Best option for MC that will get my cycle back to normal quicker

[Joleyjojo]

I am so upset having to write this. I had a chemical pregnancy the cycle before this pregnancy so to get to 7 weeks with strong tests, strong symptoms I thought everything would be great.
I went for a private scan and was measured 7+1 (yesterday Thursday)i track and know that would be accurate to the day. But the baby has no heart beat and the report says yolk sac not clearly seen. I couldn’t understand that if the baby is measuring correctly to the day why the heartbeat wasn’t there. It’s probably the case the heart stopped the same day before the scan. We are devastated. I have been referred to EPAU today (Friday) who won’t accept the private scan. So upset I will have to have another scan to give me the bad news all over again. I am 39 and fast approaching 40 so want to try straight away.
I have read different things about MC management. If I was to have surgical option is that a longer recovery to getting cycles back on track? What would be the best option for the least disruption to my cycle.
i can hardly open my eyes so swollen through crying. It’s 04.20am and can’t sleep. I had a tiny bit of brown spotting but literally only when I wiped. I just don’t know how to pick myself up, my heart just hurts xxx

I am terribly sorry for your loss. I had a MMC at 8 weeks and chose to go with d&c. My period came exactly 30 days after, and has been on track afterwards. However, I've been advised at the time to wait for 3 months before ttc again. Best of luck, OP.

I'm sorry for your loss. I've had 3 MMCs and had surgery for all of them. My period came back after 5 1/2 weeks, so just a little longer than usual for all 3. I was told by the doctors that I could TTC again as soon as I liked (they recommend leaving it until your period returns in case you get pregnant, it makes it easier to date the pregnancy). I don't think any one option makes your cycle come back quicker to be honest - waiting for it to happen naturally can take a while and you sometimes end up needing intervention anyway. Medical management is usually quite effective, but if it isn't you might need surgical management after. Surgical management is usually very effective but in some cases it might not clear everything and you might need a second surgery. It's a very personal choice.

So sorry to hear of your loss, I can only speak of my experience but I would say surgical management was most ‘efficient’ for me. I’ve had 2 mc, the first I tried medical management, assumed it had worked but turned out not so needed surgery, from start to finish it lasted 4 months, after the surgery my period came back 8 weeks later. My second miscarriage was natural but I had a small amount of pregnancy tissue left, tried medical management and pushed for a scan after to check if it had worked, yet again it hadn’t so had surgery again. That surgery was 2 and a bit weeks ago and I’m expecting my period in 2 weeks or so. So, in short surgery resolved things quicker for me.
It is a horrendously hard decision though, so I’m sorry you’re having to face this, ultimately go with your gut on what feels right for you at the time x

I’m so so sorry for your loss. All I can say about the pain you’re in right now is that I promise it will get easier. In the meantime be kind to yourself and take care of yourself.

I recently had a MMC diagnosed at the 12 week scan, had lost the baby at 8 weeks. I opted for medical management which I still feel was right for me, as I for some reason didn’t fancy surgery and wanted to be at home and didn’t want to TTC straight away anyway because of timings with a family wedding 9 months later, so if it took a little while it didn’t hugely matter in that respect.

I passed most of the pregnancy tissue etc straight away after taking the drugs, but I was still testing positive 4 weeks later and had some RPOC shown on an internal scan, but fortunately passed that in spontaneous further bleeding without further intervention. It meant it was 8 weeks between the MMC diagnosis and my first period. But I was tracking ovulation so know I ovulated 6 weeks post MMC, which was 2 weeks after the second bleed.

Ultimately everyone’s experience, even of the same approach, can be quite different, so I think you’ve just got to do what feels right for you. I know none of it will feel “right” when all you want is your baby though. Do whatever you think will help you move forward and heal in the quickest but also kindest way.

Just an update from me. The private clinic told me we had lost our baby I was referred to the hospital for MC management. The hospital did a scan and found a baby and a heartbeat and a yolk sack (the private clinic stated that couldn’t see a yolk sack either). The dates are about 6 days off so I am having a further scan on Friday. I am assuming the slight spotting was from the irritation of the internal probe. I cannot believe our little miracle was there all along. The private clinic was measuring a small chorionic gestational sac bump x

What a rollercoaster of emotions you’ve had! So pleased to hear about your positive scan and wish you so much luck with the scan on Friday! x

@Joleyjojo my god what a terrible thing to go through but so happy to hear your little baby has a heartbeat. All the best for Friday and please do keep us posted. Keeping everything crossed that all goes well ❤️ xx

Good luck @Joleyjojo.

I know this isn’t at all what you want to hear but I’ve just been through a very similar experience and it didn’t end well for me. Private scan showed I was measuring 7 days behind my (certain) dates, EPU scan a week later showed a week’s worth of growth, so progress and a heartbeat but still measuring behind. EPU told me everything was fine and I went home so happy.

But when I googled my scan measurements I could see that the yolk sac was enlarged and that’s basically always bad news. I had a further private scan with a doctor and she said it looked like a chromosomal issue - the hallmarks are measuring behind dates and yolk sac being big. Anyway the heartbeat stopped about a week later and I’ve just had medical management.

I really really hope this isn’t the case for you and it’s very common for dates to be out by a few days, but perhaps better to go for the scan fully prepared for all possible outcomes.

I am so sorry you have just gone through this. The private scan didn’t even find the baby and was measuring something completely different.
I am sure of my dates in terms of when I got my Peak fertility, however I didn’t temp so couldn’t tell you when I ovulated after peak. Also I am assuming implantation makes a difference. Potentially the scan is about 5 days out. How did you know the yolk sac was large? I haven’t seen any measurements for that.
did you have a further follow up scan or did you go for another private scan? which is when they told you?
I am apprehensive about the dating and still feel not out the woods, but do you ever feel you are 🤷🏼‍♀️. My worry is your scenario showing progression but not where it should be. I have read many stories about dates being out and then catching up. The thing is we never know what’s going to happen do we. Such an emotional time.
i am sorry again for what you have gone through. Xx

I am sorry for your loss.
I had a mmc at 12 weeks but as the EPAU handed me a tissue and told me to "go home and let nature take its course" we decided on a D&C privately, having heard some not so nice stories about NOT taking that option.
I actually then got pg 1 week later which I didn't even think was possible but DH told me he thinks the surgeon may have mentioned something about being very fertile after the procedure but he wasn't really paying attention - and God knows I wasn't!!!
It was fine physically but not great emotionally, having said that it all worked out ok in the end.
Best of luck x

@Joleyjojo it’s not possible for the dates to truly be out or to catch up on a normally developing pregnancy. Where this appears to be the case it’s actually due to sonographer error (there is a margin of error on the scans, and they can also just make a mistake) OR the dates weren’t certain anyway, usually due to late ovulation.

When did you get your positive test? If you assume you got it as early as possible, say 9dpo, count back 23 days from that (9+14 - as pregnancy dating assumes you ovulated on day 14 of your cycle) and then plug that date into a due date calculator, it will tell
you how many weeks you should be now, accounting for the latest possible ovulation date. If that date is more than 5 days different from the date showing on your most recent scan, that is likely to be problematic. If it’s still out but by less than 5 days it could just be within the scan margin of error.

Ultimately the only way to know for sure is to have more scans. The yolk sac should have been measured and recorded on your EPU scan report. If that is large for dates (you can Google the range), again it’s not good news.

The watching and waiting is horrendous and I spent so much time googling and looking for hope ultimately felt I wanted certainty as soon as possible.

Thanks for that. When I work out what you have said it works out 5 days difference.
I have checked my report and the size of the yolk sac isn’t documented, only that it is visible. The HeartRate isn’t documented either only that it has been seen.
I will see what they say on Friday. I can’t change the outcome so trying not to stress too much. X

Fingers crossed for you @Joleyjojo - good you don’t have to wait too long.

You should ask about the yolk sac size at your scan if they don’t tell you - I was surprised to find out that it is more predictive of miscarriage than seeing a heartbeat, and despite that and despite mine being large at my first NhS scan the sonographer was really positive and was telling me everything was great.

I will ask on Friday. I have had this week off work as feel so overwhelmed. I just want Friday here and out of the way. I am obviously praying and hoping for positive news, but equally if it isn’t I just want to know. That being said a positive result is only positive in that moment . I have never suffered with anxiety ever and I am now being hit with it like a train ! After what happened at the private scan I don’t want to go to any other private scan even though I really want to know what is going on after 4 days. Xx

@Joleyjojo it is really so awful - you truly have my sympathies.

I’ve had 5mcs now, but 4 of them were due to a medical condition that has now been treated, so I wasn’t expecting this 5th one, which seems to have just been bad luck. The limbo and repeated scans and appointments is really just the worst.

In answer to your original question, I would 100% go for surgical as it is all over very quickly and you have complete certainty that it has worked. With medical it can drag on for days and if it doesn’t work you end up in surgery anyway. I went for medical this time only because I’ve had surgical 3 times and there are risks with repeated procedures.

@Joleyjojo I’m sorry to hear what you are going through, and I hope things go well for you on Friday.

I have just been through a MMC with uncertainty as well. I was told by EPU at the first scan (6 weeks) that even though there was no heartbeat the pregnancy looked as expected and it was just too early, however I knew in my heart it wasn’t as I had no symptoms, and they confirmed at 7 weeks that although there was some growth still no heartbeat. I had to go back again at 8 weeks in case my dates were wrong.

I had surgical management under general anaesthetic on Friday. This is my second MMC and the first time I had 2x medical management plus surgical under local anaesthetic for retained tissue. There are positives and negatives to each one so I’ve given my views here in case you do need to make a decision:

Medical
Positives:

• can manage at home, don’t need to stay in hospital
• no scarring risk
• it wasn’t painful for me (although I believe it is for some people)
• EPU had a 24hour line I could ring for advice in the night

Negatives:

• higher chance of retained tissue vs surgical (I was told 10% vs 5% for surgical)
• Longer bleeding - they said around 7-10 days but was 4 weeks for me due to retained tissue

Surgery under local anaesthetic (MVA)
Positives:

• should only need to be in hospital for a few hours and procedure is only 15min
• should only bleed for a few days (but was 4 weeks for me, possibly still retained tissue)
• I was told there would be only “minor discomfort”
• lower risk of retained tissue than medical

Negatives

• I passed out mid procedure (I don’t think this is common though!)
• higher risk of scarring than medical
• I found it quite painful

Surgery under general anaesthetic
Positives

• no pain/memory of procedure
• lower risk of retained tissue than medical
• quick recovery - I felt fine after a couple of hours and went home. No pain at home
• only bled for 1 day after surgery
• lower risk of retained tissue than medical

Negatives

• in my hospital surgery is performed in the emergency operating theatre so I had to wait 8 hours at the hospital until the room was available
• slightly higher risks of problems under general vs local anaesthetic although risks still small, and slightly longer recovery in hospital
• risk of scarring (similar to local)

Hope this is helpful. I would choose surgical again in the future if I had to.
Assuming they are successful, I am not sure that any option brings your period back more quickly, I think it just depends on the individual.

Wishing you all the best for Friday and hope that you don’t need these options! I just know that I wanted the information beforehand so I could be ready with a decision if needed.