Will the NHS help me - what should I ask my doctor??!

[tryingnottoobsess]

I'm not sure if the NHS will help me... I have been ttc no.1 for 14 months, and have had 2 miscarriages in that time.

The GPs at my surgery seem unwilling/unable to help. They say I can't be referred for fertility problems because I've conceived twice, but I can't be referred for recurrent miscarriage, as I've only(?!) had two.

I've decided I've got to try again, and I'm going to go again on Thursday and be assertive, as the whole thing is driving me crazy.

Any ideas what I can ask for?

Am I fighting a losing battle asking for referral to a specialist? Can the GP surgery do any useful tests on us, or does anything significant need to be done by a specialist? (I've had day 21 progesterone, results fine)

btw, I'm 32, dh is 37, don't smoke, average weight, moderate alcohol, regular cycles, nothing unusual except luteal phase spotting which bugs me.

I know it could be worse, but I'm fed up and ready to take action!

Okay start at the beginning. On average it takes 13 months to conceive a child - so you are doing pretty well to conceive though like me you've lost two so it's not much consolation.

At what stage did you miscarry? This is important because when it happens can indicate the reason - early miscarriages are 95% genetic - basically the sperm or egg is faulty or the imbedding fails. I lost two before seven weeks - long enough to know you are pregnant and get excited but not really long enough for docs to do more than say 'ooh bad one' (They are not terribly sympathetic are they?)

The fact that you are ovulating is great. Has your DH had a sperm test though? He needs one to establish if his sperm are competent for the job (actually he needs two really to establish a median but go for one to start with).

You can ask to be referred for a second opinion. You can also ask to be referred to a gynaecologist about the luteal spotting. Bleeding between periods should be investigated in any case.

Personally I would get hold of Zita West's Guide to having a baby, have a look at the test info in there and also go see an acupuncturist - I didn't believe in it but it didn't stop me getting pregnant and maintaining that pregnancy (DD is 17 months and I'm pregnant with number 2 now too).

Stay positive, take your pregnancy vits and if you can see a different doc do so (make sure you take written info with you to leave with him - cycle lengths, miscarriage details, bleeding details etc).

It may be worth having a laporoscopy if nothing else works out, just to check out there is no reason embryos aren't implanting properly.

Hope that helps

Hiya, Thanks so much for replying, really helpful info. Similar to you, I lost both at 8 weeks, but they'd stopped developing around 6w... long enough to have to make up excuses why you're not drinking, but not long enough to be able to tell anyone the exciting news!

No, DH hasn't had his swimmers tested yet. Like you say, they seem to assume that if we've conceived twice that I'm ovulating and he's swimming. Will broach the subject with him and ask about it on Thurs.

Will also push for a referral on the basis of the luteal phase spotting. Think it might be more successful than pushing the fertility/miscarriage point, as they aren't classed as unusual.

I have temped on and off over the last year, so I can take my charts with me. and arm myself with a list of questions, including about laporoscopy, as the bleeding gives me a hunch it might be implantation related.

So pleased it worked out for you.... nice to hear a positive outcome from what sounds like a similar situation.

Hmm miscarriage at 8 weeks with six weeks development does point to a genetic problem - it takes ten to twenty one days for this sort of miscarriage to present (ie before you start to bleed). Basically the cells start to divide but then stop when they get to the point where the fetal poles start to develop. Now this can happen for many reasons, it can be pure chance. It can be that the sperm or eggs are in some way faulty - it can even be something as simple and environmental exposure to pollution which can interrupt the cell division. The point is, it's bloody hard to tell after the event.

But if you have a sperm test you can rule that out and also take action to improve things. My DH has low semen volumes but really high sperm levels, which means that the little blighters have no food or lubricating fluid to swim in. But we had two tests six months apart and between times I threw pills down his throat and hid the corkscrew (oh yes, your partner's alcohol is just as much as an issue as yours!) and we saw a big improvement and obviously we managed it.

Temping doesn't really show too much though - you are obviously ovulating if you are getting pregnant. You should ask also to have an early viability scan and to see and early pregnancy unit consultant when you do conceive next time.

In terms of the bleeding, yes it's possible it's implantation bleeding though if it's happening every month that's unlikely or you have a severe implantation problem - you need a blood test - sometimes for example a vitamin deficiency which can be corrected in weeks - can stop implantation happening.

Personally I'd go see a different GP - if you have a group practice find out which days your GP works and go on a different day. Or call up and ask to see a locum - if you can get a junior doctor they are often more easily encouraged to refer you because they don't want to fuck up and miss something .

You'll get there. Just keep on trying

Thanks again WMMC, you're really knowledgable... judging by how I've learnt stuff (hit stumbling block, try to find out why) either you're a healthcare professional or you must have really been round the houses with the whole fertility/mc thing. It really removes the mystery, doesn't it?! The thing I envy most about my friends who've fallen pg easily is their carefree attitude to the whole thing.

Sounds like you managed to influence your DH sperm count fairly successfully if you're on your 2nd pg. I spoke to DH last night about the possibility that he might have to w*nk in a pot soon, and he seemed fairly ok about it.

Definitely will ask for early viability scan and EPU consultant next time. And will try for a junior doc. We have a large group practise where you just see who's available, so I've seen 7 or 8 different GPs through the course of 2 pg & mc. Have noticed the younger ones seem more engaged and less 'hardened' (more scared of fucking up, like you say!), so will ask for a specific one this time.

Thanks again, your responses have given me plenty to work with and I'm feeling pretty positive about my chances, and also of getting a decent response at the docs. X

In answer to your question, I read a lot and ask a lot of questions. The thing is: there is not a lot of time in the NHS to explain stuff and so if you are smart, you find out as much as possible so you can ask leading questions.

Actually the whole semen sample thing is bloody hilarious. At our hospital you are given an appt and you have to submit your sample on that day, on that time, to the appointed microbiologist. The hospital doesn't have anywhere you can ahem donate so you can either do it in the local Sainsburys loo or at home. We did this. The thing is though, you have to get the sample in within 20 minutes of production and we live 25 minutes away. So you may well end up doing a drive by spunking

The way to deal with large group practices actually is to talk to the receptionists. Ask them specifically which docs are good at fertility - they often know who specialises or likes the subject - you'd be surprised what they let slip.

Finally the scratched record technique is good: I'd like a second opinion, I hear what you are saying but I'd like a second opinion. I'd feel more confident in what you were saying if we could get a consultant to rule out any other problems. Blah blah blah

LOL @ WMMC with the 'drive-by spunking'! Fortunately we lived pretty close the hospital, but sperm samples have to be kept at body temperature too, so my XH rode his motorbike over there with a container tucked under his armpit.

Ours went tucked into my bra! Which was fine except I flashed the waiting room attempting to retrieve the sample