An infertile's soapbox

So ex lax-1 adult dose yesterday and another this am finally got through my sons resistance to letting it all hang out so to speak. I have never been so thrilled to change a HUGE poop diaper in my life.

The relief this brings is amazing.

So I have a teeny bit of energy to get on my soap box about infertility treatment and talk passionately about my experience.

Taking my own personal experience, the experience of many bloggers I have read, many women on message boards and forums, and friends dealing with infertility, I have formed the opinion that many gyn Dr.'s are pretty reserved about pulling out all the stops, or about researching or trying new things when it comes to fertility.

My obgyn looked at my ultrasound only-didn't ask for me to get more bw. Didn't seem to think there was any info to be learned by hormone levels. The obgyn office is so kind and caring. I know they want the best for me, but I walked out of there with a we have to wait and see recommendation.

For the first 4 years of this 6 year fertility journey I gained strength, determination, knowledge courage to be a pain in the ass fighter to have questions answered and even challenged treatments prescribed by Dr. dipshit that I saw at the beginning of my journey(I was also right most of the time :). But something happened this past year or so. Probably having a baby (blessing) to take care of just leaves me with less energy, but more so, I am just worn out from all the effort.

After getting my second beta level a couple of weeks ago, I asked Dr. Miracle's office if I could wait a bit to have an ultrasound. And then I skipped getting bw drawn. Just because I fell into thinking some of what Dr. Miracle prescribes is overkill, and I wanted to try to get through this with as little fuss as possible.

Then I got a call from Dr. Miracles office with my blood results yesterday. I heard the confusion in the nurses voice. With all the meds I was "taking" the progesterone and estrogen levels didn't make sense. Little did she know one of her most determined patients had lost hope and had been skipping doses here and there.

So this am I spoke to her and called the clinic that did the u/s for exact measurements. Did some research while waiting for the nurse at Dr. Miracles office to consult with Dr. Miracle and get back to me.

When I had the consult with him a few weeks ago he had told me he had set up a study on giving estrace to patients with lower levels of estrogen. He believes it can help reduce the rate of miscarriages. My estrogen fell from the first blood test to the second. I was put on estrace. I then skipped getting a blood test for a bit over a week. During my search yesterday I found the following study:

T. Ohtsuka1, M. Taga1, T. Suzuki1 and H. Minaguchi1
(1)
Department of Obstetrics and Gynecology, Yokohoma City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236 Yokohama, Japan
Received: 2 June 1993 Accepted: 22 June 1994
Abstract In 152 patients with an early pregnancy which was subsequently normal, we measured the maternal serum levels of estradiol (E2), progesterone (P4) and prolactin (PRL) as well as the diameter of gestational sac (GS) and the crown-rump length (CRL) of the embryo by transvaginal ultrasonography. The maternal serum level of E2 had the closest statistically significant correlation with both the GS diameter (r = 0.769,P < r =" 0.736,">


Then I found the following study which will make more sense knowing that the crl yesterday was 4.8mm and the gestational sac was 8.5mm-that makes a difference of 3.7mm

Relationship of Small Gestational Sac-Crown- Rump Length Differences to Abortion and Abortus Karyotypes
RICHARD P. DICKEY, MD, PhD, TERRY T. OLAR, PhD, STEVEN N. TAYLOR, MD, DAVID N. CUROLE, MD and ELLEN M. MATULICH, RT, RDMS From The Fertility Institute of New Orleans and the Department of Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans, Louisiana
Abstract
We retrospectively reviewed ultrasound findings in 539 infertility patients to evaluate the incidence of small gestational sac syndrome and its association with abortion, karyotype of the abortus, and known abortion factors. Small gestational sac syndrome (gestational sac diameter minus crown-rump length less than 5 mm) occurred in 1.9% of pregnancies scanned with vaginal ultrasound 37-65 days after the first day of the last menstrual period. The rate of fetal death was 80.0% when the gestational sac diametercrown- rump length difference was less than 5 mm, 26.5% when the difference was 5-7.9 mm (P<.002 compared with less than 5 mm), and 10.6% when the difference was 8 mm or more (P<.0001 compared with less than 5 mm). Karyotypes were normal in all eight fetuses when the gestational sac diameter-crown-rump length difference was less than 5 mm (P<.03). Small gestational sac syndrome was present before fetal death in 10.7% of all cases, and in 24% in which the karyotype was normal. Of the factors analyzed— maternal age, previous abortions, low hCG or progesterone levels, and use of ovulation induction medications—only maternal age was significantly different (P=.011) in patients with small sac syndrome. We conclude that small gestational sac syndrome is an infrequent but important complication of early pregnancy, which occurs more often in karyotypically normal than in abnormal fetuses.

What kills me is that most of the pregnancies from this study that miscarried with <5mm difference were normal genetically.

I have been so worried about my balanced translocation causing a miscarriage, I never thought that again (my last loss due to anencephaly had nothing to do with the bt)-I would be facing a situation not related to my bt.

So Dr. Miracle called in a script for an antibiotic asap. There is a reason that he thinks it can possibly help the gestational sac catch up.

The idea that there may be a healthy genetic baby with a little strong heartbeat, stuck in a too small gestational sac-and may die because of it. Hurts really really bad.

So what will being on extra estrace, progesterone and an antibiotic do to harm me? What if it saves this baby?

My sweet obgyn sent me off to wait, with a recommendation to stop the progesterone shots since I was also on day and night progesterone suppositories. My question is why didn't he (or the avg gyn research and try things that may help, and very likely not hurt?

I am a biologist. I know that we look for large studies. But is that a good enough reason? Just because there aren't 10,000+ people in the study? Is it because it hasn't been studied 100's of times. Why not take a chance-step out on a limb-try the slightly unexplainable, think critically? Why not try everything posssible to try and save a baby?

I really do adore my obgyn. I know he cares. But I highly admire, respect and love Dr. Miracle ,because he takes chances-he pulls out all the stops. He does anything and everything logical to try and help you make a healthy baby. Every single woman with anything but a text book IF diagnosis should find a Dr. Miracle of their own. Heck-jump on a plane or in the car and go see mine in NJ. He will fight for that baby you want. I am so confident I will promise you that he will.