Secondary Recurrent Pregnancy Loss -- Best doctors?

Unfortunately, I've had two miscarriages back-to-back this year. In 2019, I had my first child (a boy) with no complications -- super easy pregnancy. I'm 30 years old, and seem to be having some trouble staying pregnant. With Kaiser, there have been extremely long waits to move forward with any testing. My rheumatologist has indicated that I may have very quiet, very early lupus (no symptoms), but that's the only clue so far as to the consecutive losses. Before we try for a third time, I'm wondering if anyone has been through something similar and had success with a particular OBor reproductive endocrinologist, line of testing, or treatment plan. My gut is telling me that the losses are autoimmune-related. I've looked up Dr. Zouves, who seems to focus on immunology and fertility, but don't think it makes sense for us to pursue IVF since conception doesn't seem to be the problem. Thank you in advance for any and all advice! This is such a lonely and frustrating experience :(

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Hi highly recommend Spring Fertility, Dr. Minjarez in Oakland. They are a fertility clinic and specialize in everything- not just IVF. She is kind, compassionate, and extremely knowledgeable. It’s possible that your insurance doesn’t cover it. But my only regret is not switching my fertility care from Kaiser to Spring sooner. It would have saved time and heartache. 

I don't have any dr recommendations really but I do know I made a lot of assumptions about what fertility drs do and there is a whole range of things other than IVF. You're having a fertility issue, so I think a fertility dr is a great person to see. It took us several months to get into a dr early this year, so I'd def recommend reaching and scheduling something. We went to UCSF Mission Bay Center for Reproductive Health and saw Dr Noel. Everyone there is amazing. Good luck and I'm so sorry for your losses. 

I’m so sorry for your losses. I had 3 early miscarriages (at 9 and 11 weeks), no previous live births- I went to UCLA high risk OB chief who prescribed natural progesterone suppositories until 11th week as soon as I became pregnant. I went on to have 4 normal pregnancies, each with the supplement to be on safe side and had no additional miscarriages. I suggest consulting a high risk OB at UCSF. Good luck! 

I'm so sorry to hear about your losses. I am 38 and went through 3 recurrent losses in late 2017 and 2018 before having my son last year and am also with Kaiser. My experience does not sound totally similar to yours (no indication of auto-immune issues for me), but will share a few things in case they are helpful. There is bloodwork specific to recurrent miscarriages that my OB was able to order for me (you should be able to ask for it, and if you want me to look up exactly what all they tested, DM me and i can look it up). Then, i got referred to Kaiser's fertility services. While i live in E bay, i was working in SF so was using SF's Kaiser services at that time, and my OB said that she heard E bay ones were much more backed up, so if you don't mind traveling to SF, that might be worth pursuing? I ended up being diagnosed with a borderline case of PCOS and took a supplement called myoinositol specific to that. Also unrelated to PCOS, from positive pregnancy test i took baby aspirin and progesterone daily, which are pretty standard recurrent miscarriage treatments. I have no idea if any of these things helped or we just got lucky. One other thing: not sure how far along you have gotten before miscarrying, i had 2 very early and 1 at 9.5 weeks, and the one at 9.5 weeks i was able to request they test to determine whether it had chromosomal abnormalities (which is the most common reason for miscarriages) - because mine had normal chromosomes, it was an indicator that something else was likely going on. 

I definitely know it can be a frustrating and lonely experience, but I've also been surprised to become acquainted with so many people who have been through stuff like this, it just is that people don't typically talk about it. Good luck to you, and best wishes for a sticky pregnancy soon!

I don’t have any advice , just wanted to say that I’m so sorry that you’re experiencing this. I’m sending positive energy and love your way.

Hi there

Sorry to hear about your loss and struggles. I moved here recently from Ireland. I imagine most likely you’ll be advised to go on clexane injections in combo with daily baby aspirin. I had 6 miscarriages and ten rounds of ivf. I’ve seen and been through it all. I’ve mild lupus with severe endometriosis. Once I was put on that protocol for recurrent loss, we had our baby girl 

good luck! 
Sarah 

No doctor recommendations, but maybe check to see if you’re a carrier of the homozygous MTHFR gene mutation. It’s a relatively common gene variant and is linked to recurrent miscarriages. Dr. Google can tell you more, including the potential treatment of taking a baby aspirin a day while pregnant. 

I’m so sorry for your losses. It is heartbreaking and I’m sending you good thoughts.

I had back to back miscarriages in 2019 (had my first child in 2017). My doctor (Sutter Health) said up to 3 miscarriages is considered “normal”, though it felt anything but normal. I’m a bit older than you, mid-30s, and mentioned my concerns about getting older and having enough time to have another baby. She agreed after the second miscarriage that we should pursue testing, starting with a test I can’t think of and a hysterosalpingogram. I got the feeling that normally she wouldn’t pursue this route until after the third miscarriage. It is a PPO, and Kaiser may be different-I had Kaiser for years and found that they seemed to have “rules” about when treatment was allowed. I had a baby this summer (after 2 miscarriages, got pregnant before pursuing the testing) and have friends who had three miscarriages before having kids. I have no idea if it is “normal” or not. That said, trust your body and if something feels off, pursue it. Wishing you all the best.

I'm so sorry to hear about your losses. I went through something similar and recall that the worst part, for me, was the agony of not understanding what was happening.

After having my first child at age 35, I had three miscarriages back to back in the span of about one year when I was 36-37. I have an autoimmune disorder (hashimoto's thyroiditis) and was very concerned that there might be an undiagnosed health condition causing the miscarriages. Like you, I had zero trouble conceiving; just did not manage to stay pregnant past 12 weeks. After my third miscarriage, I saw Heather Huddleston, a reproductive endocrinologist at UCSF. I sought her out because she specializes in recurrent miscarriages and because there's still so much we don't understand about miscarriage, but I reasoned that someone working in academia would have the latest research at her fingertips. And I was not disappointed in that regard. She was so much more informative than my "normal" OB's office was.

The first thing she did during our appointment was show me the data that pertained to women with my age and health history. The data showed two things: 1) how common it is to suffer multiple miscarriages, for women of all ages and 2) that even at my "advanced" age, I still had a very high likelihood of conceiving and carrying a baby to full term with medical intervention of any kind. One of my takeaways was that the conventional wisdom around miscarriage - that it is super rare among young women but very common among women over 35 - is not quite that straightforward and that there's a much broader range of experiences that can still be called "normal." She encouraged me to try again and also expressed a willingness to continue to work with me. I did as she suggested and my next pregnancy was the one that led to the birth of my second child, so I never did work with her on a more detailed treatment plan. But I really, really liked her and remember her as a bright spot during what was otherwise an anxious and painful time.

I wish you the best!

Just a note on not pursuing IVF because conception doesn't seem to be the problem.  I managed to conceive three times (with some minimal fertility treatment such as Clomid) but each pregnancy ended in either miscarriage, or in one case, a partial molar pregnancy that had to be terminated.  After these experiences, my reproductive endocrinologist suggested IVF, because she felt that with IVF, the most promising embryos can be selected, and the chances of miscarriage of a faulty embryo were thus lowered.  Obviously just anecdotal, but on our first IVF attempt we ended up with two embryos implanting, and healthy twins eight months later.

I can recommend Susan Willman as an excellent RE.  I don't know if she has any particular expertise in immunology.  Best of luck to you--I sympathize, it is indeed a difficult experience.

Hi, I would definitely recommend seeing a reproductive endocrinologist as your next step since you are already under the care of rheumatologist.  While I saw an RE for a different issue, they will be the most knowledgeable in what tests to perform for RPL.  For example, they could help figure out whether it's a uterine, blood or possibly a genetic issue with the embryos. I was very happy with my treatment at Spring Fertility.  I saw Dr. Klatsky at the San Francisco office, but they have east bay and south bay offices as well. I would also recommend joining reddit (if you don't have it already), and joining the r/infertility group.  I learned so much from these daily conversations between women going through the same thing and it made me feel less alone.   

I'm so sorry you're going through this. 

I had a similar experience about 5 years ago when my husband and I were trying to get pregnant. I also have Kaiser, and my experience was that it required some significant pushing on my part to have them recommend treatment. (They either told me it wasn't a problem, keep trying, or tried to steer me straight to IVF, which doesn't really make sense if conception is happening relatively easily.) As hard as it was in the midst of grieving, I ended up getting a recommendation to see a reproductive endocrinologist, Dr Orkun Tan, who I REALLY appreciated. He does some appointments in Oakland, but is mostly out of Kaiser San Ramon. He did blood test, a uterine saline test to check any physical issues, and an ultrasound (I think that was it, it's been a while). I ended up getting prescribed a thyroid hormone, and got pregnant pretty soon after, so assuming it helped. He also monitored the early pregnancy directly, and I had a lot more early pregnancy exams than a standard pregnancy, which really helped mitigate fear/worry.

Sending you and your family good thoughts. It's a hard situation. Happy to answer any questions directly, too.

I don't have any advice or recommendations, but what you are experiencing is really hard and sad and I'm sorry you are having to go through this. I commend you for seeking the answers and not giving up. 

About 25% of pregnancies end in miscarriage. So, given that probability. women have about a 6% chance of having one right after the other. That's significant. It may just be a fluke. I know someone who had back-to-back miscarriages and then went on to have healthy pregnancies and healthy children with no more miscarriages. Wishing you future success.