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Hi,

I'm writing from the Philippines. I've been contemplating whether i should write and ask but i just really had to.

I had 3 missed abortions already. The first was in Nov 2009, i was 30 years old then. At 6weeks, i started having spotting and my Doctor put me in Duphaston to be taken once a day. I was also confined in a hospital for 3 days in Oct 2009 because the spotting wont stop and it was increasing. The blood was brownish in color. I can't remember what meds the've given me at that time, all i remembered was one was to stop the bleeding and one i guess was like duphaston. After 3 days, the spotting subsided and i was allowed home. But on my 16th week, i started discharging red blood, not a lot to soak a panty liner but it was really a dark red that i really became worried so we got into ER and found that there was no longer FHB. I had a D&C the next day.

Second miss abortion was back in late July this year, again the spotting started few days past 6 weeks and i was given Duphaston to be taken once a day, first ultrasound showed that the FHB was slow, but not too slow, according to the Doctor, it might just be physiological since it was just 6weeks 2 days and the rate was 109. After 2 days, i saw a dark red discharge again and since i experienced that before, i became worried and run to ER, but during the ultrasound, we found that there was no FHB, D&C was done again in July 28. I had my monthly period the next month, August 28.

My husband and i were planning to undergo some testing because we don't want to have the same result again but I've gotten pregnant in September. We were really very cautious. I stopped working and just stay in bed since we found out i was pregnant through home pregnancy test. On my 5weeks 6days, i had my first ultrasound but there was only an empty gestational sac. I was worried that time because i read that there should already be a fetal pole by that time. But our Doctor assured us that it can sometimes happened and that it was not rare. So we were ordered a repeat after 2 weeks. I was also started on Duphaston even though i was not spotting and my lower back ached and some parts of my lower abdomen had dull pain. On Oct 22, we went for ultrasound. It showed that the fetus was 6weeks 4days, and with no FHB.. I was devastated at this point, i wasn't even spotting! So again, out doctor arranged for a D&C, but before that she checked my cervix and found it was really close so she had me under meds for contraction and for me to start bleeding then put a gel like meds inside my vagina. After more than 6 hours, i didn't feel any contraction nor there was any bleeding/spotting, but they performed the D&C anyway.

There are lots of things in my mind right now but i just first and foremost wondered, if we had only waited for a week after my last ultrasound, would it give us different result? And since the meds they put me before my last D&C had no effect on me, will it cause me something like a scarred uterus or something else bad? And finally, since my husband and i are really planning to get ourselves checked, what test would you recommend we first do?

I'm really hoping for best! We really wanted to get pregnant and have a baby soon.. Thanks in advance!

Answer
Hello Jasmin from the Philippines,

Now that you have had three miscarriages, you have the diagnosis of "Recurrent Pregnancy Loss" and a specific evaluation for this is indicated.  There are several tests that are done to evaluate for possible causes.  They are too numerous for me to lay out in this answer but if you go to my blog, I have written extensively regarding this subject and you can find it there.  There are several causes of miscarriage including genetic, anatomic, immunologic, infectious, and hormonal.  These are the systems that are checked.  The most common cause of miscarriage is genetic abnormalities and the majority of genetic abnormalities are "spontaneous" abnormalities meaning that there was some chromosomal breakage or abnormalities causes at the time of the egg divisions and development.  The good thing about this cause is that eventually 85% of patients will have a successful pregnancy.  No treatment exists for this problem.

Starting progesterone (Duphaston) after bleeding has started as a "rescue" measure will not do any good.  If the reason for the bleeding is due to luteal phase defect, lack of progesterone in the implantation and early pregnancy phase, then the progesterone needs to be started right after ovulation.  Also Duphaston is not the best progesterone to use as it is a synthetic progesterone rather than a natural progesterone.  I would suggest a natural progesterone such as Prometrium, Endometrin, Crinone or progesterone in oil injections.  These also should be used VAGINALLY NOT ORALLY as that is the most effective way to take progesterone, except in the case of the injections.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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