Tuesday, November 18, 2008

Question about Miscarriage.

I am ~not~ experienced in this topic, so let me start off by asking for a bit of leniency if I say anything wrong. I'm just curious on some aspects of miscarriage (particularly early m/c) and I am going to just ask them.

I think I had a chemical pregnancy one time. If you look at my chart page here and look at "C11, IUI #2" which started on August 19, 2007, you'll see the cycle I'm talking about. It was my first "triphasic" chart, I got a light bfp on 11dpo and then started spotting the next day with a BFN, only to get my period the next day after that. Was it an early miscarriage or simply a false positive? The test showed an ultra light "+" within the 3 minute window, but it was one of those blue ink +/- tests that have been known for false positives in the past. Did my chart's temps hold even more evidence implantation tried to happen? I don't know. If it was a pregnancy, it was before my uterus was fixed so the immense scar tissue would have been a huge detriment anywho, so I probably would have miscarried anyway.

My point here is with chemical pregnancies, how often do we really ~know~ it was a m/c or not?

I've seen a handful of girls out there who talk about there recurrent miscarriages. But the thing I am questioning is how they really know. Does a "heavy" period mean a miscarriage? I've seen some girls say they are having yet another miscarriage simply because their period is heavy. And they say their doctors are the ones who are telling them this "It's probably an early miscarriage" without taking an hpt or even confirming anything via blood beta tests. And I've seen some girls go through ~a lot~ of these - 4, 5, 6 - and that's all that their doctors say? Isn't the "rule" for recurrent miscarriages that things should be tested out after 2 or 3 of these tragedies? If a doctor just keeps saying "it's probably an early miscarriage", shouldn't these women switch doctors?

Now, I want to be straight about this and explain I am ~not~ questioning their diagnoses. I personally know two women I consider friends to have had chemical pregnancies where they just knew from their gut feeling. I don't think evidence ~needs~ to be there to have one happen. I'm more questioning a doctor's or nurse's opinion that they are suffering miscarriages without even examining them. It just doesn't seem like good medicine to me. A m/c is something so personal and so devastating, I just don't think it should be thrown around without doing some tests. And if a woman was really having m/c after m/c, shouldn't something be done?

I don't really know what kind of testing can be done with super early m/c. Or is testing only available for m/c that happen after something really starts to grow, not just when implantation doesn't "take" like it should.

Does anyone have any input? I know I'm not asking specific questions, but then again, I don't really know what to ask. It's just something I've noticed lately and I'm just not comfortable with doctors just waiving someone's heavy period off as a miscarriage when they really have no idea. I just don't think "miscarriage" should be an overall diagnosis.

24 comments:

mommybird said...

I totally don't have an answer for you because my miscarriage was only threatened and ended up being a successful pregnancy so far (25 weeks). I agree with you though, that it seems like the term miscarriage is just thrown out there like it's nothing. I believed my baby was dead for 3 days because that's what I was told and I would not want to go through that drama again without knowing for sure that there had been a baby and that it was in fact gone.

Amanda said...

I had a doctor tell me once that I had probably had an early miscarriage due to a horrific period (not just heavy, but debilitating pain). They brought me in for a blood test a week after the period began and then told me that they couldn't determine what it was since I had no hCG. No shit sherlock. A week after a probably early miscarriage I'm not too likely to have any hCG in my system.

My point is, if I were to have had recurrent situations like this I definitely would have switched doctors. Having a doctor just throw a diagnosis at me without testing would be too much. Especially when it's such a sensitive subject.

As far as RPL, I think it depends on the doctor as to whether they'll do a RPL panel after multiple early miscarriages.

Nikki said...

I hate it that I have had experience with a few types of miscarriage, so I may be able to answer your question ~somewhat.

I don't think any heavy period means a miscarriage. In fact, the period after my confirmed chemical pregnancy was not heavy at all. It was pretty regular.

They say that many women experience chemical pregnancies without knowing it. For someone TTC, tracking their temps, or doing HPTs or getting betaHCG tests done, these early miscarriages get detected.

My RE here does count even my chemical pg as a loss. I guess it depends on where you are in your treatment, however, having said that, a loss is a loss, period. Yes, women should switch doctors or at least get another opinion if their doctor just waves it off as "It's probably an early miscarriage" and doesn't even confirm it with a blood test.

Nurses and doctors should not be loosely tossing the term around. And if it is confirmed that these are in fact early losses, women should ask for testing - like their karyotypes, clotting factors etc.

Sometimes we have to be aggressive with our own health and have to question our doctors.

MrsSpock said...

I have wondered myself if I had two chemical pregnancies while we were TTC. I have never had a cycle over 28 days in my life, and suddenly while TTC I had two 34 day cycles. I thought I was pregnant, but didn't test until day 34-35. This was before I knew my progesterone was mediocre. I guess I'll never know.

Geohde said...

I've never had a miscarriage or a chem, personally. But a close relative has had at least four m/c's (all laboratory and ultrasound confirmed and recurrent m/c testing has found no treatable cause).

It's heartbreaking.

Having said that I do have a friend who had a beta of 3 and her doctor was equivocal about what it might have been because 3 is too low to pass muster as pregnant but a little higher than you expect in a non-pregnant woman.

She took it as a miscarriage, and grieved it like the loss of a baby, even though her period was never late and she never had a positive wee stick.

I guess it's all individual...

J

Cate said...

I've had one miscarriage and one confirmed chemical pregnancy. The miscarriage lasted to 6 1/2 weeks and the chemical pregnancy was from me testing early, convincing my doc to do the beta and my level going from 25 on a Tuesday to 10 on Thursday with my period starting on Friday, it was no heavier than normal. The miscarriage was much harder because the levels reached much higher and I was going in for an ultrasound when I was told there was no baby there... and my levels kept bouncing up and down.

AJ said...

I don't know a lot about miscarriages either but I do agree with you that it should not be the general or only diagnosis...is that what you said at the very end? I already forgot...lol...anyways...I agree with you!

I think that a miscarriage diagnosis should come with another diagnosis, when possible. For example, it was a chemical pregnancy or your uterus is a hostile environment. Something like that.

Those weren't the best examples but hopefully you get my drift :0)

Sarah R said...

I have always had a heavy period with very painful cramping. I thought everyone had 7 day periods, until I started talking to people and realized most people's are 4-5 days. I should say I had a 7 day AF on the pill, but now it's always 5-6 days.

A doctor should not call a heavy period a miscarriage unless a positive test was confirmed. And yes, I would change doctors if mine just assumed something like this. How stupid!

My early loss was at 5 weeks, but I had 2 positive tests before that.

areyoukiddingme said...

I had two miscarriages. One was at 11 weeks and one was at 8 weeks. They say that there are many undiagnosed miscarriages that happen and are just assumed to be late periods. I'm guessing it has to do with the mysterious chemical pregnancy. There is really no testing involved in most miscarriages, unless you have enough foresight to save whatever you pass and ask for specific genetic testing.

Miscarriages, in addition to being devastating, are also really annoying because there are no answers. No one knows why they happen, they are just assumed to be chromosomal defects until proven otherwise. According to the worst doctor I ever had, they generally make you experience 3 miscarriages (in a row) before additional testing, but I have heard of people who have had more. It's just that they have had a successful pregnancy in between. Or maybe a chemical pregnancy/miscarriage - which is probably not supposed to be as traumatic, because you would only be pregnant for a few days (ha! - sure).

What I do know is this...my 11 week miscarriage was similar to giving birth. My 8 week miscarriage was not as painful. Neither one of those was like a period in any way. The only testing that they did was to check the tissue/clots/whatever I submitted and determine if it was fetal tissue. Then they monitored my hcg levels to make sure they were decreasing. I'm guessing that an embryo that did not implant would be about impossible to detect and save, and there would be no answers.

If I hadn't insisted that there was something wrong and I needed to find out what it was, I would have been put in the line for a third miscarriage. But, since I was 36, distrustful of doctors and their abilities, and occasionally able to take charge of my own life, I got the testing done and went to see a fertility doctor on my own. That worst doctor didn't like my taking initiative (and she isn't my doctor any more).

I guess that's the lesson I learned. Don't wait for the doctor to tell you what to do. You have to take some responsibility for your own health care. If it doesn't seem right, get a second opinion. But be careful to be honest with yourself first. Don't just go shopping for someone who will tell you what you want to hear.

ssbean said...

Like you, I'm not experienced with this either. I think really the only ones that will even suspect a chemical pregnancy are those TTC, and more so those who have been trying for a while, charting and such. Why would somebody not TTC test at 11dpo? Most women I know who aren't TTC will at least wait to test after they missed a period. As for the heavier periods...I'm not sold on that being a diagnosis. I had some super heavy periods, that the thought crossed my mind, but I never really thought it to be. Turned out it was just worsening endo. My doctor said that after 3 miscarriages they do test. So yeah, if somebody has had 4,5,or 6, miscarriages, they should be getting tested. I would think anyway.

Ali said...

I had a miscarriage before each of the kids, both before 8 weeks, both verified by at home tests and blood tests by the doctor.

missing_one said...

Looking at your chart, I don't think you were pregnant because your temps got that high on other cycles. It was probably one of those stupid false positives. Unless you really thought you were pregnant, then maybe you were

In general, not much is known about the causes of miscarriage. AND they do happen all the time, often before women even know they are pregnant. My understanding is that this happens and makes their period at least a few days later than normal, not on time.
There are good doctors and bad doctors and it is our job as a patient to be informed. I am in the process of switching doctors because I don't think she really knows what she is talking about when it comes to some of my recent issues.

It does seem like people like to just brush off miscarriage and/or use scare tactics. But, I guess in all fairness, the odds of a successful pregnancy in the beginning are only less than 50%. This number goes up after 6, 8, 10 and then at 12 weeks you have about a 90% chance of having a live baby or something along those lines

Anonymous said...

With my miscarriage, I had a beta done on 21dpo. I had gotten a faintly positive HPT, and it never got any darker. I started spotting, went to the ER where they were unable to confirm via ultrasound because it was extremely early. I was told that it was too early to tell, and to see my OB on my already scheduled appointment, which was 2 days later. I had a urine test done in my OB's office, and it was still faintly positive. I also had a beta done, but had to wait for the results 24 hours later. The following day, I started cramping really badly and passed a clot. My OB wanted to see me, and he informed me that I had a beta of 46, and because of the heavy bleeding I miscarried. Just to be sure he did an ultrasound and there was no "spot," which confirmed his diagnosis. DH was with me, and naturally, we were devastated. We asked our OB what our chances of having a second miscarriage is, and he said that it was unlikely, and not to worry. The obsessive in me wanted to know at what point I should worry, as far as reoccuring miscarriages go. He said that if I had one more miscarriage, that he would elect to do some testing. As far as testing goes, I am not sure of the names of the tests because I have never had to have them done. He wanted to check the inside of my uterus, check my tubes and ovaries. Basically, he wanted to make sure that everything in my oven was in working order. He said that he would also do extensive bloodwork. After the miscarriage, I got overly concerned because of my extremely long cycles and had testing done anyway. I found out that I had some abnormal hormone levels and had to be put on predisone and kirim. Those hormones can interfere with viability, so I had to test as soon as possible. I tested at 11dpo and got a bfp. I was immediately taken off of the previous stated hormones and placed on progesterone supplements for my entire first trimester. I think that my OB was being overly cautious, but understandably DH and I were overly worried. So, the precautions made us feel so much better. We were definitely the pregnant couple that checked for a heartbeat all the time with our lovely doppler, and asked many many questions of our OB. I guess that is my story. Sorry if I rambled a little, and if I didn't answer all of your questions. :)

Jen said...

Ok, here is what I have been told about miscarriages sine I had mine in September. Again this is what my Dr's in Ohio and Michigan told me.

I wondered since my m/c was so early if it was a 'chemical pregnancy' instead. Both of my Dr's told me that typically when a women has a chemical miscarriage or pregnancy they most likely don't even know that they are pregnant. They may be a day late but that is typically it. They also told me that with a chemical pregnancy a pregnancy test may or may not come out as a +. That the only real way to know for sure if you were indeed pregnant was a blood test. However, by the time many think they have had a chemical pregnancy it is usually to late to do any testing. My pregnancy was not a chemical one, I was infact pregnant.

In my situation I had an early miscarriage. Something that was explained to me as a m/c that happened before 8 weeks of pregnancy had been met. I went for my 1st. apt. at 6 weeks, was pushed back one week. One week later when I should have been 7 weeks I was still only measuring in at just 5 weeks. Meaning that my baby probably stopped growing soon after implantation for what ever reason, most likely a heart problem or severe birth defect. There was no hearbeat at ANY of the ultrasounds that I had. I had 4ultrasounds in a little over a week to make sure. Each time the baby was getting smaller and smaller.

From all my reading I knew this, but my Dr also told me that there are different types of m/c depending on the duration of the pregnancy. Since my m/c was so early they couldn't 'test' the baby to see why it had stopped growing, there just wasn't 'enough' to test when they did my D&C. They did a test on me (can't remember what it is called) but anyways they took a sample to see if I would be prone to early m/c in the future. The test came back - meaning that I should be able to get pregnant and stay pregnant in the future.However, I would be considered 'high risk' the first 10 wks of the pregnancy because of the early m/c in the past. Most likely my m/c was just a 'flukey thing' that happened to me. In any future pregnancies I will be very up front with any Dr I have let them know my past and be watched carefully to try and prevent that hell again.

I also agree that the word miscarriage is thrown around a lot, especially from some people where there pregnancy wasn't confirmed by either a Dr, or a blood test. Yes, an extremely high number of women suffer from m/c for many unexplained reasons, but I for sure wouldn't be walking around saying I had a m/c, when in fact it wasn't medically diagnosed.

Again this is just things I've been told since Sept and my feelings about m/c. I don't want to offend or upset anyone.

sara said...

I have been blessed enough never to have had a miscarriage so I don't have much helpful imput. But I am interested to see what others say. (I'm back home and catching up with people - hope you're doing well!)

Jenera said...

I have only had one miscarriage at it was at 8 weeks. For me, it was very different from a 'heavy period'. It wasn't just heavy flow as I had clots and tissue. I had a doctor appointment (already scheduled) the very next morning, literally hours after miscarrying. Due to blood tests they determined I was in fact pregnant because of the HCG levels. I also had an ultrasound. In my case, there was no doubt what happened.

I will probably get stoned for this but I sometimes wonder if people 'claim' miscarriage to make themselves feel better about not conceiving yet when in fact they are just jumping the gun. I've had my doubts about some people personally that I have known that are quick to say they miscarried and act as if nothing.

In my opinion, if you have truly miscarried you feel the loss, no matter how early-such as women with recurrent miscarriage.

I was scorned by some of the hubby's family because my miscarriage happened early. But they did not go through the painful physical process and saw what I saw. Regardless of the length of pregnancy, that was a baby.

My doctor had no answers for me as to what caused it but was very sympathetic when I became pregnant again and was completely stressed for the first few months.

I'm not sure that I've helped or added anything beneficial but it is just what my experience with a miscarriage.

bleu said...

I have had chemical pregnancies but I do not consider them m/c's personally. I have had 3 m/c's and all were after heartbeats were seen. I do not think you have to have a heartbeat to be a m/c but for me seeing a baby a yolk sac etc is beyond a chemical and an m/c. RPL though, again in my mind, can be just that, recurrent pregnancy loss, but maybe not always recurrent m/c so maybe it becomes how well it is defined.

I can also say for my last m/c I went through actual labor during it which was VERY unexpected.

I think bottom line loss is loss and everyone deals with it differently but from a purely medical standpoint what docs tell patients and how then medically classify things may have large variances.

I hope I made sense.

Heather said...

Oh boy - I've had a lot of these. Two miscarriages, one chemical pregnancy, and a baby boy who was stillborn last December. I don't like my experience in this area at all.

I cannot understand why anyone in the medical profession would characterize a heavy period as a possible early miscarriage. I've never heard of a doctor doing such a thing. There would have to be some other factors contributing to that diagnosis, right? If I had a doctor who really thought that I was having one early miscarriage after another without doing anything to confirm it, I'd most definitely be looking elsewhere for medical care.

My chemical pregnancy was confirmed by my RE, although only via a phone call. I had 3 very light positive pregnancy tests over 4 days, bbt's that stayed high, then a regular period that was about 3 or 4 days late. My miscarriages were at 10 and 11 weeks and as others mentioned were nothing like a period. More like post partum bleeding (I also have a living child). Each loss was painful and significant, but very different.

The stillbirth of my son is, at least for me, a whole other level of loss that words cannot describe. I feel that we are doing very well dealing with it, but I cannot put his death in the same category as a miscarriage. I know some women would say that each loss is equal, and it could be very true for them, but for me that is not the case.

Misty Dawn said...

I do think that m/c's are often dxn'd w/out proof. I know with my m/c's, my GYN refused to count 3 of them as "m/c's" b/c my betas never got over 10. I've only had 2 over 30. Then when I got to my RE, he counted any beta over 5 as a m/c. So I was back up to the 5 m/c's that I knew I had. Since I already knew that the HPTs would still show the BFP after the HCG would start disapating from your blood, there was no convincing me that I didn't have 5 m/c's. I'm just glad that my RE agrees with me. Sometimes I wonder on C's that I have alot of intense cramping, bleeding and clotting, if I'm having a chemical m/c. Since my HCG disapates from my blood so quickly its really hard to know. 2 C's ago my RE is CONVINCED that I had a m/c, my Prog was 39 at 7DPO. Then my beta showed .6! So I'm glad I asked for a prog b/w that C. That is what convinced him to do my RIP (Reproductive Immunophenotype). Which has now convinced him that my body is attacking the sperm/embryo, so he has started me on a steroid. He is hoping that he will supress my lymphocyte production, which will allow me to have a successful PG. He has experimented w/3 other girls in my same situation and this steroid worked for them on the 1st C. If that is the case, I bet he is banking on this non-stimulated C to produce a BFP. We will see. I'm not crossing any fingers. It seems that everything in the IF world is trial and error. An answer to my problems that is that simple, just seems too good to be true, right?

Hollie said...

I've learned a lot from reading these stories. Thanks for sharing ladies.

serenity said...

I can only tell you my experience with my one chemical pregnancy from IVF. My beta at 14dpo was 21, very low. It rose to 98 two days later, then to 181 three days later. Then it crapped out.

My clinic defines a biochemical pregnancy as anything with a positive beta test (i.e. >5 HcG) that doesn't result in a heartbeat on an ultrasound. In my case, my betas stopped rising at 181, so it was a chemical pregnancy.

And truth be told, it was easier for me to think of it as a failed cycle than a miscarriage. I moved on much easier when I thought of it that way.

jodie38 said...

There's lots of reasons for heavy periods besides a m/c (fibroids, endometriosis, vitiman deficiency, cancer). Saying that a heavy period means an early miscarriage is ridiculous, and it's impossible to prove or disprove after the fact. I don't think a doc should say that without proof. A blood test is the gold standard, but the HPT's are extremely sensitive now. My RE took my word for it when I had a + that ended up as a chemical pg. I think I read somewhere that if you start monitoring early enough, most people will have a chemical pregnancy or three. It depends on how close you're watching things. And the earlier the m/c, the more incompatible with life the problem was, and most likely genetic. Where "early" miscarriages become statistically important is when you have repeated events. In my case, I had a chemical pregnancy (proved by a HPT) and started AF before I could get to their office the next morning for a blood test. Later, when I really got pg through DE IVF and m/c at 10w, they counted both as statistically significant and did testing to investigate. One m/c gets chalked up to fate. Two gets (well, should get) a closer look. And they found problems that they wouldn't have otherwise if I hadn't had the chemical pg.
I hate to say it, but it may also be a time thing on the part of the docs. If a patient is convinced they've had an early m/c, that can be a lot of conversation to explain things, and physicians are under ridiculous time constraints. If the patient is not showing signs of any other, more serious conditions, they may just let them believe what they like. Unfortunately, these days medicine is a business, and time is money.
I've spent waaaay too much time hanging around/working in doctor's offices...but this' just my opinion. I'm actually wrong quite often....:)

Marie said...

I had a mc a few years ago & there was no pain, no blood, nothing. I actually didnt even know until, happy me, went in for my NT scan. It is then the Dr told me that my babys heart stopped beating & from their size, it looked like it happened about 3 weeks prior. Of course my world stopped in that moment & devestated does not even fulloy articulate what I was feeling. Anyway, GOD was kind to us with the healthy pregnancy of our daughter & now the boys. A few glitches here and there but nithing that we can't handle.
Okay, enough of my rambling

Sugar and Ice said...

I don't have an answer. I wasn't aware that doctors were passing off heavy periods as early miscarriages without doing any testing. I miscarried a twin (diagnosed by ultrasound...one day there, gone a few later), and I had another miscarriage back in Aug. 2007 (blood test verified pregnancy....and then later verified that it was gone). So, I guess my doctor doesn't handle m/c the same as some others.