What would you do in my situation?

[allbookmark]

Hi all- I’d love some advice for my current situation. I’m 34yo, this is my second pregnancy this year.

I had an ectopic in May, treated with MTX, so I’m just hoping that this isn’t another

Here’s my timeline
7/31, CD24- first positive OPK

8/1, CD25 - intercourse, OPK still positive

8/2, CD26 - OPK negative, bbt dip to lowest (97.46), suspected Ovulation date

8/3, 1DPO- bbt rise & stayed elevated

8/8, 6DPO - started spotting

8/9, 7DPO - light bleeding, dark brown blood. Wore a light tampon, wasn’t even filled. Thought I was starting my period as my cycles are ~31 days.

8/10, 8DPO - spotting, all dark brown blood only when wiping

8/11, 9DPO - bleeding stops

8/12, 10DPO - nausea, headaches

8/14, 12DPO - nausea, only took a pregnancy test because I was so nauseous. Got a very faint positive pregnancy test.

8/15, 13DPO - bHCG 14 UI/L

8/16, 14DPO - metallic taste in mouth in the AM. So metallic that I thought my nose was bleeding. nausea, headaches. Pregnancy tests still very faint.

8/17, 15DPO - bHCG 26 UI/L, doubling time 53.75 hrs. Told to come back in 48 hrs for another beta.

8/19, 17DPO - I’ll get betas tomorrow. I guess I’m just delaying the inevitable. I asked my ob if she could order labs to check my progesterone as well, but basically said “there’s no scientific evidence to support progesterone supplementation so that’s not a part of our practice but sure… I’ll order the labs”.

So like, what do they do if my progesterone is low? Just say sorry, you’re SOL? Not saying that progesterone would save the pregnancy, but damn. My luteal phases are SUPER short… like 8 days at best (tracking by opks and bbt) plus I was spotting so I’m just confused why they wouldn’t want to check my progesterone? Just feeling a little unsupported & sad after this (likely) second loss.

Should we seek advice from a RE? We obviously have no problems getting pregnant… it’s just staying pregnant. Any advice would be very much appreciated

UPDATE: 8/21 bHCG 251 IU/L, Progesterone 0.27ng/mL

I’m surprised I haven’t started bleeding yet. My doubling time for HCG is 28 hrs, but my progesterone is basically non-existent. I guess I’ll just wait to start bleeding

UPDATE:
8/23 bHG 882 IU/L

8/25 bHCG 1703 IU/L, Progesterone 12.8ng/mL! I can’t believe my progesterone is now in somewhat of a normal range with no supplementation.

It’s been a rollercoaster so far, but we’re cautiously hopeful! Can’t wait to confirm via ultrasound… c’mon lil baby jelly bean!

 

[austins]

@allbookmark My understanding with progesterone is that it may be helpful if progesterone is low and all other things are normal. I think that if hcg is also very low or not doubling, there’s not much progesterone can do because there’s probably something else wrong or it may be too late, so it may just delay a MC that was gonna happen anyway. I would wait and see what hcg looks like and if you’re doubling normally and you are still worried about progesterone, maybe see if you can order it yourself (not sure where you are but in the US you can order yourself through labcorp without a dr) or talk to another provider if that’s possible. My progesterone was around 21-22, but since I had a MC before my dr supplemented it until 13 weeks. I don’t know if it really mattered for me, but i’m 18 weeks and this is the furthest I’ve ever made it, so I at least know it didn’t hurt. Good luck and definitely advocate for yourself as much as possible!

 

[allbookmark]

@austins Thank you so much for your reply! I know that my betas are super low and supplemental progesterone won’t help at this point. My doctor did put in order to check my progesterone with my next betas but basically said they wouldn’t do anything (they don’t prescribe supplements), even if it was low and my betas looked good.

I’ll continue advocating for myself and hopefully get some answers prior to my next pregnancy. This community has been so helpful! Congrats, by the way! I hope you have a healthy, uneventful pregnancy

 

[austins]

@allbookmark Thank you! I’m sorry you’re dealing with this. My OB was also not super helpful with stuff like this either and very dismissive in general about anything related to MC. I ended up seeing an RE after my MC and I didn’t end up needing fertility treatment, but they were willing to prescribe progesterone and help with letting me come in often for reassurance scans, etc. I feel like REs are more concerned with preventing MC, and OBs aren’t as interested. That’s just been my unfortunate experience, but may be different for others. If you are able to go to an RE in the future, I definitely recommend it because I felt they were about a thousand times more accommodating and reassuring. I really hope your next beta looks good and I am so sorry you’re sitting in limbo right now.

 

[allbookmark]

@austins I’m glad you got the care you needed from your RE! That makes me feel better about making an appointment and I’m not crazy for feeling unsupported by my OB thank you for validating my worry!

 

[viral1997]

@allbookmark My cycles have been very irregular since coming off birth control and continued miscarriages. My specialist seems to think my irregular cycles are the cause of my losses. We've done a huge RPL panel to just tick off the boxes. Also ruling out PCOS - but my periods were perfect prior to birth control. But he is very convinced this is the root of my problems. Has said long cycles for example mean your hormones aren't doing what they are meant to be doing, this can lead to problems with endometrium thickness and implantation. Then simply pregnancy progression. So we're trying medicated cycles and hormone monitoring. My last cycle seemed a lot normal with my ovulation date - just waiting on my period now so we can officially TTC next cycle taking letrozole. I'm sharing this as I can see you ovulated cycle day 26 (have super long cycles). Wishing you all the best - and in the unfortunate case things don't go well for you, hopefully this info will be helpful.

 

[allbookmark]

@viral1997 Thank you so much for sharing this.. it truly means a lot. I feel like I have a similar issue with my hormones. I didn’t have a period from Feb 2020-Aug 2021, despite having a copper iud in. When my cycle restarted, they were long at first (37 days) then shortened to 29-30 days but ovulation being late (day 20-22).

I’m definitely going to find a new doctor to do similar testing. I feel like it all points to a luteal phase defect and like you said, an issue with implantation. I hope your medicated cycles go well! I’m glad you found a doctor that’s helping you navigate the stress of trying to find answers. Are you seeing a reproductive endocrinologist? Or is it your regular obgyn?

 

[viral1997]

@allbookmark Oh I seemed to miss the short luteal phase. He is a fertility/IVF specialist who has studied recurrent losses. Late ovulation and short luteal phase - I reckon he would put you on the same plan as me. I was so convinced that my cycles had something to do with it - but I hadn’t seen much discussed about it on reddit. I even posted once to see if anyone thought there was a link with coming off bc/hormones/long cycles but didn’t get much response. So I’ve made it my mission to share it wherever possible now because it could be such an easy fix for many. I’m saying that I have all my fingers and toes crossed. I fell pregnant both cycles trying - then have been on a mission to let myself recover. I’m finally excited to try again next cycle. Please keep us update - I hope all works out for the best. Got my fingers and toes crossed for you..