Recurrent Early Pregnancy Loss - 2 - Hormonal Causes

93 Comments:

• At Wed Apr 04, 09:57:00 AM 2007,  Elechi said…

  hi ,i have just read a lot of what you said about early preganancy loss, am very interested to find out more on hormonal imbalance as a cause of miscarraige in early pregnancy,yesterday i had an evacuation after the doctor discovered i had some internal bleeding and found no development in my prgnancy after six weeks,that was my first pregnancy and that resulted as a result of my taking clomid as i was not ovulating also my period has been irregular since that started at about the age of 14-15 when i say irregular i mean that i go sometimes for about 3 months without a period! and was on duphastion to bring on a period before i could take my clomid treatment,it was also discovered after my miscarriage that i had rhesus negative and i was given an injection for this...i am desperate to find out what the chances of a miscarriage happening to me and is my case a rare one?thanks i would appreciate comments on this..elechi

   

• At Tue Apr 10, 12:40:00 PM 2007,  Anonymous said…

  Hi, I have also just read your post after desperately searching the internet for some explanation as to what is causing my recurrent early pregnanct losses. I have been on the pill (microgynon) for the past 10 years (now 30 yrs old)and came off it in August. I had 2 regular periods then fell pregnant in oct/nov. I began bleeding at 5 weeks and went on to completely miscarry. I became pregnant again straight away with no period in between. I started bleeding again at 5/6 weeks. I then became pregnant again straight away with no period in between and this time started bleeding at 7 weeks (although I went for early scans and pregnancy was developing 2 weeks behind what i knew it should have been). i went on to miscarry at 12 weeks (it was only the size of 7 weeks pregnancy. I have had the routine blood tests and am awaiting results, however I am convinced this is hormonal. Although my periods are regular (to the day)I never get any pain(absolutely none whatsoever) and get no PMT symptoms either. I am extremely interested in your comments re this situation and likelyhood of this being hormonal, and how you think progesterone supplements may be able to help my situation. Any help much appreciated.

   

• At Thu Apr 19, 04:13:00 PM 2007,  Anonymous said…

  I am 6wks. I have been told that I have a polyp on my cervix. I have also had an infection which I have been treated with antibotics. I have having some bleeding and the morning sickness also. I have been losing weight instead of gaining and I feel sick all the time. I am so worried I need info on cervical polyps durning pregnancy. PLEASE HELP ME I AM SO UPSET!

   

• At Thu Apr 26, 05:33:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Thank you all for reading and for your questions.
  
  Elechi, in view of your menstrual irregularity, it is highly likely that you are ovulating very irregularly if at all. There could be many causes for this that may be affecting your ability to carry a pregnancy through first trimester. I would recommend that you find a specialist in Reproductive Endocrinology and Infertility (REI) to begin a thorough evaluation and to develop a sensible plan to optimize your chances for a successful pregnancy
  
  For anonymous, if you are having regular, cyclic menstrual periods, and are healthy, it is highly unlikely that you have a significant "hormonal" problem. Consider reading my series of posts between 3/25/2007 and 4/14/2007 and especially the last 3 which addressed evaluation and therapy for patients with recurrent pregnancy loss. It is highly likely that your losses have simply ben the result of 'naivete' of your immune response to pregnancy and I will bet right now, the outcom will be better the next time around. certainly there is no contraindication to supplementation with a 'natural progesterone' product during the luteal phase and in early pregnancy and I actually make that part of my 'empiric therapy' offering to patients as something 'safe' and potentially beneficial (see post 4/12/2007). Good luck, and if things don't work out the next time around, I would recommend a more thorough evaluation.
  
  With regard to the cervical polyp, if yours does not have a wide base, it can probably be easily (and safely) removed during the pregnancy. If you are having bleeding from the polyp, it is probably contributing to your "vaginal infection." Blood raises the pH of the vagina and incresaes the risk for overgrowth of less favorable bacteria. Although the polyp is probably not cancer, it should be sent for pathology if it is removed. Ask your doctor about the nausea and weight loss. You do not need to gain a bunch of weight in early pregnancy, but you do need to maintain your fluid and electrolyte balance. Have you tried a little extra vitamin B6 and the over-the-counter sleep med called Unisom? They are both very safe to take in early pregnancy. Hope things go well!

   

• At Mon May 14, 01:36:00 PM 2007,  NYCaren said…

  I have had 11 (some doctors say more)m/c's. 1 ectopic, 1 blighted ovum, and all the rest were under 3 weeks. I got my period when it was due, and if I didn't go in to get a blood test, I would have never know I was pregnant. Home PT's don't detect it. I've been on progesterone suppositories 90mg's. I took 3 a day and then went into have an endometrial biopsy. My linning came back on day 15, when the test was taken on day 24. Now after 11 years of m/c's, my period is coming every 30 days (that has never changed) but now I'm bleeding inbetween my period. Some days it's red and others it's a dark brown, like when I m/c. Usually I know I'm m/cing if I bleed for longer then 4/5 days. I've tried clomid, estrogen, hcg injections and months of progesterone. Never have I gotten pregnant on those drugs. I only do it on my on, only to m/c a few weeks later.

   

• At Wed May 16, 06:48:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  With your history, you not only need to see a specialist in Reproductive Endocrinology and Infertility, but possibly one with a special interest in recurrent pregnancy loss. There are too many possibilities in your case to even begin a discussion here! I would encourage you to read my whole series on "Recurrent Early Pregancy Loss' to get a feel for what needs to be done.

   

• At Sat May 19, 06:42:00 PM 2007,  Anonymous said…

  In the past 4 years i have had 3 miscarrages, all with the same bf. OThey were at 6 weeks, 10 weeks and again at 6 weeks. It is weird too, beacause, I must be getting pregnant pretty well the same time each year, my due dates, were feb 22, feb 20 and march 6th. I have had all the blood tests, and chromazone tests, and my bf has as well. The only thing I am waiting for now is a dye test. It takes along time to get in, they tell you to call back everymonth, I am getting stressed out. My docter told me just to keep trying. It is now may 19th, and I am trying because I got pregnant the last 3 times, at this time. I don't know what other tests to get done, i think i have had most of them, I just want to have a healthy baby, I am 31 and n ot getting any younger, anything more I can do??

   

• At Mon May 21, 10:19:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Hi. With regard to your questions regarding what else could be done from a diagnostic and therapeutic standpoint, see my posts on evaluation of recurrent early pregnancy loss (http://www.healthline.com/blogs/pregnancy_childbirth/2007/04/recurrent-early-pregnancy-loss-9.html) and on 'empiric therapy.' (http://www.healthline.com/blogs/pregnancy_childbirth/2007/04/recurrent-early-pregnancy-loss-10.html). You might also consider seeing a specialist in Reproductive Endocrinology and Infertility if you are not already. Good luck with things!

   

• At Wed Jun 06, 12:46:00 AM 2007,  Anonymous said…

  Hi Dr. Trofatter,
  
  I'm wondering if you can help me. I am 27 years old, and recently had a saliva hormone test because I have not mestruated in the last five months (pregnancy has been ruled out). The results were abnormal - my Estradiol level was 1.1 (Range 1.0 - 9.0) and my Progesterone was 10 (Range 25 - 250). I am wondering what is going on with my body and WHY I would have such abnormal results.
  
  I am in generally good health, exercise on a semi-regular basis and have about 20 % body fat (I am lean but not that lean which would cause absent menses). I starting menstruating when I was 13 and have always had irregular periods, excessive blood loss, pain etc. When I was 21, I was diagnosed with Endometriosis via laparoscopy. Since my diagnosis, I have been on the pill to help regulate my periods and decrease bleeding. However, I notice that whenever I am on the pill (I've tried several different kinds), I experience very severe bloating and will gain 3-5 lbs. I stopped taking the pill last year, tried it again in November 2006 (with a different brand) for 2 months, and because of severe side effects, I just stopped taking it altogether. My last period was the end of January. My gynecologist induced my period at the beginning of May with Medroxy-progesterone and I did have one. She wants to put me back on the pill but I don't want to because of the side effects and bloating (I really feel quite sick and very uncomfortable because my abdomen swells like a balloon). I am more interested in finding out WHY I haven't menstruated, WHY both my hormone levels are so low and WHY I have such severe bloating and side effects when on the pill. What could be causing this? I am scared I may be entering pre-menopause or that I might be infertile. I just got married last month and would like to have children eventually (not for a few years) and it would help to know what you think is going on with my body and what you recommend I do. Please let me know - any information is appreciated. Thank you so much
  
  Jasmine

   

• At Wed Jun 06, 10:42:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  You are not menstruating because it appears that you are not ovulating on a regular basis, if at all right now. And, I am also concerned that your estrogen levels are so low. (I am not worried about the progesterone right now, because progesterone only gets made after you ovulate). I cannot tell at this point whether you might have a deficiency in the production of the 'gonadotrophic releasing hormones' made by the hypothalamus in your brain (hypothalamic amenorrhea) or whether this could be 'premature ovarian failure.' In either case (hopefully neither is the problem), I strongly suggest that you see a specialist in Reproductive Endocrinology and Infertility. You may have to rethink your plans about trying to get pregnant, but they will be in a better position than I am to evaluate and advise you accordingly. Good luck and thanks for reading!
  
  P.S. Sorry I did not address the "bloating" and birth control pills, but I think these other issues are more important for you at this time.

   

• At Thu Jun 07, 08:12:00 AM 2007,  Anonymous said…

  Hi, wondering if you can diagnos what my problem might be. I am 26 years old, have had very irregular cycles, it goes as much as 35 days in between my cycles with 7 days of flow. I once was diagnosed with dysfunctional uterine bleeding, my period flow was very heavy at the time and flowed in between two cycles. This has become a recurring problem as i most times bleed in between two periods. Furthermore,my PMS is really serious, it makes me throw up most time on my period. I will also like to add that have only been pregnant once in my life and that was about 7years ago. I had a D&C when i realised i was pregnant because i did not want to have the baby at the time. I have been trying to get pregnant for the past one year and i suspect that i may have been having miscarriages. This because when i have one of those very delayed cycles (of up to 36 days) my period on starting is very brown and sometimes has a very offensive smell. When it flows for a while it then normalises. This has happened for a couple of times. Please help i really need to have a healthy baby.

   

• At Mon Jun 11, 12:40:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Hi there. With the irregular periods and now the spotting between periods, you may not be ovulating at all at this time. If you are truly interesteed in getting pregnant, I strongly suggest you get either a good general OB/GYN or a specialist in reproductive endocrinology and infertility (REI) to help you. The odor you are having may simply be the result of the bleeding. Blood changes the pH of the vagina and this allows the nastier bacteria with which we are all colonized to take over and replace the healthy Lactobacilli bacteria that are supposed to present in the vagina. However, other problems may also cause the smell and these could be more serious. So again, get yourself a doctor, girl! Thanks for reading and good luck!

   

• At Thu Jun 14, 07:11:00 AM 2007,  Julissa said…

  Dr. Trofatter, I'm 27 yrs old with one healthy three yr. old and for a year and half I have been trying to conceive. I have always been irregular (sometimes 3 months without period) and for most part have been on birthcontrol since I was 18. I was diagnosed as being anovulatory due to my missed periods and prolactin results and my OBGYN prescribed prescribed progestone tablets, clomid (5-9) and metformin last year. In Nov 06 I had a D & C for a blighted ovum. I was 10 wks, but growth was around 5-6 weeks. I used the same meds to get pregnant again but again miscarry @ 5 weeks in late May. With my last pregnancy I started progesterone suppositories within a week after receiving a positive pregancy test. I recently was prescribed Clomid, estradiol and progesterone suppositories. And I also had blood drawn for a complete analysis (awaiting results). My question is @ this point do you think I should be seeing an RE instead of my OBGYN? Also, would you recommend the 5-9 routine for Clomid or do 3-7? Do you know of any women that have been successful with the clomid, estradiol and progesterone? Thank you.

   

• At Fri Jun 15, 08:40:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Julissa, I know this will make you OB/GYN doctor angry, but if you do not concieve successfully in 3 or more cycles on clomid, you probably should find yourself a good REI doctor for both evaluation and treatment. With the elevated prolactin levels, there could be more going on than you are aware of. The REI folks are so sophisticated now,there are lots of things they can do to help. And after you get pregnant, they will send you back to your OB/GYN to care for you during the pregnancy!

   

• At Fri Jun 15, 09:37:00 AM 2007,  Julissa said…

  Thank, Dr. Trofatter for the quick response. I will surely heed your advise if not successful the third time around.

   

• At Fri Jun 15, 12:57:00 PM 2007,  Anonymous said…

  I KEEP HAVING M/C (06/06,01/07,04/07)I HAVE STARTED PROVERA 10MG,PRENETAL PILL,BABY ASPERIN 81MG ALL ON CD14-28.IS THIS RIGHT FOR A LUTEAL PHASE DEFECT?WONT THE PROVERA STOP ME FROM OVULATING?I GET PREGNANT BUT ONLY GO 4 DAYS AFTER PERIOD ID DUE THEN HERE COMES THE M/C.PLEASE HELP

   

• At Sun Jun 17, 04:34:00 AM 2007,  Anonymous said…

  Hi,
  
  I have been reading your articles on early pregnancy loss and am hoping you might be able to shed some light for me.
  
  I am 28 years old, have always had regular periods with 28 day cycles. I have had 2 abortions, 1 when i was 14 and the other when I was 22. I gave birth to a beautiful baby boy 6lbs 6ounces in sept 2004 after a text book pregnancy. My husband and I are now trying for our second baby and have miscarried twice successively. I do smoke, and did while I was pregnant with our son, and after reading your comments on smoking and pregnancy, I have decided to quit as having another baby is much more important to me than killing myself slowly.
  
  The first miscarriage occurred at 6wk 3d and the second miscarriage occurred at 8wk4d, however, an early ultrasound at 7wk3d revealed a healthy heartbeat.
  
  I am just wondering, could the smoking alone have caused both miscarriages or would/could there have been another cause either on its own or in conjunction with the smoking?
  
  I would appreciate your thoughts on this.
  
  thanks
  Flip

   

• At Tue Jun 19, 04:17:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Flip, I do not think you are at the point that you need the mega work up for miscarriages. I have had several women over the years who only successfully carried a pregnancy after they quit smoking. I know that is not a big problem for most women, but some may not handle the toxins in tobacco as well as others. With your two early losses, however, they fit a patten more consistent with chromosomal abnormalities that just couldn't make it through first trimester. I would suggest that you quit smoking, start on a prenatal vitamin and some extra folic acid, start taking one baby aspirin a day and try again. If you miscarry one or two more times after that, then you should get a more extensive evaluation! Thanks for reading and best of luck. By the way, if it works, you don't need to name your child after me!

   

• At Tue Jun 19, 04:53:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous from June 15: That is a very unusual treatment regimen for a luteal phase defect. Several questions - How do you know that you have a luteal phase defect? Do you have a doctor helping with the treatment? The times you "miscarried", did you actually have a positive pregnancy test? What other evaluation have you had for miscarriages - I am presuming there were others before the three you mentioned?

   

• At Mon Jun 25, 01:21:00 PM 2007,  Julissa said…

  Dr. Trofatter, I'm back again. I just got the blood results from my DR and I'm a big perplexed. Any info that you could provide would be most helpful. I have a slightly elevated APTT (53H) and PTT (41.3H) My OBGYN referred me to my primary care physician, but should I see them or a hemtaologist. I don't know what it means and my DR obviously doesn't I'm just frustrated. What can you tell me about these tests? Thank you.

   

• At Wed Jun 27, 05:32:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Julissa,
  I reviewed our previous correspondence and you current inquiry. The elevated PTT indicates that you may have a "lupus anticoagulant" in addition to your other problems. This was one of the first "autoimmune" abnormalities identified that is associated with recurrent early pregnancy los. If you have this, you could have other antibodies that might affect the success of your pregnancies. Please read my posts related to immunity and pregnancy loss that are included in this series. My previous advise still holds. Find yourself a specialist in Reproductive endocrinology and Infertility who has an interest in recurrent early pregnancy loss. I think its time to stop beating around the bush! You do NOT need a primary care doctor of any sort for this problem at this time. Good luck and thanks for the follow-up!

   

• At Wed Jun 27, 07:16:00 PM 2007,  Liz said…

  I have recently suffered through my second miscarriage. FIrst loss was at 9w, development stopped at 7-8w, second loss was at 8w, development stopped at 6w. With both pregnancies, we have detected a very slow fetal heartbeat. Due to low basal temps, I suspected a progesterone deficiency, so I went for testing with this most recent pregnancy. At 6 days past ovulation (and pregnant), progesterone was 6.2. At 11 days, it was 12.4. At 17 days, it went down to 8.3, and they started me on progesterone. HCG continued to at least double until day 25, when it did not double anymore. We also found a subchorionic bleed at 4w 5d. I have had a normal live birth, uncomplicated, when I was 34. I am now 38 and find my inability to carry past 9 weeks heartbreaking. I am going to see a RE, but I was interested in your thoughts. Thank you for this series - I have found it very helpful. Liz

   

• At Thu Jun 28, 08:26:00 AM 2007,  Julissa said…

  You're right. I am being around the bush, kind of nervous. Scheduled my RE appt - July 13th :) Thank you!!!!!!

   

• At Thu Jun 28, 06:25:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Hi Liz. Sorry for your losses. With age, you might have developed a luteal phase deficiency. There is also a chance the babies were simply chromosomally abnormal, but I suspect the former. Since your 'biological clock' is running down, I agree with your plans to see an REI specialist in the near future. There are other medical problems, such as thyroid disease that also increase with age, bbut a good REI will evaluate from top to bottom (literally and figuratively!). Good luck, thanks for reading and for your kind comments.

   

• At Thu Jun 28, 06:33:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Go for it Julissa, and let me know how things turn out!

   

• At Mon Jul 02, 03:25:00 PM 2007,  Anonymous said…

  hi there, thanks for this site, very helpful. i have had 2 early miscarriages now. we just began trying to conceive this past december. before that i was on the pill. i am 26 years old, my husband is 31 and we no children. i got pregnant in early february and lost it at about 5 weeks 5 days. i miscarried naturally, waited a cycle, and then got pregnant again in april. i miscarried on april 25th at 5 weeks 3 days. my dr. did the anti-coagulant panel and thyroid testing...now he is just thinking i have had a couple of flukes. we are ttc again now (i waited 2 cycles this time) and i am taking 81 mg. asprin daily, a prenatal vitamin (have been on this since feb) and 200 mg oral progesterone (prometrium) post-ovulation. what do you think my chances of having a normal pregnancy next time around are? what will the progesterone do for me? i am completely freaked out even though all my tests came back normal. they just seem too similar to be flukey. thanks for your insight. -mmp

   

• At Tue Jul 03, 11:15:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous July 2: That medical regimen is purely empiric, but that's where I would start too! You might consider throwing a little extra folic acid (2-4 mg) into the mix as well. The progesterone is being used to help 'support' the pregnancy early on in case you have a 'luteal phase deficiency' and don't make adequate amounts of progesterone on your own. If your pregnancy is successful, you can stop taking that by 12-14 weeks since the placenta will be making plenty of progesterone by itself by that point. If you are not successful this go-around, consider a very thorough evaluation (see one of my last posts in this series on that subject) before moving forward again. Fortunately, it appears you have no trouble getting pregnant, so things should eventually go well for you! Best wishes and thanks for reading.

   

• At Mon Jul 23, 08:56:00 AM 2007,  jennifer w said…

  Hello. I have just had my third miscarriage in two years. I had one in March 05 that ended at 6 weeks. I had one in March 07 that ended at 6 weeks where I had normal hcg values of around 2500 and they suddenly started dropping and Imiscarried. I just got pregnanct again july 07 and had a very early miscarriage. I took a test two day after missed period and got a positive result. Two days later I retested to make sure and there was nothing, no second pink line. All breast tenderness went away and I am now starting my period. I have a history of very regular cycles. After the miscarriage in March 07, however, I have been having lots of ovulation like discharge nearly every day of my cycle. This past cycle it lasted from day 6 to day 22 and is stringy and stretchy like ovulation discharge. It was very heavy at times, seemingly with no rhyme or reason. I was wondering if this discharge could indictae a problem hormonally or what else might be causing these early miscarriages. Thank you!!

   

• At Mon Jul 23, 10:09:00 AM 2007,  Jennifer said…

  I forgot to tell you I just turned 30 and I had two successful pregnancies at ages 22 and 25 and then the miscarriages began. Thanks for your input!
  Jennifer

   

• At Mon Jul 23, 10:45:00 AM 2007,  jennifer said…

  Sorry! It's me again!! I forgot one last bit of info! The pregnancy in March 05 was chemical, no sac on ultrasound. The pregnancy in March 07 there was a visible sac and fetal pole. This recent one I am assuming is chemical because it had such short duration. I promise this is my last post! :)Jennifer

   

• At Mon Jul 23, 08:51:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Jennifer July 23: Well, Jennifer, one thing you did not tell me is if the father of your children is the same as the person who fathered the pregnancies you have miscarried. Also, have you developed any medical problems, gained much weight, become a smoker or anything else since you've had those babies. Have any other family memebers had recurrent miscarriages on either side. Have you ever been screened for any pelvic infections or had an abnormal Pap test. I am concerned that the change in "discharge" does indicate some condition that is interfering with either conception or implantation. It could be "hormonal" but it is more likely to be fibroids, a uterine or cervical polyp, endometriosis, or some other source of cervical or intrauterine inflammation. Thanks for your question and why don't you raise these concerns with your doctor as a starting place for evaluation of your recurrent early pregnancy losses.

   

• At Tue Jul 24, 08:06:00 AM 2007,  Jennifer said…

  Hello! Thank you so much for your reply!
  Yes, the father is the same. No, I do not smoke, drink, or use drugs. My weight hasn't changed. I weigh 105 and am 5'1. I do not have family members with a history of miscarriages. I can't think of any significant health changes other than I had inguinal hernia surgery in 05.
  I have never had an abnormal pap. However, right after the miscarriage in March 07 they did an exam because I was having intense pain and cramping and I had endometriitis. I was treated with antibiotics and the pain went away so I assumed all was well. The discharge did start some time after that, I just can't pinpoint it because it was less persistent. I can remember right after the miscarriage wondering if I was having some sort of super ovulation or something though because of the amount of discharge. It seemed like it was not happening every day then, however and I thought it was cyclic.
  Also, I was treated for a sinus infection with antibiotics in May. Maybe this caused some sort of imbalance in bacteria growth?
  The only other thing that has been different than normal was that at my last menstrual cycle I was having weird cramps. They felt very different than normal like they were targeted right on my ovaries and were very rhythmic. It was a different sort of pain than regular cramps, but subsided after my period was over. I also had intense lower back pain for four days before the period began. That is also new for me.
  I did call my doctor last week and they said the discharge was normal as long as it did not have an odor, itch, or burn. I think I will call and get an appointment now. though.
  Sorry for the overload of info!! I really appreciate all your insight!
  Jennifer

   

• At Tue Jul 24, 07:03:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Hello again Jennifer! From your description, I am now more suspicious than ever that this could be endometriosis/adenomyosis adenomyosis is endometriosis in the uterine muscle itself). Our infertility specialists believe that this could be a major, unrecognized cause of recurrent pregnancy loss. I am very curious how things will turn out in your case, so please let me know. Best of luck and regards!. Dr T

   

• At Sat Jul 28, 10:22:00 AM 2007,  Anonymous said…

  My daughter has a beautiful healthy 2 1/2 year old daughter. Last October she miscarried at 7 weeks. She recently found out that she was expecting again. She went to her doctor at 6 weeks and the gestation sac looked good. 3 days later she had a brownish discharge and the following day was bleeding. She went to see the doctor and the gestation sac appeared small for 7 weeks so they feel she is miscarrying again. Should she ask to be tested for hormone levels. Except for morning sickness and a really tough delivery (which ended up being a c-section after 28 hours) her first pregnancy was a good one.

   

• At Mon Jul 30, 05:20:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous July 28: She could be miscarrying again. There are lots of different reasons (including simply 'chance' chromosomal abnormalities) that things have not worked out the last two times. The best thing she has going for her is that she has already carried one pregnancy successfully. If she loses this baby, she should discuss her diagnostic options with her doctor. They may choose to do nothing further until she tries again. If she has had a previous c/section, though, they might consider performing a sonohysterogram or looking inside her uterus with a hysteroscope before she tries again. Some women who have had a c/section will have some scarring inside the uterus or will have developed a submucosal fibroid that acts as a site for chronic inflammation and decreases the likelihood of a Thanks for your question!

   

• At Tue Aug 07, 08:33:00 AM 2007,  Anonymous said…

  Hi, I am 40 years old and have 2 children who were born via C Section. My periods have been irregular for as long as I remember although, it has become more irregular in the past few years. I get a period once every 40+ days, sometimes even longer. I had an IUD in place for 6 years 1999-2005. Shortly after the IUD was removed I became pregnant only to have a "missed abortion" at 6-7 weeks. I became pregnant again in July and had another "missed abortion" and again a month ago another. A total of 3 "missed abortions" in 18 months all around 6 weeks, all which a D & C was used. I had a chromosonal test on the last "missed abortion" only and it was found "normal." I have an appointment with a specialist and I would like to know if there are certain issues that I should bring up or certain tests that I should request. Also, in your experience, what do you think about my situation?

   

• At Wed Aug 08, 06:39:00 PM 2007,  Anonymous said…

  Hi. I have a concern. I am about 6 weeks pregnant and started spotting yesterday and then bleeding today. I am concerned because I lost one baby last year. that was my first miscarriage. I have 4 healthy children by my late husband. He was also the father of the 1st m/c. now I am suspecting that I am losing this one. This one is by my current bf. He believes that he is O- and I know that I am A+. the 1st m/c was at 8wks. but I am concerned that the rh factor could have something to do with this one. any ideas or suggestions? I am suppose to go to the doctors again on Monday but am concerned that this may not hold until then.

   

• At Sun Aug 12, 06:34:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Aug 8: No, I am afraid it doesn't sound good. You didn't mention how old you are or if you have any medical problems. However, it is highly likely the miscarriage you had with your late husband after having 4 children was the result of a baby with a chromosomal abnormality. That is the most common cause of isolated miscarriages in women who have had children with a partner. The current problems could, again, be the result of a baby that has a chromosomal abnormality, but it could also be simply the result of having a new partner. Your immune system may have to get used to the differences between you and the new partner so that you can succesfully carry a baby with hime. Sometimes a single miscarriage takes care of that. We do know for example that women with new partners are also at greater risk for developing preeclampsia and that may be related to the same thing. If you would like to learn more about that, check out the series I wrote on "Hypertensive Disorders in Pregnancy." Thanks for reading and for the good question! Dr T

   

• At Mon Aug 13, 06:57:00 AM 2007,  Anonymous said…

  Hi, I am 40 years old and have 2 children who were born via C Section. My periods have been irregular for as long as I remember although, it has become more irregular in the past few years. I get a period once every 40+ days, sometimes even longer. I had an IUD in place for 6 years 1999-2005. Shortly after the IUD was removed I became pregnant only to have a "missed abortion" at 6-7 weeks. I became pregnant again in July and had another "missed abortion" and again a month ago another. A total of 3 "missed abortions" in 18 months all around 6 weeks, all which a D & C was used. In all preganancies we heard a heart beat. I had a chromosonal test on the last "missed abortion" only and it was found "normal." I have an appointment with a specialist and I would like to know if there

   

• At Tue Aug 14, 05:33:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Aug 13: I am glad that you have made an appointment to see a specialist. Fertility decreases with age for reasons that are not completely understood. In some cases it is simply the increased risk for having a chromosomally abnormal baby; in some, it is decreased production of hormones; in others, thet might have developed an intrauterine fibroid or polyp; or, you may have another medical problem that has not been identified. If your periods are irregular and becoming moreso, we already know that you have a hormonal problem of some sort. (By the way, is the father of the miscarriages the same as the father of your children?) There are so many things that need to be checked out ASAP at your age that I hope the specialist you are scheduled to see is a Reproductive Endocrinologist. There is no sense beating around the bush at your age. Incidentally, you might want to check out my post in this series that discusses "Hormonal Problems and Recurrent Early Pregnancy Loss." Best of luck, thanks for reading and hope things turn out well for you. Dr T

   

• At Wed Aug 15, 07:06:00 AM 2007,  Anonymous said…

  Hellow Dr. T,
  It is August 13th...The father of my second child is the same. I understand that my age is a factor. I know that it is no unusual to have a child now in the 40s. What do they usually recommend as far as testing for a person in my situation? My regular MD did some testing on me last year and my progestrone was just slightly above what is the range of normal. I am able to get pregnant so quickly, but is it possible that my eggs don't produce enough hormones to sustain the pregnancy? Do the Dr. need to suplement my pregnancy with some meds? Perhaps if they would have given me some meds, mypregnancies would have gone fine? Three miscarriages in a row are such difficult experience to go through. It makes me feel like my body is letting me down in a way. Thank you so much for taking the time to answer us women. You are one of a kind.

   

• At Wed Aug 15, 03:27:00 PM 2007,  Anonymous said…

  Dr. Trofatter - I wrote you back on June 27th regarding my second miscarriage and you suspected a luteal phase defect. I recently had an endrometrial biopsy. The tissue came back saying that it was Day 24-25 of the cycle. Now, my normal cycles are 31 days, and the biopsy was actually done on Day 41, post D&C. Now, I know that I was still getting positive pregnancy tests as late as July 1 or 2, which would make August 2 (the day of my biopsy) closer to day 31 or 32 of a cycle. I also know that I ovulated on July 23. It seems like a result of day 24-25 would be consistent with a possible luteal phase issue. Just as a side note, We've also found a single MTHFR mutation and impaired glucose tolerance after MUCH testing, but I wanted to get your thoughts on the luteal phase defect issue, since that is what we were talking about back in June. Thanks again for this series, it has made me a much more informed patient as I deal with my REI.
  
  Liz

   

• At Wed Aug 15, 06:41:00 PM 2007,  Anonymous said…

  Dr. T,
  In your article, I cut and pasted you state that long cycles may be associated with thyroid disorders (I am normal T3 and T4), excess amounts of the pituitary hormone prolactin (no issues with this particular issue) from any cause, and women who have ‘polycystic ovary syndrome’ that may be accompanied by hyperandrogenemia (increased levels of male hormones), elevated levels of luteinizing hormone (LH, another pituitary hormone that stimulates androgen production in the ovary), and insulin resistance.
  Are these tests can only be administered by a Reproductive Endocrinologist or can a regular MD requests these tests? Thank you again!

   

• At Wed Aug 15, 10:56:00 PM 2007,  Anonymous said…

  I am 32yo and have two healthy girls, 3 and 1 1/2 yo. In the past year I have had three miscarriages. First one baby was developing slowly but had strong heartbeat at 8w to die at 9w. Second was healthy at 9w and passed at about 10 -11w and third was a blighted ovum. In all cases the pregnancy continued with the placenta and gest. sac continuing to grow at correct stage and so a D&C was performed each time at 10 - 13 w. My periods are always 26 -28 days and all babies are with the same father. Each time however at about 3 months after all babies I have suddenly put on about 5kgs which I have found harder and harder to get off so it is adding up. I have also started getting migraines on a regular basis. My OBGYN has done all tests on chromosomes, thyroid ANA's etc on both me and my husband. He is going to put me on progesterone next time but is there anything else I can do? Thanks

   

• At Fri Aug 17, 05:37:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Liz August 15: Sounds like your REI docs now have something to work with. Different REIs will take different approaches to your situation. They are the BEST at what they do, so take their lead! (Remember, I am just a lowly Maternal-Fetal Medicine doc!). Some will add metformin (a drug that increases your sensitivity to insulin) to whatever infertility they choose in women who have your problems and have been shown to have glucose intolerance. That may also reduce your risk for miscarrying once you conceive. I tend to leave women on this through their pregnancies since it may also reduce your risk for developing gestational diabetes. The MTHFR polymorphism is probably nothing to worry about, but I still would probably offer you supplemental folic acid (2-4 mg/day)in anticipation of another pregnancy. Best of luck and thank you so much for the feedback! Dr T

   

• At Fri Aug 17, 05:40:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous August 15: Your regular doctor can order these tests, but if you have a history of infertility or recurrent pregnancy loss, you might still want to go to a good REI for the whole deal! Thanks for reading! Dr T

   

• At Fri Aug 17, 05:58:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Aug 15 1056 PM: Did your doctor try to send tissue from any of the pregnancies to see if the babies were chromosomally normal? Have you been screened for any genetic or autoimmune thrombophilias (your doctor will know what these are)? Have you been screened for diabetes?
  
  I see you have had two girls and no boys yet, so there is a possibility that you have an X-linked mutation that might deleteriously affect only male babies. You might consider seeing a genetic counselor to help you understand that.
  
  I see nothing wrong with starting progesterone with another pregnancy, and that is best started during the luteal phase of the cycle just after you ovulate. As additional 'empiric' therapy, ask your doctor about taking extra folic acid and a baby aspirin each day as well.
  
  By the way, if you have developed migraines, and this is not something you've had throughout your life, consider seeing an internist or a neurologist before conceiving again. An objective eye might identify something else that is causing your headaches and could also be contributing to your early losses. Regardless, if you have another loss, I would recommend seeing a specialist in Reproductive Endocrinology and Infertility. Thanks for reading! Dr T

   

• At Fri Aug 17, 06:11:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Aug 13 and 15: Follow the recommendations of the Infertility specialist you have arranged to see. He/She will be in the best position to find out what is going wrong, what medications to offer you, and how it will be best to get you pregnant and KEEP you pregnant! Let me know what they find out and plan to do. Thanks for being such a great reader and best wishes to you and your husband!
  Dr T

   

• At Sat Aug 18, 06:52:00 PM 2007,  Anonymous said…

  Hi Aug 15 1056pm again. I did have tests for genetic and autoimmune thrombophilias and diabetes and all came back normal. I had tests on the first baby and it was 69XXY, second was unable to be tested because the culture did not grow and I have not received the test from the third. My husband and I have had karotype testing which came back normal so I suppose that rules out an X-linked disorder. Ny GP advised me that my migraines as they are regular with my cycle are probably because of hormone fluctuations and therefore I should try going on the pill but as I am trying to get pregnant that isn't an answer at the moment.
  Thankyou for your insight and I will try progesterone next time and keep my fingers crossed.

   

• At Tue Aug 21, 03:40:00 PM 2007,  Anonymous said…

  Hello Dr., I have had two fetal demises at 10 weeks and 11 weeks in the past three years. At first both pregnancies were progressing well but later ultrasounds revealed no fetal heart beat.I have has three m/c at 7,6,7 weeks prior to the two f/d. I have a healthy 9 year old and had no complications during that pregnancy. I am now 32 and unsure what the problem may be. I do have irregular cycles and believe it may be a progesterone deficency. I would appreciate any input. Thanks

   

• At Tue Aug 21, 05:59:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  Back to Aug 15: It sounds like you have had a very thorough work up to date. Since at least one of your pregnancies was karyotypically abnormal, it is helpful that both you and your partner had chromosomal stucies as well. Normal chromosomal complements do NOT rule out the possibility of an "X-linked" disorder. That is a situation where half of your sons will be affected and half of your daughters will be 'carriers'. But there isn't anthing you could do about that anyway except to keep on trying. If there is no family history of the same, it is unlikely that that is the cause of your losses. Good luck and let me know how things turn out for you!
  Dr T

   

• At Fri Aug 24, 06:22:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Aug 21: If you are 32 years old, have irregular cycles, and have had 5 miscarriages, you need a very thorough evaluation by a specialist in Reproductive Endocrinology and Infertility. I would do this BEFORE conceiving again and as soon as possible. I would recommend you read the last couple of articles I wrote in this series on "recurrent early pregnancy loss" to get some idea of what may need to be evaluated and your options for treatment. By the way, was the father of your 9 year old the same person who fathered the pregnancies you have lost? Best of luck to you. Dr T

   

• At Thu Sep 13, 01:15:00 PM 2007,  Anonymous said…

  Hallo. I am 29 yrs old and I am 10 weeks greg. I have cervical polyp (still doc not sure if it is endometrial polyp), and last 3 weeks I am having regular dark brown discharge. Was on low dose pececillin for 5 days, but discharge seems to get worse. Please help. Is it Ok to have regular dark brown discharge when you have cervical polyp. My scan appears to be normal and baby growing.
  
  Thank's
  
  Melanija

   

• At Thu Sep 13, 04:33:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Melanija Sept 13: Most likely it is just a cervical polyp. If that is so, it would be very easy to remove, and I recommend you have that done. The more you bleed, the more likely you are to get an intravaginal infection with bacteria that could eventually cause an intrauterine infection. That could cause you to go into early labor or break the bag of waters early. Good luck with your pregnancy and thanks for reading. Dr T

   

• At Sat Sep 15, 09:46:00 AM 2007,  Anonymous said…

  Hi, I am soon to be 41 and have had 2 m/c's from natural conception and 1 after IVF cycle (8wks). I attempted to do another cycle, however, only 2 little buds showed up and I was dismissed from that cycle. I was told that there is a leak in my right tube but everything else seems to be okay. I've had a cyst removed in my 20's and 5 fibroids removed about 3 years ago. A couple of pollups were removed one year after that, so that I could start the 2nd IVF cycle. I am becoming very fustrated and with the age thing, fear I will definitely run out of time and eggs. I also want to know if it is possible to be pregnant and have a regular period? Can you have similar symptoms (sever nausea, slight breast tenderness, cramping, back ache, ankle swelling) just before your cycle? I was considering an OV Watch, as I have obviously conceived naturally before but am unsure, if I should even try naturally with my history. My sister has offered to be an egg donor for me but I'm unsure whether I want to put her through that and my chances of carrying a pregnancy to term seem to be dwindling fast. Please advise if I should nix the watch and donor procedure and try to adopt? Thanks

   

• At Mon Sep 17, 11:57:00 AM 2007,  Anonymous said…

  Hi-
  
  I am 41 and have been trying to get pregnant since November 2005 with no success. I had my first child 3 months before I turned 35. As soon as we started trying, I became pregnant very quickly. Back in December 2004, I found out I had Severe Dysplasia. I had laser oblation of my cervix to correct the condition and am continuing to have normal pap smears. I recently had an internal exam from a reproductive endocrinologist and she confirmed everything looks fine. My current OB-GYN (who did not perform the oblation surgery) had also previously confirmed everything looks fine. I also had a hysterosolpingogram and the results were no normal, however the doctor had to dialate my cervix to perform the test.
  My hormone levels (done March 2006) were all normal, but the Repro. Endocrinologist would like to repeat the levels which is probably wise to re-check.
  I began charting my temperature since mid March and have concluded that my Luteal Phase is too short. Can you tell me what causes a short Luteal Phase?? My doctor agreed with my conclusion. My doctors suggested I take Clomid, but I am hesitant about taking it. I have read taking Vitamin B6 can lengthen the phase. What other natural methods can I do to help lengthen the phase rather than taking clomid or what other methods my be available to me. Do you think I might be having other issues in regards to the laser oblation to my cervix???? I would appreciate feedback regarding this.
  LKJ

   

• At Mon Sep 24, 05:47:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Sept 15: Sorry I haven't gotten back to you sooner but readers have had a LOT of questions lately! I am also afraid that I am going to have to defer to your reproductive endocrinologist to answer most of your questionS. You need someone who knows you and your medical situation very well to help guide you to the decisions that are right for you. Do you have a long history of infertility or did you simply choose to wait before trying to get pregnant. What problems have your doctors identified that are contributing to your infertility other than your age? What studies have you had done? Have you ever had a child or have all you pregnancies ended in miscarriage? What medical problems do you have? Were you anovulatory in the past? The symptoms you are having before your periods are probably simply related to progesterone production during the luteal phase of the cycle. If your doctors have been stimulating ovulation, your body may simply be seeing more progesterone than it has in a long time! At your age, most doctors would suggest that some form of assisted reproductive technology is your best bet, but many will not even perform IVF on women past 40 because the success rates go down so dramatically. Ask your REI about your sister's offer. He/she will be in the best position to advise the feasibility of that in your case. Sorry I can't be more help, but thanks for reading and the best of luck to you. P.S. Sometimes the best way to get pregnant is to begin adoption proceedings!!!!!! Regards. Dr T

   

• At Mon Sep 24, 06:13:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To LKJ Sept 17: Listen to your doctors! At age 41, you are going to need all the help you can get in as little time as possible. We do not understand all the factors that go into infertility as we age, but fertility drops dramatically after age 35. In other words, take your vitamin B6, and throw in some extra folic acid, a prenatal vitamin, and maybe even a baby aspirin, BUT take the clomid too! Luteal phase deficiency is partly the result of inadequate progesterone production and there are various reasons that may occur - bad eggs or bad stimulation from the hypothalamic-pituitary axis. Your cervical condition may make it harder for your husband's sperm to get into the uterus or they may not be undergoing the proper biochemical changes that occur (capacitation) as they travel through the cervical canal. Some of this may be the result of your surgery and some of it may simply be the changing hormonal milieu from aging. If the clomid doesn't work in a timely fashion, your REI will probably offer intrauterine insemmination (IUI) following a 'stimulation cycle' or pull out the big guns - IVF. Good luck, but if you are serious about getting pregnant, don't beat around the bush either! Thanks for reading! Dr T

   

• At Tue Oct 23, 06:27:00 PM 2007,  Anonymous said…

  Dr. Trofatter,
  I've recently been diagnosed with insulin resistance, barely elevated. I'm currently on Metformin. I've had three previous miscarriages. When I research insulin resistance it's always linked to pcos. Also, I don't have all the "main" symptoms of PCOS, but I do have irregular menstrual bleeding that starts and stops intermittently, occasional migraines around menstrual cycle, weight in midsection (though not excessive). What does the intermittent menstrual bleeding have to do with pcos, insulin resistance or egg quality???
  
  The nurse at my RE's office, said that the Metformin should help with egg quality. I'm pretty sure that I ovulate regularly. With my last two pregnancies, my lh surge was on day 15. Could this (poor egg quality) have anything to do with my miscarriages? Also, with my last pregnancy, it took longer than usual (4 months) to get pregnant. In fact, I had the hcg "booster" shot on day 15 of my last two pregnancies. Perhaps I wouldn't even have become pregnant because of "poor egg quality" to begin with if I didn't receive that shot at ovulation. My follicle did look "good" at the time. My menstrual cycle is 28-30 days.
  
  Thanks in advance for your help! LRR

   

• At Thu Nov 01, 11:34:00 AM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To LRR Oct 23: Sorry I am so long returning to your questions! It has been very busy lately. It sounds like you are in good hands with your REI doctor; and, he/she is going to be in the best position to answer your questions since they know far more about you than I do! I guess it would help me to know more about your miscarriages, medical problems, age, REI workup, etc before I could add anything to the regimen you are currently on. It can take metformon several months to really work on you 'insulin resistance' and not all women will respond to it. It sounds like you ovulate somewhat irregularly and thet little bit of asynchony between the endometrium and the time of ovulation and implantation may be contributing to your losses. Do you have any living children? What other medications are you on? Many REI folks will place women in your situation on clomid to regularly induce ovulation as well. Get back with me if you have some aditional information you might think be valuable for counseling purposes. Otherwise, good luck with things and thanks for reading! Dr T

   

• At Tue Nov 20, 08:24:00 AM 2007,  Judychrz said…

  Hi- I have had a chemical pregnancy (ended 5.5 weeks) and a clinical loss (ended at 12 weeks, growth stopped 10 weeks). I have a regular cycle, have had not problem conceiving and am newly pregnant again. I had blood work drawn at 4w+1 showing the HCG 1379 and progesterone 9. I'm seeing an RE, and she was adamant that I not start a progesterone supplement. Is 9 an okay number at this early stage, or will a supplement not work after conception? Thanks for your comments!

   

• At Mon Nov 26, 06:42:00 PM