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Ultrasound is useful because it provides information about the number of pregnancies (multiple pregnancies are not uncommon after infertility treatment and should be looked for!) as well as their location. If the sac is not seen in the uterine cavity, then a tubal pregnancy should be suspected. The ultrasound provides information that is complementary to that of the HCG level. Often both need to be done simultaneously and interpreted together.
What about do's and don'ts during pregnancy? What precautions should you take to minimize your risks? Unfortunately, there is little anyone can do today which is of much use. During pregnancy, most doctors may put you on supplemental progesterone injections (to help support the endometrium); and perhaps multivitamins; and low-dose aspirin. All this treatment is empiric - there is no proof that it works! Also, many patients will put themselves on bed-rest to prevent disturbing the pregnancy but the value of this is doubtful as well. If the pregnancy is going to have a problem, no matter what you do, it will. And if it is going to be uneventful, then you don't really need medical attention in any case. The trouble is we do not know which pregnancy is going to have problems and which one is not! Any bleeding, no matter how slight, should be taken seriously - and usually calls for hospitalization.
Unfortunately, it is a fact of life that 10% to 20% of all pregnancies will end in a miscarriage - and the risk of an infertile woman's miscarrying is even higher. This is because they are often older; their medical problems which caused the infertility can also cause miscarriage; and sometimes the infertility treatment also increases this risk. Of course, some of the increased risk is only apparent, because the testing is so intensive and thorough.
Unfortunately, no treatment exists for preventing early miscarriages - and all the doctor (and patient) can do is wait and watch. This can be shattering! Nevertheless, the fact that you have got pregnant provides hope for the future.
If the pregnancy miscarries, then curettage is needed. This tissue must be sent for histopathologic examination, to provide documentation of the pregnancy. This also helps to rule out an ectopic pregnancy.
Coping with miscarriage after a long duration of infertility can be hell! When you finally get pregnant after so many years of trying, you feel it is cruel on God's part to then snatch it away. In fact, perhaps the only trauma worse than not being able to conceive is to lose a pregnancy after trying so hard. Remember that nature is not perfect and neither is medical care. The most painstaking attention to detail cannot stop the unexpected from happening and no amount of obsession with detail will guarantee a perfect outcome.
If you miscarry, you are going to blame yourself - that it was something you did (or did not do) which caused the miscarriage. However, remember that 70% of miscarriages are because of a chromosomal abnormality at conception - something over which you have no control.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
