Well, it took me an hour and a bit to get there, and about 2 hours to get back (the first hour of which was sitting in traffic in a rainstorm), but it was a fairly satistfying visit. The nice nurse is very nice, and very sensitive - you couldn't really do her job and not be sensitive. She asked me if it was OK to talk about the miscarriages - I suppose you need to be prepared to talk about them to go along to an appointment like that, but it does tend to bring it all back. She also asked if we had "any little ones at home" and said if we had another miscarriage they'd do some analysis on "the little one" which made me cringe a little but apart from that, full points. She didn't say "oh, perhaps the second one wasn't a pregnancy" which I had feared.
I asked all my questions apart, I think, from the one about implantation - I am pretty sure I am right about the cramps, since they only started after the first miscarriage (and we were only trying to get pregnant for 3 months before the first pregnancy), and don't happen every month. I don't think our problem is getting the sperm to the egg.
So the story is:
Multiple clotting factor tests, including all the ones that were done before and then some, and lupus etc. - she distracted me while taking the entire arm's worth of blood from my useless vein (I must have been a junkie in a former life) by telling me about the house she is buying where the previous owner was proud of not having hoovered in 17 years. If any are positive they will recommend either aspirin or aspirin plus low molecular weight heparin once I get pregnant. She said she saw where the nice gynae was coming from suggesting I take it anyway, they don't really suggest it but she didn't sound like it could do any harm. They won't do the genetic clotting tests again.
There may be a spina bifida issue. My brother and father have club feet (spina bifida can cause this, or you can have it alone) and there was a question of a cousin with a dimple in her spine. She wants me to take 5mg folate if I get pregnant - she said no need to do it before. I think I may get a prescription just in case, as finding out I was pregnant on holiday, for example, would be needlessly nervewracking. This also counteracts the hyperhomocysteinaemia (MTHFR) so that would be sorted too if I have it.
If all the tests come back negative then they will ask me if I want to be entered into the NKC trial. Since the tests are due back just as my next (but one) period starts (in a month's time) I might be able to get the biopsy done for that in September or October. So it is not all that shabby - she even apologised that they weren't recruiting this month because of too many lab staff being on holiday. So they are only recruiting people who clearly have idiopathic recurrent miscarriage. It being a clinical trial and all. I think they do also recruit from elsewhere in the country, again with a diagnosis of IRM.
I think it is at that stage that they would do a uterine ultrasound too. I'm not entirely clear what they see when they do the laparoscopy, but I would have thought they'd see anything obvious - so I'm not massively worried about that.
They don't do progesterone supplementation - if you have oligomenorrhea they give HcG - but I'm too regular for that.
So, if I see those two blue lines I'm to ring immediately (do not pass go, do not ring Mr Spouse - OK, I think I can ring him!) and they will follow me up. I could, I think, have similar follow up in my local hospital - in fact, it turns out the nice gynae used to work in the Liverpool hospital, as a research registrar - but I think I might use it as an excuse to take more than the odd day off work. I am even thinking of asking if I can go part time for a while (most it can be is 2 months, right?) if (when! when!) I get pregnant again. It does seem as if supportive care is actually the best - and extremly succesfull - intervention for IRM.
I actually feel like there is a way forward - and I have also started to feel more positive about adoption. I don't feel the same urge to get and stay pregnant, though it would be nice. I think that our plan C* (apply officially to adoption agency 6 months after last miscarriage i.e. in November) could still work out, as it is highly likely all my tests will be over by then, and I don't really think IUI is that crucial for us any more.
Things that made me well up yesterday: Seeing an undergraduate student come in with her TWO count them TWO little girls who were both accidents and who mean she's taken 4 years so far to do two years of her degree. Seeing the "baby wall" at the RPL clinic and not believing I'm ever going to have a baby picture to put up there. And then hearing that my father-in-law, in his 80s, is in hospital with pneumonia. The vicar decided he needed to go to hospital, having called round to see them. Mr Spouse (who was also tearful, not surprisingly) is worried he won't come home, because he doesn't think he can. We also worry about my mother-in-law, who is a similar age but more hale and hearty, but who does not tend to go out on her own, as she lacks confidence, so is at great risk of getting very isolated.
*A having been "get pregnant quickly" and B being "OK, we forgot to mention the part about staying pregnant, so let's get pregnant again and keep it this time."