What should I ask my obgyn?

[r2d2pink]

Hi there Ladies. So unfortunately I had my 2nd miscarriage a few days ago at 9wks. Hb had been detected at 7 wks although the foetus was measuring small (6wks). I ended up haemmoraging with a dash to A&E and an emergency D&C. I am due to go back to my obgyn next week for a check up and I was wondering which questions I should be asking her? I have the obvious ones: how soon for ttc, possible causes for mc, but I am not familiar with the process re investigating mc, monitoring future pregnancies etc I should probably add I have a history of thyroid disorder. What would be on your list?

[Jiltedjohnsjulie]

Sorry pink I've got nothing to add! just didn't want you to go unanswered. Hopefully someone will be along soon.

[Jiltedjohnsjulie]

Sorry about the exclamation mark, should have been a comma.

[r2d2pink]

Thanks Julie, I just know my mind will go blank during the appointment so I want to go prepared. I did find these questions on a website.

• Do you believe this miscarriage was due to hormonal or chromosomal/genetic issues?
• Is Rh factor something I need to be concerned about?
• Do I still need to be concerned about infection?
• How long will it take for my hcg levels to drop down to normal?
• Was there a chance to save this pregnancy if the progesterone had started a little earlier?
• Next time, will I need to be on progesterone from after I ovulate until 10 weeks?
• What do I do with the progesterone I have now?
• Am I more likely to have another miscarriage now? Do I have any risk factors that could increase my odds of having another miscarriage? How can I reduce my chances of miscarriage moving forward?
• Do I belong here or at my OB/GYN? What is correct course of action to take from here?
• Will you do the Day 3 and Day 21 tests? Do OB/GYNs not typically do these tests?
• What other blood work should I have done? Is there any other testing I need (HSG – normal, SA – somewhat low count, everything else looks good)?
• Did everything look normal with my uterus and tubes during the ultrasounds?
• How long do I need to wait until trying again? Is it ok to start trying again immediately?
• Will it take as long the next time? Am I more fertile now? For how long?
• How long will it take for my normal menstrual cycle to return? Will my cycles be different? Will the ovulation process continue as before?
• Is there anything else I can do to help increase my chances?
• Should I keep taking prenatals?
• Will I need to make sure to always track progesterone along with hcg in pregnancy moving forward?
• What should my progesterone be during pregnancy?
• Will I need to have frequent betas for the next pregnancy? Will I need additional monitoring?
• Do I need to call as soon as I find out I am pregnant again? Can an OB/GYN track progesterone?
• Are there any other recommended treatments to address the problem?
• Are there any dietary supplements to improve fertility?

As my obgyn is fairly new to me, I also want to get an idea of how experienced/proactive she would be in case of more miscarriages. Any questions that help with that would be great.

[Bakingtins]

r2d2 I'm very sorry for your loss. There is a standard protocol for investigating recurrent miscarriage but it is not usually triggered on the NHS until you have had 3 losses in a row. If you are already under consultant care then you may be able to access some of the tests now.
I'd particularly focus on your identified thyroid problem - were your levels tracked in the most recent pregnancy? You need an increase in your thyroxine as soon as you get a BFP and then regular (fortnightly) monitoring of levels. I have a good friend who lost a baby due to poorly controlled underactive thyroid, and was fine in her next pregnancy when it was monitored more closely.
I'd also ask if it's possible to have cytogenetic testing on "products" (sorry, horrible term) from the ERPC. It makes a big difference to whether you actually have an underlying issue whether you lost a baby due to a random chromosomal problem or whether for some reason you lost a potentially healthy embryo.
I outlined the RMC testing process and recommended some books in this recent thread which might also be helpful to you.

[r2d2pink]

Thanks Bakingtins, the link is very helpful. I am living overseas, and have private treatment. I was told that a thyroid test a month was sufficient, but I will ask again re more frequent testing.