Jim and I drove to (undisclosed large city about an hour and a half away) yesterday to go to yet another specialist, this time the reproductive endocrinologist. We were a little nervous about what he might recommend, because we had pretty much decided that if he strongly felt that I needed the Lovenox injections, we were going to put babies on hold indefinitely, if not forever. Lovenox is very expensive, for one thing, and Jim's company recently made some fairly significant cutbacks. As Swistle has said, there is no perfect time to be pregnant, but there are certainly times that are not ideal, and an expensive pregnancy when money is tighter than ever certainly did not seem to be good planning.
However, there may be a baby or two in the cards for us yet, because the doctor seemed to think that the Lovenox recommendation was really jumping the gun for my particular situation, and that in this case the rewards would not outweigh the risks. He said that since my miscarriages were not consecutive, and both occurred very early on, they seemed to be indicative more of just bad luck than of a specific problem causing me to abort, like luteal phase defect or the blood clotting defect.
We really liked his demeanor- he seemed much less eager to jump to conclusions and say, "Oh, you had low progesterone? THAT is why you miscarried!" or "Wait, you also have this somewhat unusual blood clotting factor? THAT's making you miscarry!" Which is what the OB and the hematologist seemed to want to do. I think some doctors believe that the more definite and sure of themselves they sound, the more reassured the patient will feel. Honestly though, I feel more inclined to trust a doctor who doesn't act so confident about everything and who is willing to shrug and say, "Yes, we believe that x may be linked to y, but there's no definite proof that it's affected you at all yet, or that it ever will."
He pointed out that in certain people groups, this supposed blood disorder is actually found in up to a third of the population, but only one to five percent of them will actually present with any related symptoms. Given that information, plus the fact that I have had two healthy babies, I have never had a blood clot myself, nor has anyone in my family, it seems wisest to go with the least aggressive treatment method- i.e., go ahead and take the baby aspirin and extra folic acid, but nothing else at this point.
We ARE doing a few more blood tests, which I guess will indicate whether I am one of those few who are actually at risk for developing symptoms based on the blood disorder. If those come back positive he said he would recommend Lovenox after all, but that he really doubts they will based on my healthy history (the fact that I've actually been on bedrest on three different occasions, all while pregnant, which would put me at pretty significant risk for clots if I was in fact predisposed to them, yet I never have had one.)
What else? Oh yes, I'm supposed to take an antibiotic the first week of my cycle to possibly help with the preterm labor thing. I didn't really grasp everything he was saying about that- my mind was stuck on, "Oh thank GOD I don't have to give myself injections!"- but I think the gist of it was that there has been a link seen in women who have this latent infection and women who tend to go into labor too early. The infection never presents symptomatically in the mothers themselves, just seems to trigger contractions and dilation. So they've been treating women prone to preterm labor with this antibiotic for ten days before they ovulate to see if it might prevent early delivery. He admitted there isn't much data on its effectiveness yet, but said it's kind of like progesterone treatment, in that it can't hurt anything and it might help, so why not?
That's kind of our theory regarding Clomid, too, and the doctor concurred: no, I don't necessarily need the help ovulating, but I did carry my last healthy baby while using it, it does seem to boost hormone production, and it doesn't seem to affect me TOO negatively, so... why not? I'm on the lowest possible dosage, so the risk of multiples is still fairly low, and one we're willing to take.
To sum up, the new game plan is as follows: Still take Clomid, probably; take some antibiotic before I ovulate; take Prometrium as soon as I ovulate and then double the dose if I were pregnant; continue to take baby aspirin and folic supplement. BUT. No Lovenox. Whew.
Also, if you made it through this whole post without taking a break or clicking away in exhaustion, pat yourself on the back for being a very patient and noble person.