Dear Dr. Marc,
Last year I had two pregnancies. The first was a missed miscarriage at 8 weeks and the second pregnancy we terminated at 20 weeks due to a rare condition called fetal CHAOS. My husband and I desperately want a child. Since out tx we have been trying to conceive. This upcoming cycle will be cycle number 6 for us. I just don’t understand why we are not getting pregnant. With both of my previous pregnancies I got pregnant on the first try. I am now thinking about asking for clomid and an iui. Do you think that at this point that is a good idea? I am almost 36 years old. How many cycles should I wait before doing this?
Thanks so much!
A
Hi A,
It sounds like you have been through quite a lot in the last year. Between suffering through a miscarriage, then being diagnosed with an incredibly rare syndrome like fetal CHAOS, I can understand your frustration.
The good news is that I believe you have an excellent chance to have a healthy baby! I also believe that it is time to start taking some active steps towards that goal.
First, the fact that you became pregnant 2 times last year bodes well for your future. This means that the sperm and egg are coming together and implanting in your uterus. Without these steps pregnancy is impossible. However, the fact that you haven’t conceived in the last 6 months might mean that something has changed with your husband’s sperm or with you eggs. It is worthwhile obtaining some preliminary ovarian reserve testing like an AMH level, or an FSH and Estrogen. Your general OB/GYN should be able to order these for you. It is important that the FSH and Estrogen are taken on the 2nd or 3rd day of your period, AMH can be tested anytime. You general doctor should also be able to order a semen analysis on your husband to be sure that his swimmers are okay.
Another test that is worthwhile is an HSG (Hysterosalpingogram). This test is best known as way to assess the fallopian tubes, but it also gives information about the lining of the uterus. After two losses, we want to be sure that there is no scar tissue in your uterus.
Further, it might be worthwhile to evaluate you for factors that could increase the risk of another loss. Not all experts would agree that you need an evaluation for recurrent pregnancy loss, but I personally believe that some preliminary testing is worthwhile. This is especially true if there were any genetic abnormalities like translocations discovered in your most recent loss.
While this testing is going on, I would recommend that you continue timed intercourse. Once everything is done, if the results are normal, I would definitely move to Clomid IUI.
Best of luck
Dr. Marc
