". Unless we can get this problem under control
ther may be no way to complete a pregnancy. Treatment involves infusions of
IVIG (intravenous immunoglobulin). The drug is called Gammamune and it is
administered through an IV over a period of three days each month
(preconception). Dr. Beer arranges to have this given through a home health
care agency. the latest studies concerning this treatment are more than
encouraging. Woman who have unexplained infertility are able to conceive
with this treatment. Preliminary studies in recent clinical trials are
showing as high as 80% are able to conceive with the use of IVIG.
Light at the End of the Tunnel
Our consultation with Dr. Alan Beer although hard, was a breath of fresh
air. Dr. Beer with his impecable credentials and extensive knowledge of
immunology exudes compassion for his patients . For many of us this is our
last stop. Dr. Beer did both his residency and Genetics and a fellowship in
Obstetrics and Gynocology at the University of Pennsylvania. He is a board
certified OB/GYN who is also a joint Professor in the Department of
Obstetrics and Gynocology and Microbiology and Immunology at the Chicago
Medical School. Dr. Beer has been researching the issues associated with
the question of why a mother does not reject the newly formed child in
utero since 1970. I hope David and I will have a "Beer Baby" but whatever
happens I will forever be grateful to Dr. Alan Beer and his dedicated staff
for turning on that light at the end of the tunnel. For there truely is
hope now that didn't exsist before.
Addendum:
Dr. Beer started treating us in November of 1993. We went back to IUI and
then again to IVF. We were again successful on our FET (frozen embryo
transfer) but this time the pregnancy is well underway. At this writing I
am almost 26 weeks pregnant. We are due August 13, 1995. Our little "Beer
Baby" is indeed on the way and that light at the end of the tunnel is very
bright indeed now!
Nancy P. Hemenway inc...@mnsinc.com
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It has been my experience that the miscarriage process has not been
adequately covered by books or by doctors, especially, the emotional
distress afterwards. Besides the understandable grieving process, I think
that there is also a hormonal aspect that has caused me to experience "PMS
times 10" for a month after each miscarriage. I had never had a PMS problem
before I had the miscarriages, so I was not prepared for the emotional
rollercoaster that followed. While some of it was natural mourning, and
therefore a process that is necessary, even spiritually beneficial, to
undergo, some of it was simply distressing and non-productive. I am
starting to research literature on reducing PMS symptoms to see if it would
also reduce the post-miscarrage syndrome.
While I have not found much on herbal or vitamin recommendations for post
miscarriage there are several for the traditional PMS. The whole B complex
- especially B-6 has been shown to be useful for alleviating symptoms.
Folic acid is also recommended. Supposedly, one of the reasons for the
chocolate cravings that occur with PMS is a need for magnesium, which
should be taken with calcium. I don't even like chocolate that much but I
found myself wolfing down candy bars after each miscarriage. Herbal
treatments include: St. John's Wort for depression, Valerian for anxiety
and Dong Quai (there are numerous spellings) for disorientation.
From the readings, I gather that Valerian should only be taken before
bedtime, but the other two can be taken during the day. In fact, St.John's
Wort not only has an immediate soothing effect, but supposedly has some
enzyme-like positive effects that can only be felt after a few months of
usage. Please research these before taking there are some medications that
can't be taken with St. John's Wort, like asthma medicine. I took it during
my pregnancy, along with Skullcap, to help sleep. There is a book that
mentions these herbs called "Relief from PMS" by Pamela Patrick Novotory,
published by Dell. I hope this helps.
Deborah Pastor DAnnP...@aol.com
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Bleeding in Pregnancy
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The question came up about bleeding during pregnancy and whether or not
that indicates miscarriage. The summary of what I have to say is that I
have been told that more than half of the women who bleed during pregnancy
go on to deliver a full-term child, but pay attention and don't take it
lightly if you find yourself bleeding.
When I miscarried, I spotted for three days, lost the baby, and then
continued to bleed for another week. I read like mad before I lost the
baby, so I found all sorts of information. The three best books I had were
"The Well Pregnancy Book," "A midwifes Guide to Pregnancy and Childbirth,"
and "Preventing Miscarriage: the Good News." I also talked to about 5
doctors in the course of being given 2 ultrasounds and some phone advice in
the face of various changes. Things I learned (this is graphic):
All vaginal bleeding *OF*ANY*KIND* should immediately be reported to your
doctor. Don't wait until lunch, don't wait until morning, don't wait to
make the drive: call and report what you can to whoever is in a position to
advise you.
Heavy bleeding is more likely to indicate miscarriage than spotting, but
even women who bleed heavily do carry to term. One book said some women
shed the uterine lining that is not near the embryo's implantation site.
Bleeding accompanied by cramping or any kind of abdominal pain is more
likely to indicate miscarriage. It is also an indicator for an ectopic
pregnancy--especially if the pain is more on one side than the other.
(Ectopic pregnancies will lose you a fallopian tube if you don't catch them
*very* early.) Don't panic if you do have cramps, because digestive
distress and stretching of uterine ligaments can cause abdominal pain too.
Bright red blood is much more likely to indicate miscarriage than dark
brown blood. Anything gray or pink is a very, very bad sign, since it
usually indicates embryonic tissue or placenta. In my case, the fetal sack
itself was unmistakable and left me no room for doubt (or hope).
Bleeding that continues for three days or more is more likely to indicate
miscarriage than some spotting that stops.
Bleeding that occurs when you would have had your period is much less
worrisome than bleeding that occurs during what would have been mid-cycle.
Implantation bleeding is *very*common*, and it occurs around when your
first period would have been. Many women will have bleeding at their normal
menstrual points for up to three months.
If you have a fever, faintness, or nausea markedly worse than it has been
until you started bleeding (especially if it is accompanied by worsening
abdominal pain), you may have an ectopic pregnancy that needs emergency
treatment: don't wait to make that call--you need to receive further
instructions based on your case.
Two of my books told me that women who bleed and can get an ultrasound
should be totally reassured once they see a strong regular fetal heartbeat.
One book told me that 90% of the women who are bleeding but have a fetal
heartbeat shown with ultrasound will carry to term. You have to be careful
though, because those statistics are for abdominal probe ultrasounds, and
apparently seeing a heartbeat using the trans-vaginal probe is not so
reassuring. (I only found that last out because I lost my baby after seeing
a strong heartbeat on the ultrasound monitor.) So I guess the amended rule
is that if you are far enough along to see the heartbeat with an abdominal
probe (and you see the heartbeat), stop worrying.
The last, and most depressing thing I have to say is that if you do start
losing anything gray or pink (or anything solid), you need to save it and
give it to your doctor. What you lost can tell them if you have miscarried,
if you might need a D&C to make sure no tissue is left behind, and (in very
rare cases) clues to the cause of the miscarriage. Mostly, you will never
know what caused it, but if you are like me, you have a tremendous need to
try to find out how this happened.
In my case, the fetal sack was a good clue because it was much too small
for my stage of pregnancy. Even though I had a baby with a beating heart,
something was wrong. Two doctors suggested that even though the
cardiovascular system of my little one was showing signs of working well,
the baby was not getting enough in the way of nutrients. They suggested
that it might be an implantation problem. This is all conjecture, but even
having a plausible scenario helped me. I needed an explanation of how I
managed to violate the maxim about no longer worrying about the bleeding
once you see the heartbeat.
Tracy Larrabee larr...@cse.ucsc.edu
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Tracy, thank you for a very informative article on bleeding in pregnancy,
however, I would like to point out one thing about the statistic above. The
fact that over 50% of women who bleed during pregnancy go on to deliver a
full-term child doesn't mean (and you didn't imply this, either, but I'm
sure someone will read this this way) that if you do bleed you have a 50%
chance of miscarriage.
I am currently 24 weeks pregnant with my second child, and with both
pregnancies I bled and had cramps at the beginning. The first one was worse
and I spent three months thinking a miscarriage was imminent. I had
intermittent, heavy, bright red bleeding accompanied by sometimes severe
cramps. Fortunately, everything turned out fine, and I delivered a big
healthy baby boy. If I had read this article during those first three
months, however, I would have freaked out.
Anyway, maybe you could add a note to your FAQ article pointing out that
every pregnancy is different and that although bleeding is a signal that
you should get checked by the doctor, it doesn't necessarily mean
miscarriage is likely, or even indicate a 50% chance of miscarriage for any
particular woman.
BTW, in my case it turned out that I wasn't bleeding from the uterus after
all, but that I have what they call a "friable cervix," which means that it
has a lot of blood vessels in it that bleed easily. So despite all my
worrying, I probably wasn't in any more danger of miscarriage than in any
non-bleeding first-trimester pregnancy.
Anyway, this is just my experience.
Thanks,
Judy Drake ju...@pendragon.cna.tek.com
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I first want to preface this by telling you that I had a perfectly healthy
baby boy - 8 lbs 11 oz, 23 1/2 " long! At 7 weeks, before my first Dr.'s
visit, I had spotting of the dark brown kind. This was over the weekend, so
the Dr. told me to schedule an ultrasound on monday morning to see if
everything looked normal. The baby's heartbeat and growth all looked
perfectly normal, so he said I could continue all regular exercise. Don't
take up a new sport, but he specifically said my horseback riding was
perfectly fine, just no jumping. At 10 weeks, I tried out a friend's horse
for only 10-15 minutes, but when I got off the horse, I had floods of blood
running down my legs. I was hysterical, and my friend rushed me to the
emergency room. I assumed I had miscarried because I couldn't believe there
could be so much blood and the baby could live. They called in an
ultrasound tech, and the ultrasound showed a healthy baby with a normal
heartbeat. 10 weeks is before the placenta is completely formed, but they
guessed that I had a low lying placenta and had torn off a piece of it. I
was given strict orders for bedrest for a week, but before the week was
out, I had hemorrhaged again. This heavy bleeding continued off and on
until 14 weeks even with bedrest. For no apparent reason, I would stand up
and the floods would just start. It went away on its own. Later sonograms
confirmed that I had a small piece of placenta that had torn off. They
explained that the danger passed because as I got bigger, the placenta
moved up with my expanding uterus. At the time, all they could tell me as a
diagnosis was "threatening to miscarry". Any unexplained vaginal bleeding
during a pregnancy gets this label. I carried my pregnancy to term, but the
next time I am pregnant, I will not ride a horse regardless of what the Dr.
says!
Michelle Schott MB...@psuvm.psu.edu
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I think when you start to bleed in the first trimester, this is not good,
but not always bad. My doctor had me check the color (bright red is bad),
as well as the amount of bleeding. I was in my 8th week when I started to
spot.
My doctor told me that if bed rest doesnt slow down my bleeding they would
have me take a quanitative pregnancy test. The test showed that my HCG
level was down very low and this is why I was bleeding and if it continued
to drop that meant that I was miscarrying. I miscarried after 1 1/2 days of
bed rest. I got pregnant 4 months later and gave birth to a healthy baby
boy in May. I feel that my first pregnancy that ended in miscarraige was
not meant to be. It took some time to get over, but I did. I do think about
it, I did all through my second pregnancy, and I thank God for giving me
Zachary.
I think its important that women who are pregnant be aware of what may or
may not happen. I went into my first pregnancy thinking that every thing
would be perfect, I had no worries, then boom it happened. With my second
pregnancy I knew what could happen, so I took it one step at a time. I
didnt tell anyone until I was well into my third month. Then when I started
to show and I heard the baby's heartbeat I just sat back and enjoyed being
pregnant.
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I had spotting with both my pregnancies (one ended with a lovely girl, the
other was a miscarriage at around 6 weeks) and the only difference I could
see was that the spotting was a little heavier for the one that miscarried.
So spotting may not be a definite indicator of an impending miscarriage.
I also disagree with the doctor who said to keep on with normal activities
even with the spotting. My doctor recommended taking it easy the first
trimester (the spotting ended after that) because that's the time when you
are most likely to miscarry and a little extra care (no heavy lifting, no
athletic exercise beyond walking, etc.) would go a long way to prevent any
sad endings.
Joanne Petersen joa...@hpcc01.corp.hp.com
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