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misc.kids FAQ on Miscarriage, Part 1/3

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Archive-name: misc-kids/miscarriage/part1
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See reader questions & answers on this topic! - Help others by sharing your knowledge
		    Misc.kids Frequently Asked Questions
			    Miscarriage

			    Part 1 of 3

---------------------------------------------------------------------------
Collection maintained by: Laura Brooks (http://scalos.mc.duke.edu/~brook006)

Last updated: March 16, 1997
---------------------------------------------------------------------------

                              A Little History

In the spring of 1994, I had my second miscarriage in a row. Anxious to
learn more, I posted a message to misc.kids, asking for information and
moral support. I got a lot of both, along with the suggestion that I look
at this FAQ.

After awhile I consolidated the mail I had received into a large addition
to the FAQ, and the woman maintaining it at the time asked me if I would
consider taking it over, so I did. I added my changes and made it available
over the WWW (http://wdg.mc.duke.edu/~brook006/miscarriage.html). Since then 
I've occasionally made revisions to the Web version, but not as frequently 
as I'd like.

I have recently made an attempt at reorganizing the FAQ, by breaking it
into sections. One section has words of support, one has technical
information, and there are also smaller sections dealing with bleeding,
molar pregnancies, and how long to wait before trying again. By far,
though, the largest section is made of personal stories, sent in by other
readers of the FAQ. This brings me to a dilemma. Every story is different,
and each deserves to be told. Reading other peoples' stories, I know, is
one thing that helped me to not feel so alone when I was going through my
own miscarriages.

However, the FAQ file has grown so large that it could only be posted to
the Usenet in 7 or 8 pieces. Furthermore, it continues to grow, and change,
and I don't want to have to limit that growth. Therefore, I have decided to
break out the personal stories into their own file. You may access this
file at: http://wdg.mc.duke.edu/~brook006/stories.html, or send mail 
to me at: brook006@mc.duke.edu and I will send it to you.

Occasionally people send me mail asking for advice or with specific
questions. This is OK, but the only information I'm qualified to give is 
an account of my own experience, and a little moral and emotional support. 
I don't have any medical training or special "insider info". I'm just someone 
who's been there, twice, and lived to tell about it. 

I'm also happy to report that my third pregnancy was successful, and our 
daughter Sarah was born in March of 1995.  As a result, I'm a lot busier 
now than I used to be, and wouldn't mind passing the maintenace of this 
FAQ on to someone new.  If you are interested, please e-mail me at 
brook006@mc.duke.edu.  Thanks a lot...

                             How to Contribute

If you have information not covered in this FAQ that you feel could be of
use to others, please send e-mail to me at brook006@mc.duke.edu, and ask me 
to add your comments to the FAQ file.  Unless otherwise requested, your name 
and e-mail address will remain in the file, so that interested readers may 
follow-up directly for more information/discussion.  To contribute your story, 
see the instructions in the personal stories file (http://scalos.mc.duke.edu/~brook006/stories.html).

                              Other Resources

There are some very good other resources on the net, which may be able to
provide you with more specific data, or interactive support.

   * The Miscarriage Support & Information Resources page 
	(http://www.pinelandpress.com/support/miscarriage.html)
   * The Recurrent Pregnancy Loss Testing page
	(http://www.pinelandpress.com/support/rpl.html)
   * The SPALS mailing list (Subsequent Pregnancy After Loss)
	(http://www.inforamp.net/~bfo/spals.html)
   * The SANDS Home Page Stillbirth and Neonatal Death Support (Western Australia)
	(http://hedgehog.highway1.com.au/~lawtbm/sandshome.html)
   * The Growth House Miscarriage page 
	(http://www.growthhouse.org/natal.html)
   * The Grief, Loss & Recovery page 
	(http://pages.prodigy.com/gifts/grief.htm)
   * The Usenet group soc.support.pregnancy.loss
   * The Usenet group misc.kids.pregnancy


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A Rough Table of Contents

   * Words of Support
   * Causes and Technical Info
   * Bleeding During Pregnancy
   * Molar Pregnancy
   * How Long to Wait Before Trying Again
   * Other Resources

---------------------------------------------------------------------------
Words of Support
---------------------------------------------------------------------------

                            Just Those Few Weeks

                            For those few weeks-
                            I had you to myself.
                      And that seems too short of time
                        To be changed so profoundly.

                            In those few weeks-
                           I came to know you...
                              And to love you.
                    You came to trust me with your life.
                   Oh, what a life I had planned for you!

                           Just those few weeks-
                              When I lost you,
                        I lost a lifetime of hopes,
                     plans, dreams, and aspirations...
              A slice of my future simply vanished overnight.

                           Just those few weeks-
                  It wasn't enough time to convince others
                    How special and important you were.
              How odd, a truly unique person has recently died
                    And no one is mourning the passing.

                           Just a mere few weeks-
                 And no "normal" person would cry all night
                       Over a tiny, unfinished baby,
            Or get depressed and withdraw day after endless day.
                         No one would, so why am I?

                You were just those few weeks my little one
               You darted in and out of my life too quickly.
                But it seems that's all the time you needed
                      To make my life so much richer-
                  And give me a small glimpse of eternity.

By Susan Erlin
---------------------------------------------------------------------------
My friend gave me the most valuable perspective on miscarriage and I would
like to share it with those who could use it most. Most people believe that
when they miscarry they lose out on ever knowing "that child." My mother,
who miscarried before having me, always told me that I wouldn't be here if
she had not lost her first. My friend feels differently. She says that the
souls of children find their way to the right parents, and that miscarriage
occurs when the soul of the child was not ready, for some reason, to enter,
or renter, the world. When a healthy baby finally arrives, it is the same
spirit as the one that was lost, finally ready to join its family. I know
it is unorthodox, but it helped me tremendously after my miscarriage. I
just wish our child would do what it has to to get ready! Good luck to all
of you.
---------------------------------------------------------------------------
I was very sorry to hear that you have lost your baby. I can't imagine what
it must be like for you and your husband. You had a little being that was
growing closer than anything had ever been to you before, and now you mourn
because it is no longer there. You will probably be blessed with another
child in the future. It will not be the same as this first one that you
have lost; no other child will be the same. Time and the closeness you have
with your husband will probably help to reduce the hurt. I'm sorry.
---------------------------------------------------------------------------
I know the combination of pregnancy and miscarriage and finally my daughter
has changed me, deepened me, more than I ever thought possible. I can't say
that I'm glad that I lost a child, but I can say that I believe that people
who experience life intensely, both the good and the bad, are luckier than
those who just drift through. And in that sense we women are lucky, far
luckier than men. Men will grieve, and will sorrow, but it's not the same.

When I had my miscarriage I think I was most worried about whether there
was something "wrong", about whether I would ever be able to carry a child
to term. I thought about the IUD I had in for my wilder years. I thought
about the years I was too serious about swimming and didn't have periods. I
thought about the stretch where I was too thin. I thought about everything
I'd ever done that was less than healthy. I suppose the bottom line was
that I haven't failed at many things in my life and I didn't like it very
much. But then along came my daughter and the misery drifted away, with
only a little bruise to show for it. And for some reason I wasn't worried
at all during the second pregnancy. I guess the statistics about
miscarriages and first babies really don't lie.

But in some sick way, it has all helped. When my brother's baby died this
year, I knew what to do. And that ability to empathize, to experience all
the ups and downs, is what life is all about. Really and truly.
---------------------------------------------------------------------------
People say the strangest things when they are trying to comfort me. I
suppose you got that too. Why would people tell me it is for the best? How
can this possibly help me? Why would they go out of their way to say it
isn't so bad for me since I hadn't been pregnant a long time? I know I will
get better; I hope I will get pregnant again soon, but I think these things
are for me to say, not for them. I know they are trying to be nice, but I
don't care if my baby wasn't viable: it hurts just as much either way. I
don't care to have my pain minimized or swept away.

Someone helped me yesterday: I talked to a wonderful doctor right after I
lost the baby (she just happened to be on call). I told her it was quite
ironic, but though I had never met her, I was scheduled to talk with her on
Tuesday because I was interviewing doctors for OB care. She told me to come
on in anyway, even though I lost the baby. I did. She was great. She spent
half the time talking to me about this loss, and half the time telling me
about her philosophy of labor and delivery and preparation for birth. After
I left, I realized that she got me back to concentrating on the future in a
very gentle but practical way. She told me I would probably be nervous and
antsy when I first get pregnant again and she encouraged me to come in
early just to get confirmation and a feeling that someone knew I was
nervous and was going to watch me and be aware of my concerns.

Don't get me wrong: I am not saying this woman magically fixed everything,
but she did help some. I still cried last night, but I feel positive
potential in my future. I worry. I will worry. But I hope too.
---------------------------------------------------------------------------
I talked a lot to my sister-in-law when I had my miscarriage. She kept
telling me the same thing over and over:

"Remember, it's nothing you did. If lifting heavy things could cause a
miscarriage then there would be an epidemic of 14-year-old female
weightlifters in New York City."

It's true. If there were anything at all that could cause a miscarriage,
desperate people would have found it. And if any sort of bad health habits
could set you up for this kind of thing, then the birth rate in inner
cities wouldn't be so astronomical. Your body's fine, and you'll be
pregnant again before you know it.
---------------------------------------------------------------------------
Just thought I'd let you know that my sister-in-law had two miscarriages in
a row, and did the same as you, had the fetal tissue tested. For her, it
was also the trisomy-16 problem. The doctors told her the same thing your
doctors told you. Her third pregnancy was just fine (yea!), and she now has
a 9-month old daughter.

Hope this makes you feel a little better!

(it DID!!!)
---------------------------------------------------------------------------
I don't know if this will help you or not, but something you may want to
add to the list.

I have had several family members and friends who have had problems with
pregnancies. One thing that seems to be common is that when a child was
lost (still born, cord accidents, etc.), the woman had a miscarriage less
than a year later. In some ways, I've always wondered if it was a way of
her body just "making sure" since all these women went on to have a healthy
child about a year later.

It is hard and tragic to lose 2 children in under a year. Support groups
and counseling have been what kept some of my friends & family going. The
things that were most valuable to them were: a) take time to grieve. You
lost a child. It doesn't matter if it was born or not, YOU STILL LOST A
CHILD. b) Remember life goes on. If the doctor says there are no problems,
wait and try again. Almost everyone who has had a miscarriage hears from
women who had one (or more) or knows someone else who had one. An example I
use a lot in comforting friends is my mom. There are 6 kids in my family.
In 1946 (or 47) my mom had a tubular pregnancy and lost her right fallopian
tubes. The doctor told her she'd be lucky if she ever got pregnant again.
Eight pregnancies later (6 kids, 2 miscarriages), she asked the doctor to
put her on the pill since she felt she was "too old to deal with baby
shit." ;) When my youngest sister was born, they brought a bunch of med
students/interns in to marvel at the two of them.

In my family alone was my mom & her problems. My brother Steve & his wife
had a blue baby who died the day after he was born. Mari miscarried 6
months later. They adopted a boy and she gave birth to their second son 1
year to the day after Adam came home with them. They currently have 4 kids
ranging from 5 to 13. My brother Gerry's wife miscarried and later had a
wonderful and healthy boy (Nicky the human noodle). I contracted rubella in
the first trimester of my pregnancy and lost that baby. I now have a
healthy 2 year old and I am due in February. My husband's sister miscarried
3 times before they had their first son. They currently have 3 kids (ages 2
to 6) who are healthy and normal.

One of my good friends describes herself as "not built for pregnancy." She
had several miscarriages and had to have an abortion once when the fetus
was literally killing her. Her pregnancy with her daughter left her
hospitalized several times in her first trimester, but her daughter is a
thriving 3 year old now. Last year, she gave birth to her son and had a
hysterectemy immediately after. She claimed it was an easy pregnancy since
she was only hospitalized once before her due date.

My best friend from college lost her first son. He died as the result of
massive birth defects 2 weeks after he was born. She miscarried 9 months
later and a year after that had a beautiful baby girl.

I could go on, but I won't. I just want to pass on examples of
encouragement. I hope they are useful. They seem to have been for some
friends. ("Please tell me you know someone who survived this and has
children," tends to be the biggest request from them.) One thing that helps
too (at least with my friends) is breaking things. Buy a bunch of "yard
sale china" and smash it. Take out your anger and frustration on something
like that instead of your husband & family.

MOST IMPORTANT: The man is grieving too. Many people make sure the woman is
fine and forget about the man. My brother Gerry said the best thing that
happened to him was receiving flowers from me to him. Everyone seemed to
have left him "outside" when it came to comforting. I remembered how much
he helped me when I lost my first and wanted to do something for him. When
one of my friends had an ectopic pregnancy recently, I sent her husband a
plastic fish full of goodies. She said it made a big difference to him.

Men grieve too. While the wife goes through medical and emotional trauma,
the man feels the sense of loss and helplessness as well. Make sure they
don't get ignored.

karla Shapiro karla@shiva.com
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I too had three miscarriages in a row. May 93 (12 weeks LMP), December 93
(10 weeks LMP) and March 94 (10 weeks LMP). Now I have a 15 month old. I
had the 4 standard tests as well in the spring of 93. I have no advice,
just some reassurance that for me, and lots of people I think, the problem
resolved its self. I remember how horrible it was to try not to have your
hopes up and try not to analyse every symptom or missing symptom. And I
hated it when people told me to relax. But what I can say is that the
pregnancy that resulted in my daughter was totally unplanned (we were
taking a break for the workup and moving to another city/job etc) and I
didn't worry about it at all because I didn't know until 8 weeks LMP. Good
Luck!

---------------------------------------------------------------------------
Causes and Technical Information
---------------------------------------------------------------------------

**The following is from an actual M.D. on the net, but he did not give
permission to use his name**:

First let me express my condolences at your loss. It makes no difference
what the gestational age is, there is still the loss of a pregnancy, and
this will result in grief and the need to work that through. Trying to find
out 'why' is part of the grief work.

Let me reassure you that your experience is VERY common. I see similar
cases every month in my practice. The problem is that experience with the
vaginal probe ultrasound is very limited, and to extrapolate the presence
of fetal cardiac activity on vaginal probe ultrasound to previous
reassuring statistics about discenment of cardiac activity by abdominal
ultrasound (doppler) or earlier auditory auscultation (stethescope) are not
valid. Most spontaneous abs occur prior to the 12th week, and a very short
time ago, cardiac activity was not discernable prior to the 12th week with
any degree of regularity, so the common statement was "Once we hear the
fetal heart we don't worry about miscarriage."

But now we are using a more sensitive technology and this trueism will not
hold up.

So I can only encourage you to work thru the loss of this one, and have
confidence that you will conceive again with success. And another bit of
advice is to wait at least 4 months before trying again. We have good
studies that indicate the risk of repeated SAB is much greater in the first
three months after a previous miscarriage.
---------------------------------------------------------------------------
> I would like to find out more about what the chromosomal test actually
> involves, and what they might be able to find out from it.

They will count the chromosomes to see if there is the right number (46).
They will look to see if the chromosomes are complete, with no missing
parts. They will look to see if part of one chromosome has broken off and
rejoined another chromosome. They will look for any kind of abnormality
they can find. Chromosomes in eggs and sperm are at a somewhat higher risk
for getting things screwed up because they undergo a process called
"crossing over" where, for instance, chromosome 1 from your father and
chromosome 1 from your mother may swap equivalent parts, leading to a new
combination of genes on the resultant chromosome 1's. This is good for the
species, but when things don't go quite right, it's bad for the individual
that will inherit those chromosomes. Most of the time when this happens,
the conceptus or zygote is completely incapable of normal development, and
either never implants or dies within a few days of doing so, and you never
know about it. But some limp along until some critical gene that has been
damaged is needed, and then they die in a first trimester miscarriage.
Because the chromosomes can be seen with an ordinary microscope, any large
rearrangements or duplications/omissions can be easily detected, and the
cause for the miscarriage known.

> Also I would like to talk to other people who've had tests run on
> themselves and/or their spouses. I would also like to hear from people
> who's progesterone levels were too low to support a pregnancy (my OBGYN
> doesn't think it was that but hasn't ruled it out - I keep wondering about
> it because it happened to my sister-in-law).

It would be helpful to know when your miscarriages occured. Through most of
the first trimester, progesterone is produced by the corpus luteum---the
"scar" left behind when the egg popped out of the ovary. It produces
progesterone because it detects chorionic gonadotropin (HCG) in your blood.
The HCG is produced by the part of the embryo that later becomes the
placenta---the trophoblast, in scientist-speak. For the first 10 or 11
weeks, a progesterone insufficiency would be due to either the trophoblast
not producing enough HCG, or the corpus luteum not responding with enough
progesterone. For instance, my mother miscarried all three times between 8
and 11 weeks, and never had any morning sickness with any of those
pregnancies, but she did get it when she had her four children. My personal
opinion of this is that the first 3 embryos were not producing enough HCG
to sustain the pregnancy for whatever reason, since the first trimester
nausea is often correlated with HCG levels. It's difficult to use morning
sickness as an indicator though, because women vary enormously in their
sensitivity to it. Some women can have raging levels, and have no morning
sickness, and some will still be vomiting from the low maintenance levels
in the 2nd and 3rd trimesters. Anyhow, getting back to established fact,
HCG levels in a normal pregnancy rise dramatically until about 2 months
(this does vary though), and then begins to drop off as the corpus luteum
ages and becomes incapable of producing hormones anymore. The placenta by
this time has become mature enough and large enough to produce its own
progesterone, and it ramps up production as the corpus luteum is winding
down. If these two events are not quite in sync, you can experience a
slight dip in progesterone levels, and since rising progesterone levels
(absolute level doesn't matter, it is the rate of change of levels, which
is why progesterone levels continue to rise throughout pregnancy) keep the
uterus relaxed, contractions that expel the fetus can result, just like at
birth. Rates of miscarriage decline the further along in pregnancy you get,
except that there is a slight spike right at the end of the first
trimester, when this switcheroo maneuver is underway.

> And finally, I would appreciate hearing from anyone with any information
> about women developing antibodies to their fetuses, and how common (or
> rare) this is. And basically, just anyone else who has anything to tell me
> at all that might be helpful.

It's very rare. It's not precisely known why all pregnant women don't
develop antibodies to their fetuses, since they are, after all, foreign
tissue. The theory is that the placental interaction between the cells
derived from the baby (placenta) and the mother's cells in the uterine wall
induces the fetus to produce an enzyme that damps the immune response at
the interface. Theoretically, certain "markers" are used to determine where
the immune response is supposed to be dampened, and the cells do a little
comparison between themselves and their neighbors on these markers and if
they are different, then they produce the enzyme. The difficulty (again,
theoretically) is when the father coincidentally has the same set of
markers as the mother, then the fetus' cells look just like the mother's
cells when the comparison is done, and no enzyme is produced. The mother's
immune system could care less about these markers, however, and the other
differences between mother and fetus trigger an immune reaction and
antibodies are produced. Again, this is all theory, nobody knows what the
markers are even if they exist, but what is known is that a woman who
consistently has an immune reaction against fetuses fathered by one man
will be able to carry a fetus fathered by another man (say by artificial
insemination) to term quite nicely. The man will also be quite capable of
having children with another woman.

Your practitioner probably did a blood test that included a white cell
count, and possibly other measures of immune system function. If you are
rejecting the fetuses, you may experience similar symptoms to an immune
reaction to just about anything else---a fever, feeling sick (not
necessarily nausea, but the same feelings you get whenver you're battling
the flu, a cold, or other infection---being very tired, loss of appetite or
a ravenous appetite, etc.), and the evidence of your immune system fighting
an invader may show up on your blood test. But it also may not unless it is
being explicitly looked for---if some of the theoretical enzyme is being
produced because at least one of the markers is different, then the immune
response may be weak enough not to show any symptoms, but still strong
enough to kill the fetus.

I hope this hasn't been too dry and technical for you, and I hope it's been
helpful. Myself, I cling to the example of my mother, who had so much
heartbreak and then was rewarded with four wonderful kids (if I may say so
myself :).
---------------------------------------------------------------------------
Ok, so, if we're going to try to look for an answer to why these
miscarriages occured, we'll consider the facts. On a gestational age basis,
the first embryo died somewhere around 5 weeks old (LMP is approx. 2 weeks
longer than gestational age). At this age, the embryo is about 1 centimeter
or 4 tenths of an inch long. The second embryo died at about 6 weeks old,
and is a little over half an inch long at this age. Important to note is
that the embryos died well in advance of being expelled. If there were a
hormonal problem, the embryos would have been alive and well, but the
uterus would have expelled them anyway. Usually (though not always) in
cases of the mother's immune system attacking the fetus, the placenta
suffers the most damage, because it is the part directly connected to her.
Bleeding from the damaged placenta almost always precedes such a
miscarriage. So this is unlikely to be the cause.

When the embryo just up and dies like this, it is usually because something
has gone wrong (either chromosomally or developmentally), and the embryo is
simply incapable of continuing on. It's pretty amazing that development
ever goes totally right. The first weeks are an incredibly fast and furious
process of cells dividing, migrating, bending, making seams, all having to
be highly orchestrated to happen at just the right time. If something
doesn't happen quite right, the embryo may die or be born with profound
defects later on.

However, it's quite unusual to have 2 miscarriages in a row with this
cause. There's about a 1 in 20 or 25 chance of this happening in any given
pregnancy, and to have it happen twice is like drawing a ball from each of
two bags of 25 numbered balls and having both balls be number 25. It's a
very low chance, but somebody has to be the unlucky one, I suppose.
---------------------------------------------------------------------------
[I sent eMail to someone on the net whom I knew from earlier postings to be
a geneticist, asking him about the chromosomal test - his answer:]

I am really sorry to hear about this situation with you and I hope that my
notes can expand your information base so you can ask better questions to
your doctor. To begin with, I would double-check my statements with your
doctor/genetic counselor in regards to the SPECIFICS of your INDIVIDUAL
case. When a miscarriage occurs, a cell tissue is taken for this test and
grows for a period of several days which can vary according to cell type:
blood, bone marrow, amniotic fluid. This is called "growing a culture"
which will take a number of days. For example, I am learning the procedure
this week and last Friday, I took my own blood and let it grow until
Tuesday. On tuesday, I activated the cells to grow at the same rate by
adding certain chemicals. After that I blew up the Red Blood cells and
removed the waste to leave behind only the White Blood Cells. This is done
because Reds do not contain any DNA while White do. Thursday, I will take
this purified blood sample and fix it onto a slide where I can analyze it.
By using a microscope with a computer screen, I cut apart the chromosomes
and sort them according to type. This results in creating my 'karyotype'
which I will print out & in the case of other people return this data to
their doctor.

WHAT CAN THEY TELL?

Good question. I do not know your age but most expecting mothers over 35
take this to find out if their child has Downs. This is detected by an
extra 21 chromosome in the cells fixed to the slide which reflects the
baby/patient depending on source. Other errors are able to be detected are
extra chromosomal numbers such as 69 or 92 but this is VERY unlikely and I
highly doubt this is your situation. I suspect you can not help but suspect
the worst but well..wait for the results.

In regard to why, they may test you and the father? Well, sometimes about 1
in 200 people have balanced translocated chromsomes which in simple english
means that no genetic info was lost but people have a chunk of their
chromosome 3, for example, attached to chromosome 5, for example. This
looks odd compared to others in a 'karyotype' but the cells do not care so
long as all the genes are present. If the baby has a balanced translocation
in the test, they will want to know if it was new for the baby or you have
it as well. I won't be that surprised if I have this myself so don't panic.

But most likely, their is no genetic reason for this miscarriage but a
result of other reproduction factors. I MUST STATE THAT I AM ONLY A
BIOCHEMISTRY SENIOR AND AM LEARNING THIS PRODEDURE but I hope that this
info makes you feel more informed with your situation.
---------------------------------------------------------------------------
The hardest thing is finding that there is often no one or no thing to be
blamed--it just happens and nobody knows why. Give yourself lots of time,
as recovering emotionally is not unlike recovering physically--just because
wounds are felt rather than seen doesn't mean that there hasn't been damage
that will take a while to recover from. In a real sense, this is a death,
so you may need to mourn and grieve for a while. Take lots of time with
yourself emotionally as well as physically. And, by all means, if you are
uncomfortable with your OB-GYN--you're not getting answers to your
questions, etc.--find another one immediately.

> And finally, I would appreciate hearing from anyone with any information
> about women developing antibodies to their fetuses, and how common (or
> rare) this is.

This is all very new stuff, so there isn't a whole lot of data around. As I
understand it, in order to strengthen the blocking response of the
placenta, white blood cells (a half unit) from the (prospective) father are
administered to the mother, and then they try to conceive again. While some
reports of the succes rate are as high as 70%, I don't know that the sample
is large enough yet to be significant. There are, for example, other
studies that have shown that psychological counselling was also
effective--again, the data sample is small, so it's hard to tell how
significant a result this might be.

My wife and I had the white cell stuff done in Richmond VA and we now have
an 18 month old son. Clearly, *something* worked--even though we didn't
have the full course of treatment that the Richmond people wanted. But now,
we're having troubles even conceiving again--which wasn't the slightest
problem before.

> And basically, just anyone else who has anything to tell me at all that
> might be helpful.

It's not your fault. Even though it happens in your body and to you, it's
not your fault. It hurts like hell, but these things just happen, the way
asteroids sometimes slam into the Earth. Boom. Stuff flies. Things get
killed. It's nobody's fault. It just happens. We pick up and try to go
on...
---------------------------------------------------------------------------
Last week my husband and I suffered through the pain and disappoinment of a
"missed" miscarriage. Simply put, this condition is caused when the body
fails to recognize that the cell cluster which has implanted has not become
a viable embryo and so continues to go through the motions of supporting a
pregnancy. For about a month after the pregnancy test was positive, my
husband and I thought about and planned for our baby. The fact that our
dream was shattered so soon didn't make it any less heartbreaking.

The reason I thought I'd write you, though, is to publicize the method used
to help us move on. You see, it was awful enough to try and accept the news
that the growing pregnancy sac we kept seeing on the ultrasound monitor was
empty and that it always would be. Still worse was the fact that we had to
select the method for ridding my body of the pregnancy support system still
growing in my uterus.

Option one was to let nature take its course. It might have been weeks,
though, before my body recognized there was a problem. The choice would
almost certainly have ended in a trip to the hospital for an emergency D&C.
We did not need the expense nor the trauma of this option. The second
option was having a scheduled D&C. We believed that this choice sounded
good because of the fact that it would be done under safe, controlled
conditions and under the peaceful sleep general anesthetic provides. By
contrast, the third option of a reletively new office procedure would cause
all the cramping and bleeding normally associated with a miscarriage,
induced by a drug not FDA approved for the purpose.

We were prepared to choose the scheduled D&C when we arrived at the
doctor's office for a final ultrasound. We said that we wanted to make the
choice which would be best for my physically AND mentally. He was certain
that the office procedure fit the bill. He went on to list the risks of a
D&C: perforation, infection, extensive bleeding, and a 2% chance that it
would have to be repeated. The office procedure also had a 2% chance that a
followup D&C would be required, but there was no chance of perforation or
infection since the procedure was non- invasive... and he was ready to do
it then and there. (It was a real blessing that we didn't have to go home
and dwell on it for a day or two.)

At about 6:00 PM the painless, five minute procedure was performed. A small
pill was broken into four pieces. (This drug IS FDA approved for other
uses, but it was explained that no matter how much pain, suffering, mental
anquish and money this procedure would save women, it was still technically
an abortion and no drug would be approved for abortion use. The doctor went
on to say that the FDA has never approved any drug for use during pregnancy
either - not Tylenol, not TUMS, nothing. He added that if doctors had to
wait for the FDA to approve everything obstetricians would have nothing to
use at all! Procedures and drugs, then, are chosen based on results found
in medical journals. This one has been used with increasing frequency and
with excellent results.) The pieces of the pill were placed around my
cervix - painlessly - and held in with a tampon. I was sent home with a
prescription which we filled immediately. I ate a small dinner, took one of
the prescription-strength Motrin, and waited. About 8:00 the cramps
started. By 10:00 I had become very uncomfortable, but my husband gave me
lower backrubs which helped immensely. I was further diverted by a good
movie on TV. The cramps were no worse than the intense ones I'd suffered
through during my teenage menstrual cycles. (I only took that one Motrin.)
I went to bed at 11:00 and slept soundly.

In the morning it was over. I was amazed to discover that the bleeding had
already tapered off to little more than spotting. At my recheck that
evening, the doctor found signs (through ultrasound) of only a small bit of
tissue remaining, which he was almost certain would pass on its own.
(Sometimes a second treatment is needed, but it results in much less
cramping since the uterus is almost emptied and nearly back to normal
size).

I will have to have weekly QHCG (blood) tests until my level returns to
zero (indicating that a D&C will not be necessary). In the meantime, my
husband and I are on StressTabs with Zinc and prescription-strength Folic
Acid to prepare for our next try. I'll be filling my new Clomid
prescription soon, and I already have an appointment for mid-June so my
period can be started by injection if it hasn't already done so on its own.
In short, we might be pregnant again by the end of next month! (There is no
good medical evidence, according to the doctor, that suggests that waiting
more than one cycle will improve our chances for a healthy pregnancy. In
fact, he believes that the knowledge that we can try again so soon greatly
enhances our emotional well-being, a factor that is also very important.)

There isn't anything that anyone could have said to make this experience
any less heartbreaking for us. We knew we didn't do anything to cause the
miscarriage, nor could we have done anything to prevent it. Still, we can't
deny the fear that it might happen again. We know that the people who told
us "it was for the best" and "at least you know you both work" were only
trying to help, but we wanted to scream each time we heard that. In fact,
the only good thing about all this was how fast and easy the doctor made it
to move on. No hospital visit, no paperwork, no recovery room. It was fast,
it didn't hurt (other than the cramping, which is short-lived and not too
terrible), we saved a fortune, and my husband and I went through it
together in the privacy and comfort of our own home. I don't know under
what circumstances the procedure can replace a D&C, but having had both
now, I can say that this is DEFINATELY the way to go. We will always be
grateful to this doctor for coming as close as any man can to understanding
what it's like to be a woman in this position.

Elizabeth Foss nfn04287@naples.net

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