Recurrent Early Pregnancy Loss - 2 - Hormonal Causes

126 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 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To judychrz Nov 20: Sorry so long getting back to you but I just received your comment in my mailbox today. I am not sure why your RE did not want to put you on progesterone. Most REs hand that out like water and natural progesteronr should be harmless enough unless there is something I don't know about. Why don't you ask why they didn't want to use it. Anyway, good luck with your pregnancy and if things don't turn out better, let me know, or check out my post on "recurrent pregnancy loss- empiric therapy" from sometime in April. Best wishes and thanks for reading. Dr T

   

• At Wed Dec 12, 08:11:00 AM 2007,  Julissa said…

  Dr. Trofatter - I posted a comment on your blog earlier in the year (June)and I followed your advice and consulted with an RE. After one treatment of femara w/ progesterone suppositories, baby aspirin. I'm happy to say that I'm now four months pregnant. I have had three ultrasounds and heard the hearbeat. God willing all will go well with this pregnancy. Thank you for your support!

   

• At Fri Dec 14, 03:55:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Julissa: Congratulations! Let us know how things turn out. I will be waiting to hear back from you! Dr T

   

• At Wed Dec 19, 08:25:00 PM 2007,  Anonymous said…

  Hi. What a great forum! A quick question for you: I'm about to start 100 mg of clomid after irregular cycles following birth control, and I'd like to jumpstart this as much as I can. Is it safe to take vitamin b6, robitussin (just guaifenesin) and baby aspirin with the clomid?
  
  Thanks!

   

• At Thu Dec 20, 03:49:00 PM 2007,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Dec 19: None of those medications is especially risky. We frequently use vitamin B6 as a supplement before pregnancy and early in pregnancy to help control nausea. I would suggest adding a little extra folic acid to the mix. Why the robitussin? And, why do your doctors think you are having ovulatory dysfunction? Are they concerned that you have polycystic ovary syndrome? Dr T

   

• At Wed Dec 26, 11:38:00 AM 2007,  Anonymous said…

  Hi Dr. Trofatter
  
  I am 31 years old and have been trying to conceive for 7 months now. My husband is 39. I have been having very regular periods since I was 11 (never even missed one!) and was on the pill from the age of 16 until October 2006. I have been taking 1mg of folic acid daily since Oct 06. About 6 years ago I suffered from an eating disorder and started having breakthrough bleedings. My weight was never severly low my lowest was about 110 lbs and I am 5 4". (issue was more phsychological than anything else) My OBGYN put me on a different pill at the time and the bleedings stopped. Now when I went off the pill last year the bleeding came back. For about 6 months every month I would start spotting heavily on day 24ish and then by day 28 I got my period. For the past 4 months I have seen a change in my cycle for the first time in 20 years. Every second month I spot on day 24 and get my period on day 25 and then the following month I spot on day 26 and then get my period on day 28. It's flips back and forth now. I also never really had many PMS symptoms but now suddently most months since I've been TTC, I've been getting severe breast tenderness approx 1 week past ovulation. I have never been pregnant but am wondering if I have been having multiple chemical pregnancies. I started taking my BBT last month. I clearly ovulated sometime between day 9 and 12 of my cycle. My temps shot up on day 13 and today is day 23 and my temp just dropped almost to my pre-ovulation levels. This means I will likely start spotting tomorrow and get my period the next day consistent with recent monthly patterns. My temps only remained high for 10 days. I am suspcting I have a LPD but I had my progersterone tested a few months ago on day 21 and I was told it was normal. Could it have been that the test did not pick up the low progerterone becasue my temp only dropped later? I have read that my temps need to remain high for at least 12-14 days past ovulation in order for successful implantation to take place. Do I likely have a LPD? If so what are the chances that progerterone is all I need. I am extremely healthy, non - smoker, exercise regularly and I have been at a healthy 130 lbs for 5 years now.
  
  Your insight would be much appreciated!!

   

• At Thu Jan 17, 10:52:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Dec 26: Sorry for the long delay in responding to your questions, but for some reason, your comment just got to my mailbox. I don't know quite where to start with you. I suspect some level of hormonal dysfunction but the possibility of another underlying medical condition or a uterine abnormality (such as fibroid or endometriosis) may be contributing to your difficulties as well. You are only 31 , but still entering that period of life where 'infertility' becomes a gretaer issue. I would suggest at this point you either ask your OB/GYN for a refrral to an REI specialist, or seek one out on your own. It's time to stop playing around with this and to get some answers and an aggressive approach to therapy to help you have a successful pregnancy. Not that your OB/GYN might not be able to help, but I really think you need to go about this in the most efficient way possible. Best of luck and let us know what you find out. Again I apologize for the delay in getting back to you and hope this finds you well. Dr T

   

• At Fri Feb 01, 06:23:00 PM 2008,  Jen Gerard said…

  Hi Dr. Trofatter,
  Can you tell me if there are any natural supplements that you can take to help raise progesterone level. I just turned 42 and have six children ages 22-7. I recently miscarried twins at 7 weeks 3 days. We had just moved to a mountain town located at 10,000 ft. in elevation 7 days earlier, but I also was not feeling any pregnancy symptoms except in the very beginning. I have always had a very regular menstrual cycle. I am now pregnant again and am definitely feeling symptoms. I had an ulrasound today at 6w 4d. everything looked good and the heart was beating. My concern is my progesterone levels, they were 22 at 21 days gestation and went down to 20 at 29 days gestation (I am pretty sure about the day of conception). I am concerned about how I will tolerate progesterone since I have only taken the pill one time, after a possible pregnancy scare, and was sick for a month. But I don't want to lose the pregnancy either. What do you think? I have read online about B6 and red rasberry leaf extract possibly helping. Is there any merit to these? If you could respond I would be so appreciative as I am very nerveous about the pregnancy now that I am so old. Thank you for your time, Jen G.

   

• At Thu Feb 14, 04:28:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Jen Feb 1: I don't know Jen. I am very cautious of any "natural compounds" in pregnancy because of the unknowns as to what might actually be in them. They are not routinely analyzed nor standardized as to content. Besides, progesterone is about as "natural" a substance as you can get. You can take entirely natural progesterone in various forms - orally (which you did not tolerate well), vaginally, rectally, and by injection. The latter might be much better tolerated since they do not have to go through your stomach. These compounds can be given in "pure" form from the standpoint of the progesterone content and should be completely 'safe' for pregnancy. Remember, at your age there is a very good chance the twins you lost were not chromosomally normal, but you are also correct in recognizing that your body might not be as efficient at producing progesterone at a level that is essential to pregnancy support during the first 9-10 weeks as it was when you were younger. Once you get to that point in the pregnancy, the placenta takes over where your ovaries have left off and you should do just fine if you really have a 'progesterone deficiency.' Good luck and I apologize for the delay in my response. Dr T

   

• At Thu Jun 12, 02:39:00 PM 2008,  Julissa said…

  Dr Trofatter - I posted a few comments early last year and the last note I advised that I finally was pregnant. Well, I had a healthy baby girl on June 3rd. I'm so happy I found this site. Thank you!
  
  Julissa

   

• At Sat Jun 14, 07:56:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Julissa: CONGRATULATIONS and thanks for letting all of us know! Best regards, Dr T

   

• At Sun Jun 15, 01:48:00 PM 2008,  Anonymous said…

  Dr Trofatter,
  I wander if you can help. I 36 year old and by now had 6 pregnancies in last 4 year all with the same partner. Fist pregnancy resulted in miscarriage at 7 weeks, then I had my daughter who is 2.5 year now; and after her I had 4 miscarriages in a row : one biochemical pregnancy, another at 9 weeks and followed by 3 biochemical pregnancies. We have done all tests to find the reason but no abnormalities were found. I have no problem to get pregnant. I do not smoke or drink, healthy weight, my periods are regular. For last 8 months or so I had period-like pain during ovulation but my doctor said that is not uncommon… Any suggestions as to what we can do to maximise our chances of successful pregnancy. Thank you.

   

• At Mon Jun 16, 06:13:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous June 15: What tests have been done to look for the reasons for your losses. Did you have chromosomal studies done on any of the babies you lost? Have you had a sonohysterogram and a hysteroscopy performed to evaluate the uterine cavity for abnormalities such as scar tissue, fibroids, or polyps? Do you have pain with your periods and has that gotten worse in recent years? Let me know and I will tell you what I think then! thanks for reading. Dr T

   

• At Tue Jun 17, 03:18:00 AM 2008,  Anonymous said…

  Dr Trofatter,
  Fistly thank you for your reply.
  
  We had chromosome analysis done on me and my partner, immune tests, blood clotting, hormonal analysis, blood test on progesterone level and an endometrial biopsy, I had test done for infections all came back normal. My womb is slightly "balky" so I had hysteroscopy performed and a sample of tissue was taken but all was normal.
  My periods have not changed at all, it is my ovulation is more painful. I always know when it is happening and I have a period-like pain and/or shooting pain and a lot of discharge (clear egg-like) for about 10 days or so..
  No tests were done on any lost babies. Do not know why.. I always bleed during first 12 weeks of my pregnancies all successful and unsuccessful. I am rhesus neg (my partner positive), but I had anti-D immunoglobulin after my miscarriages.
  
  Thanks again.

   

• At Sat Jun 21, 05:06:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous June 17: Hmmm still not sure what's going on. Since chromosomal studies were not done on the pregnancies you lost, it could be that you have simply had a string of bad luck and had several conceptuses that were chromosomally abnormal. However, the increasing pain with ovulation is also interesting. It may be worth having a diagnostic laparoscopy done to see if there is any evidence of endometriosis internally or any evidence that your ovaries are beginning to look 'polycystic' with thickening of the ovarian capsules. If you do have another miscarriage, I would suggest sending some tissue from the pregnancy for chromsomal analysis. Please let us know what you find out and I am sorry I cannot offer more help at this time. Dr T

   

• At Sun Jul 06, 04:29:00 AM 2008,  Anonymous said…

  Hello,
  I am almost 35 and have two healthy children 4yr and 6yr. I got pregnant first month with both and had great pregnancies. I am ttc now. I am 14dpo and just got a faint positive. I have been spotting for over a week. Some days brown, some red. Red today. My periods come every 28 days but I always spot a week before. My OB has not done any tests and he said it is "Hormonal". I assume I am going to miscarry. What tests should I ask for? I went for my annual last month and he said it was too early to start testing (This is 5th month ttc) Thank you!

   

• At Sat Jul 12, 07:37:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous July 6: You could still have a normal pregnancy, even if you are having some spotting at this point. However, if you do lose a pregnancy, the most common cause is a chromosomal abnormality. And, if you do not conceive within the next 3-4 months, at age 35, we would recommend evaluation for that sooner than later to rule out potentially reversible causes of 'infertility' that come on with age. Good luck. Dr T

   

• At Mon Jul 21, 08:03:00 PM 2008,  Gracie565 said…

  Hi, I am 36 yrs old and am going through my 2nd chemical pregnancy/early miscarriage in 1 year. My past medical history is significant for 3 normal pregnancies & deliveries with my 1st husband, with a TL in 2000 and a tubal reversal in 2006. I am remarried and my 2nd husband has no biological children. He did however have one other pregnancy with an ex that also ended in miscarriage. I know that the tubal reversal probably has a lot to do with my reduced fertility (shorter tubes than normal and questionable scar tissue on HSG) plus my age doesn't help. To complicate matters, my cycles are on the long side and I usually don't ovulate until CD20 to 25, with normal cycle length of 35-39 days. I've tried Clomid and it gave me migraines. I began seeing an RE right before this 2nd m/c and they want to push IVF due to my previous TL/TR. My husband's sperm count was really high at 750 million with normal morph. rate. What I'm beginning to wonder though is, could something be wrong with his sperm to keep causing miscarried embryos? I am at a loss. I don't really want to undergo IVF but don't want to keep waiting a year between pregnancies, only to keep losing them very early like this! My fertility is dwindling and I'm anxious. Thank you, this is a very informative website and thread!

   

• At Mon Jul 21, 08:30:00 PM 2008,  Gracie565 said…

  Also, Dr. T, a few more tidbits to add. I do not smoke or use drugs, I drink alcohol only socially and I am not extremely overweight (my BMI is around 26.8). Since TTC, I have modified my diet to reduce caffeine intake to under 100 mg daily and other than prenatals, take no other pills regularly. I truly believe most of my problems are related to old eggs due to late ovulation. My luteal phase is really good at 13-15 days. In other words, I don't think my fertility challenges are hindered by any of the above factors. Thanks again, Gracie

   

• At Wed Jul 23, 01:09:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Gracie: Has your partner had chromosomal studies done to see if he has a chromosomal rearrangement (balanced translocation or inversion)? And, yes, sometimes males can contribute to early pregnancy loss if they certain abnormalities in their sperm. I wrote a post on this earlier this year. The link to that post is
  
  http://www.healthline.com/blogs/pregnancy_childbirth/2008/02/abnormal-sperm-morphology-and-recurrent.html
  
  Just copy and paste it in your browser! By the way, with the current success rates of IVF in stimulated cycles, I would have to agree with your REI docs. Good luck! Dr T

   

• At Fri Aug 01, 03:30:00 AM 2008,  Anonymous said…

  Hi, I contacted you in november last year. Shortly after that i sadly miscarried at 14 weeks due to a cystic hygroma. I am currently 71/2 weeks pregnant again, i went for an u/s yesterday . the sonographer said there is a small area of possible bleeeding measuring 35mmx8mmx5mm. They told me to wait 2 weeks for a repeat u/s. my question is.. should i be on bedrest to help it heal (i havent bled yet) or should they be testing my hormone/progesterone levels?. i feel as if i have been brushed off and am extremely worried about miscarrying again. thank you

   

• At Thu Aug 07, 06:26:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Aug 1: If you are not bleeding at this point and the baby has a good heart beat, chances are that the "hemorrhage" is simply part of the early placental development. You probably do not need to take any special precautions at this point. Good luck and let us know how things turn out. Dr T

   

• At Wed Aug 13, 11:59:00 PM 2008,  Anonymous said…

  iam prenant with 10 days after that my menstration come.my menstration cycle is regular but i dont know why i loss my pregnancy with in 10 days. for 9 months i live with my husband im not getting pregnant for 8 months and this month july - august im prenant my first pregnant but i loss it.

   

• At Sat Aug 16, 07:25:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Aug 13: I am sorry for your loss. Was this your first pregnancy? The most common reason for early pregnancy losses is still a chromsomally abnormal baby and that is something over which you and your husband have no control. Dr T

   

• At Tue Aug 19, 11:56:00 AM 2008,  Anonymous said…

  I have had 4 miscarriages within one year. Two at five weeks and two at 6 weeks. I am seeing a specialist in a british hospital next week to get the results of my blood clotting tests. All of my hormonal and genetic tests have come back normal as has my husbands karyotype test. i am 30 years old and my husband is 48. What I would like to know is what tests are available for the male factors? Nobody at the hospital has even mentioned this too me so far, and I would like to go back next week knowing what can possibly be tested. All of the miscarriages have been with my husband. Could you also tell me more about how the immune system could affect this problem?

   

• At Fri Aug 22, 05:42:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Aug 19: Did you have chromosomal studies done on any of the pregnancies you lost? Even though you and your husband are chromosomally normal, the babies may not have been. At your husband's age, you might consider having him see an andrologist who specializes in abnormalities of sperm that can contribute to recurrent early pregnancy loss. I know I wrote a post on this earlier in the year, so if you go back in my archives, you should find it. Don't worry abot explanations regarding your immune system at this point unless some of the laboratory tests you have had done indicate that may be a possible concern. Regards, Dr T

   

• At Tue Sep 02, 09:35:00 AM 2008,  Anonymous said…

  Okay I have a 12 year old and a 2 year old. 12 year old from a different partner. My husband and I had a healthy 2 year old born in April of 2006 and have been trying ever since to get pregnant again. I am 35 years old and had 3 miscarriages in a row at 8 weeks, 6weeks and 5 weeks. Had the full blood word done and was diagnosed with the Antiphospholipid Syndrome and started baby aspirin daily and Heparin shots once I recevied a positive pregnancy test. The problem now is I've had 3 positive pregnancy tests that have turned into Chemical pregnancies. My HCG numbers come back at less than 12 each time. Any ideas???

   

• At Tue Sep 02, 04:35:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Sept 2: Without more information, this could be anything ranging from recurrent chromosomal abnormalities, to a 'hormonal' problem, to an intrauterine abnormality, endometriosis or the antiphospholipid antibodies. By the way, what antibodies were found and what were their titers? My suggestion, if you haven't already, is to ask for a referral to a specialist in Reproductive Endocrinology who has an interest in recurrent early pregnancy loss. You need to have a good sonohysterogram and perhaps a hysteroscopy done as well as further evaluation after the studies you have had done to date are reviewed. Good luck. Dr T P.S. What dose of heparin are you on? You might try starting the heparin even before a pregnancy is confirmed in midluteal phase, but I rewally recommend more of a workup before doing too much empirically.

   

• At Sat Sep 06, 02:51:00 PM 2008,  Erin said…

  I had a miscarrge on July 7th ( I was 4 1/2 weeks pregnant). I had my first period after the miscarriage on August 2nd. On August 30th, I took a Digital Clear Blue Easy HPT and it was positive. I was supposed to start my period on August 29th. On September 2nd, I had a quantitative blood test and my doctor said my HCG level was less than 5. I know I was pregnant when I had the positive pregnancy due to the obvious changes in my breasts. I did not start my period until today Sept 6th. I am never late and am always regular. I go see my doctor again next week. My doctor thinks I had a false positive test on the 30th but I know I was pregnant. My doctor wants to test my progesterone levels and possibly put me on medication for that. What tests should I have now? I want to find out if there is anything wrong before I get pregnant again. This has been very distressing and I don't think I can bear one more miscarrage. I feel positive as I was able to get pregnant in the two months I tried but I don't know what to do now. I have been taking Prenate Elite since last fall to prepare for getting pregnant. I took the pill/patch for 7 years from last October 07.

   

• At Mon Sep 22, 07:49:00 PM 2008,  lolita said…

  Hi Dr.,
  Im trying to send this a couple of times not knowing if u got it already.I am 33 and this past year i had 2 blighted ovum .One was in oct 07 and the second in march 08.I get pregnant very easily.I had read in one of your post about hormonal imbalance wich i think i have.I get my period every month with a 28 day cycle but the problem is that i bleed one day only and thats when i urinate .I had also suffered for many years of bulimia which i have stopped for a while already.Please help me end let me know what kind of test i should do.My doctor tells me to try again to conceive but im scared i will have to go through this nightmare again and another D&C.I am waiting for ur reply.thanks in advance.

   

• At Tue Sep 23, 07:22:00 AM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Erin: Do you have any living children or any medical problems? How old are you now? Hs your partner had any children outside of your marriage? It sounds like both your losses (if indeed the most recent was a miscarriage) have been very early. Although that does not make them any easier, it does speak to an implantation problem. The most likely causes for this are a hormonal problem, a fetal chromosomal abnormality, or an intrauterine abnormality. Before just "starting on progesterone," I would suggest at least thyroid studies, luteal phase progesterone, prolactin levels, and a sonohysterogram and/or hysteroscopy. I would not send off chromosomal stucies on you and your partner unless you wanted to incur the expense, lost another pregnancy, and/or had another documented loss in which the products of conception were analyzed and showed a chromosomal abnormality consistent with either uopur or your partner having a balanced chromosomal rearrangement. If you had another loss, I would also recommend a workup for genetic and acquired "thrombophilias." You might want to read a few of the other posts I have in this series on recurrent early pregnancy loss. Best wishes to you and let us know what you find out. Dr T

   

• At Tue Oct 07, 03:31:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To lolita Sept 22: I would suggest that you have thyroid studies (TSH and free T4); prolactin; FSH; antiphospholipid antibodies; lupus anticoagulant; and perhapss chromosomal studies on yourself. Is your weight stable now and do you have any medical problems for which you are currently being treated? Regards, Dr T

   

• At Sun Dec 14, 05:25:00 PM 2008,  Anonymous said…

  Dr. T
  
  I spoke to you back in October. I had gone to a fertility specialitsts in KS City to find out why I had two second trimester miscarriages at 15 weeks. My first two pregnancies were live births. I had found out back in Sept. or Oct. that I was pregnant again at about 4 weeks. I have protein C diffiency and Factor V Leiden Mutation. I go in once a week to my O.B. They have me on Lovenex, baby aspirin, progesterone,and insulin for gestational dibetes I am now 17 1/2 weeks pregnant. Everything is going good so far. I've passed the 15 week mark when I lost my last two babies. Just thought I'd keep you posted.

   

• At Mon Dec 22, 08:43:00 AM 2008,  Anonymous said…

  Hello, I have read your items with interest. I have recently experienced two chemical pregnancies - both only around 18 days post ovulation. My first was in Sept 08 and my second Dec 08. I am waiting to see a specialist. I chart my temperatures and notice that my temperature plummets at 10 days past ovulation and start my period at 11 days post ovulation. In both chemical pregnancies, my temps plummeted and struggled to get higher for a few days before i bled. I;m thinking i possibly suffer from a luteal phase defect...is this possible. I should also mention that i already have a 2 yr old (same partner) but it took about 18months to conceive him.

   

• At Sun Jan 04, 12:16:00 PM 2009,  Charmaine22 said…

  Hi, are you able to point me in the right direction for my symptoms. I am a healthy 34 year old. I was on the pill (microgynon) for 14 years. I came off the pill and starting trying for a baby after 10 months with my husband. I got pregnant immediately and carried through to a successful pregnancy. The only anomaly was that three blood tests came back showing that I had an under-active thyroid. I did gain weight very quickly at the start of the pregnancy. I cured the under active thyroid using acupuncture and at 10 weeks, a further blood test came back as normal.
  
  Since my first baby turned one, I have miscarried every six months. The first was a rupture ectopic pregnancy in my right tube. The Doctors kept it in as the left tube was found to be blocked.
  
  I then had two further miscarriages (6 months apart) at 5 weeks. No embryo was found in either of these pregnancies and my HCG levels were very low and slow rising (after 2 weeks of monitoring they were still below 120).
  
  All three miscarriages had a commonality; I seemed to have a normal period and therefore did not suspect a pregnancy. At day 6, 1 day after my period should have ended, fresh blood started to appear. This happened on the ectopic and the other two miscarriages.
  
  My cycle used to be 28 days but in recent months seems to have increased to 31 days.
  
  I just had what I thought was a normal period but again the bleeding has come back at Day 6 and I am yet to test for a pregnancy.
  
  I do get PMT before my period and a lot of pain on day 1 of the period (Cramps and back ache). I also get swollen breasts consistently. Therefore, I am probably okay hormonally.
  
  I wondered if you could englighten me more on the thyroid issues as this came up in my first successful pregnancy. I have not been tested since. My weight is stable at 58kilos (5ft9) but I do seem to gain a small amount of weight before each miscarriage (1-2 kilos). The weight comes off again immediately after the miscarriage.
  
  I also dye flushed through my tubes and the right one was open, the left closed (as already suspected). The second miscarriage occurred immediately after this procedure.
  
  Sorry that this is so long but I wanted to give as much detail as possible to get your thoughts.
  
  Thank you.

   

• At Sun Jan 04, 12:16:00 PM 2009,  Charmaine22 said…

  Hi, are you able to point me in the right direction for my symptoms. I am a healthy 34 year old. I was on the pill (microgynon) for 14 years. I came off the pill and starting trying for a baby after 10 months with my husband. I got pregnant immediately and carried through to a successful pregnancy. The only anomaly was that three blood tests came back showing that I had an under-active thyroid. I did gain weight very quickly at the start of the pregnancy. I cured the under active thyroid using acupuncture and at 10 weeks, a further blood test came back as normal.
  
  Since my first baby turned one, I have miscarried every six months. The first was a rupture ectopic pregnancy in my right tube. The Doctors kept it in as the left tube was found to be blocked.
  
  I then had two further miscarriages (6 months apart) at 5 weeks. No embryo was found in either of these pregnancies and my HCG levels were very low and slow rising (after 2 weeks of monitoring they were still below 120).
  
  All three miscarriages had a commonality; I seemed to have a normal period and therefore did not suspect a pregnancy. At day 6, 1 day after my period should have ended, fresh blood started to appear. This happened on the ectopic and the other two miscarriages.
  
  My cycle used to be 28 days but in recent months seems to have increased to 31 days.
  
  I just had what I thought was a normal period but again the bleeding has come back at Day 6 and I am yet to test for a pregnancy.
  
  I do get PMT before my period and a lot of pain on day 1 of the period (Cramps and back ache). I also get swollen breasts consistently. Therefore, I am probably okay hormonally.
  
  I wondered if you could englighten me more on the thyroid issues as this came up in my first successful pregnancy. I have not been tested since. My weight is stable at 58kilos (5ft9) but I do seem to gain a small amount of weight before each miscarriage (1-2 kilos). The weight comes off again immediately after the miscarriage.
  
  I also dye flushed through my tubes and the right one was open, the left closed (as already suspected). The second miscarriage occurred immediately after this procedure.
  
  Sorry that this is so long but I wanted to give as much detail as possible to get your thoughts.
  
  Thank you.

   

• At Thu Jan 08, 01:10:00 AM 2009,  Anonymous said…

  Hi Dr. I wonder if you could point me in the right direction on the following:
  I am a healthy 34 year old and my husband is 33. My first pregnancy was successful at the age of 31 however, early blood tests showed an underactive thyroid. I used natural remedies (acupuncture and pendulum) to sort this out and a fourth blood test at week 10 showed that my thyroid had returned to normal before the Drs could put me on medication. I gained a lot of weight early on in my pregnancy at 7 weeks because of the thyroid issue.
  
  12 months after giving birth, I had a ruptured ectopic pregnancy in my right tube. The left one was found to be blocked anyway so the Drs left the right tube in. A dye test recently showed the right tube is open.
  
  6 months and 12 months later I miscarried at 5-6 weeks. All 3 failed pregnancies displayed the same symptoms at the start; I had what I thought was a normal period but the bleeding continued past 5 days which is my normal cycle. In the 2nd and 3rd miscarriage I was monitored due to the ectopic risk and my HCG levels were very low and slow rising from the start. They never got above 112. Also there was no embryo found on the scans in all three 3 pregnancies.
  
  I remember also putting on weight with the 2nd and 3rd miscarriage and losing it immediately after the miscarriage.
  
  This month, I got swollen breasts before my period. My period was 3 days late (31 days instead of 28) and again the bleeding continued longer than normal by 4 days but this time was very light. My tummy was very swollen for a prolonged period of time until the bleeding stopped and I gained weight before and lost it when the bleeding stopped. A pregnancy test was negative so I suspect it may have been a chemical pregnancy.
  
  I suspect that the underactive thyroid may be responsible for the recurrent early pregnancy losses. I am not overweight (58kilos for 5ft10)but I do tend to gain weight quickly when pregnant (1.5 kilos before period is due).
  
  My periods are usually regular. What help should I seek please?

   

• At Thu Jan 22, 12:19:00 PM 2009,  Anonymous said…

  Dt T - I am 6 weeks pregnant and I had a miscarraige earlier at 5 weeks. I believe my estrogen level is 41 and this is a bit low? What is the required estrogen level. Is this an alarming number that I shd be worried about?
  Thanks

   

• At Sat Jan 31, 08:11:00 PM 2009,  Anonymous said…

  Dr. Trofatter,
  
  I am 35 years old and I have just endured my 3rd consecutive early miscarriage yesterday (7/08, 11/08, 1/09) at 5 weeks. I have a 3 1/2 year old daughter from a healthy and uncomplicated pregnancy in 2005. I have regular, 28-day cycles, A- blood type, a low positive lupus anticoagulant (6 weeks ago was 1-160 and retested a week ago was 1-40.) My daughter had a transient, positive lupus anticoagulant back in Nov (found when doing a pre-op workup for tonsils). I have a hypothyroid controlled with medication, Psoriasis, and I have had low HcG for all of the preganancies that resulted in miscarriage. I am a non-smoker and adopted so I don't know of any family history. I have an appointment with a reproductive specialist in several weeks. My OB/GYN mentioned baby aspirin if I decide against whatever other options I may be given. He said he does not know why these miscarriages have occurred with only the low positive ANA as a possiblility. My husband and I are struggling and we would appreciate any insight or advice. Thank you, Lisa

   

• At Wed Feb 25, 05:21:00 PM 2009,  ItsJustMandi said…

  This is a very interesting post... It reminded me a lot of myself. I have extremely regular periods and have since I began menstruating at age 13. They were 28 days apart before I had my son 5 years ago, and after him, I kicked right back up 6 weeks to the day and the cycles shortened to 26 days. In November '08 I suffered an early miscarriage at about 5 weeks into the pregnancy. I was devastated as my first pregnancy went without a hitch, so to speak. The OB told me to wait 3 months, or until I had completed 3 normal periods and to try again. Surprisingly, my periods came back at 23 day intervals this time. I had no idea when I would ovulate, but my husband and I decided to try again and I expected to get it right on the first try like I did with my last successful pregnancy. We had sex every other day the whole month, and what do you know, my period was a week late, which never happens, but when I found that I wasn't pregnant after all, I had to wonder if there isn't some reason for not getting pregnant after all of that. I know that many women try for months to get pregnant, but my family history proves that the women in my family do not have to try more than once! There have even been several surprises in the family due to the fact. So, I'm wondering if my body could be still trying to regulate the cycles since 23 days seems extremely short and I could see how it would be hard to conceive if the progesterone didn't kick in at the right time. Also, if a woman never has had late periods, and suddenly does, does this mean that she might have almost been pregnant? I know that sounds silly, but I felt like I was pregnant this last time but the tests kept coming up negative and then the period finally came. I have just never had a late period before - especially by a whole week. Any thoughts?

   

• At Mon Apr 06, 12:31:00 PM 2009,  Anonymous said…

  Hi,
  I read your article on pregnancy loss and I am interested in finding out more. I have a current dr. who hasn't really helped find out the cause. I am switching dr's. My last menstrual cycle was on feb. 4th. I believe that I ovulated very late around the end of feb. A week and a half ago I went to the emergency room. I found out that my hcg levels were low and there was no sign of a baby. Three years ago I had the same thing happen only she ruled it as being a possible ectopic. She wasn't really sure though. Could have been an early mc. My husband and I have been really frustrated.
  Since I started my periods at 12, they have been irregular. I can go a few months without having one. My cycles are longer than the 28 day cycle.
  I haven't had any tests or etc except the hcg levels checked. I mentioned hormones but she never checked those levels.
  I would appreciate any comments or feedback.
  Thanks

   

• At Mon Apr 27, 05:01:00 AM 2009,  Anonymous said…

  Hello doctor! I am going through your articles and found these to be much more informative and logical as compare to other web materials. Hope you would assist me too... I had my miscarriage last month (7 weeks). I always have a regular cycle. 30 years old got married an year back. I started having a brown discharge around 10 days after I was expecting my periods followed by bleeding. Doctors teasted for HCG and it comes to be very low(560) then I undergo a medication and then doctor tested me again for HCG after 2 days but it didnt doubled (695) then she adviced for d & c after performing an ultrasound. She performed lot of tests 15 days after miscarriage i.e. haemoglobin test, thyroid test, progesterone test, glucose test. TORCH test. All tests were normal except CMV teast as it was positive so she prescribed me " NATCLOVIR" for 10 days. Could you please advice what could be the reason of the miscarriage and low HCG level . Was CMV infection resulted in the miscarriage. PLease help?

   

• At Mon May 04, 01:45:00 PM 2009,  Anonymous said…

  Hi Dr. Trofatter, I would like to know the effectiveness and safety (Category X drug) of HCG shots during the first trimester. I was prescribed HCG shots every 3 days for the first trimester for recurrent pregancy loss. I am also taking progesterone vaginal suppositories. The Category X really concerned me, and I am wondering if the benefit of taking this medication outways the risks.
  Please help.

   

• At Thu May 07, 06:11:00 PM 2009,  Anonymous said…

  Hi,
  I just went through my 4th pg. loss in a row. I am 30 and my husband is also 30. We do not have any children. I get pregnant very easily (first cycle each time), but can't seem to make it past 8 weeks. First two losses my hcg levels were low; 2nd pg. they didn't rise properly. First two losses were natural miscarriages. 3rd pg. I made it to the 9 week u/s and we found out baby died at 7w5d and chromosomal analysis revealed baby girl had trisomy 22
  I have Factor V Leiden heterozygous and have had 1 positive and 2 negative lupus anticoagulant tests. I was on heparin injections and low dose aspirin for 4th pg. Went in for 6 week u/s and saw 2 gestational sacks (one irregular) and one sac with 6 week embryo with hb of 112 beats per minute. Went in for 8 week u/s and irregular sac had vanished and baby had died at 6 weeks. I just had a D & C and we are waiting for karyotyping.
  Husband and I have both had genetic analysis done on us and it came back normal.
  I have had some TSH levels that were low 0.06 but they came back up a few months later. Free T4 was 27.7 but it also went back down.
  I consider myself to be in good health, but with 4 m/c's in a row and no concrete ideas as to why I am feeling as though my chance to become a mom is slipping away.
  I also had my FSH and Estradiol tested and FSH was 4.3 iu/l and Estradiol was 53.
  Any thoughts are much appreciated.
  
  T.

   

• At Sun Jun 07, 01:24:00 PM 2009,  Anonymous said…

  Dear Sir
  
  Many thanks for all that you do!
  
  I wrote last year as I had miscarriage number 2, however, I can't find it on the site.
  
  My brief history
  
  29 yrs old - Husband 32
  
  I suffer facial and excess body hair, cycle ranges from 38-58 days. Been advised high testosterone/PCOS but no cysts(2007)
  
  Feb 2007 Blighted ovum had ERPC as MMC. Hadn't had a period since Nov 1st 2006 , several negative tests in dec, Bleed 1-3rd Jan(thought period), positive test 8th jan.
  
  SECOND
  16 months later(trying every month) June 2008
  6weeks had early scan as spotting, scan revealed a tiny flicker of a HB all looked good. 7 Weeks still spotting sonographer said they couldn't see anything at all. 8 Weeks different sonographer saw a nice healthy sac etc but nothing else. Still bleeding decided on ERPC .
  
  THIRD
  October 2008
  + test 8th october , a few days later had massive bleed, scan revealed miscarriage had occurred, 2 further HCG tests revealed correct and reduced to zero naturally.
  
  All standard tests carried out + chromosome on hubby, all ok. Consultant said its just unlucky.
  
  June 2009
  Just found out that I am pregnant, clear blue predictor states 1-2 weeks since conception.
  
  The reason I tested was not because I had missed a period or had any other symptoms but was because of this awful spotting I always get when pregnant and at no other time.
  
  27/march 09 LMP
  was expecting to have next period approx 3rd may (38 days)- Nothing, test negative. 10th still nothing test neg. 15th Negative . 20th (day 58)thought period had finally arrived, lasted 3 days, normal flow etc.
  June 2nd, third, fourth spotting brown/ red with cramps - 5th tested and + result on several cheap and 1 clear blue test.
  
  I am still bleeding/spotting and am sure this will end as the others did, have GP appointment tomorrow.I have no other symptoms as I normally do.
  
  I am totally confused, we both lead normal healthy lives, all tests have come back ok and we fear we will never have a child. can you suggest anything at all?
  
  Oh my mum has Lupus SLE but I have been told I am ok.
  
  Many thanks In advance

   

• At Wed Jun 17, 04:29:00 AM 2009,  Anonymous said…

  For the 11 years of my marraige, I have gone through 9 pregnancies out of them the 3rd (@28th week) and the 4th (@30th week) i ended up with Still births and the rest were miscarraiges. After, certain test it was confirmed that out of the 2 genes that decided the placenta is negative and i was asked to continue with 100mg Asprin and a 5mg folic acid daily pre, during and post pregnancy. This is the only illness found with me after the necessary check-ups carried out. Will you please, advice me doctor whether it is advisable for me to try out for another pregnancy and is there any more threatments that i should under go prior to the next pregancy,

   

• At Thu Jun 18, 05:10:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous June 7: You need to find a specialist in Reproductive Endocrinology and Infertility who will do more for you than tell you that you are "unlucky." You CAN be helped, but the longer you wait, the harder it will be. Best wishes,
  Dr T

   

• At Thu Jun 18, 05:13:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymus June 17: You have not told me what "problem" has been identified and it would also be helpful to know what tests have been done and are "negative." The least you might benefit from is empiric therapy with heparin or low-molecular weight heparin (such as Lovenox) staring even BEFORE conception. Thanks for reading.
  Dr T

   

• At Sun Jun 28, 04:02:00 PM 2009,  danyelle said…

  hi there, I am a 28 year old healthy female, who has a healthy 3 year old son. I have been trying to have a second child for over a year now, i have had three miscarriage in the past 8 months.....all have been very early. One at 5 weeks one at 4 weeks and the third one day before 5 weeks. I have been to see a OBGYN. a few times and everytime he says its just bad luck ....
  I have had HCG levals done with last 2 miscarriages and they start going down right away. my last miscarriage was at 31 at 4 weeks then 2 days later 40 then down to 9 5 days later.
  I have had all the blood tests done evan progesterone and my doc says they are in the normal range.
  I do have a lot of cramping on the day of ovalation, around day 12-14of my cycle. I never felt that untill about a year and a half ago, i dont know if it means anything???? Other then that everything eles seems normal.
  Im just really sick of being told "it's just bad luck the next one will work, keep trying." Im sick of trying!!!!!
  Do you have any ideas????? thanks Danyelle

   

• At Thu Jul 02, 07:36:00 AM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Danyelle: I think you have had enough problems that you need to see a specialist in reproductive endocrinology and infertility who has an interest in early pregnancy loss. You appear to be having "implantation" problems and there are MANY factors that can contribute to that rather than "bad luck." So, GOOD LUCK to you and let us know what you find out.
  Dr T

   

• At Wed Jul 08, 06:22:00 PM 2009,  danyelle said…

  hi dr T
  Danyelle again...so i recently had a ultra sound done (witch i had to insist my docter give me) and it turns out the lining of my uteris is thin, only 3 mm and my doc said it should be at about 10 cause i was at day 16 of my cycle.
  So now my doc is doing more blood work to check progesterone and a estradiol on day 12 of my next cycle, what im wondering is why you think he might be doing this instead of just giving my progesterone witch i thought was the comman treatment.....now im waiting for 2 more cycles before we can try again. My doc is not a very friendly talkative guy thats why im asking you.lol!!! thanks so much ...id love your opinion. thanks Danyelle

   

• At Thu Jul 09, 06:18:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Danyelle: Let me know what the test results show, but let me emphasize my previous recommendation - find a specialist in REI!
  Dr T

   

• At Fri Jul 10, 04:32:00 PM 2009,  Faith said…

  I've read through 1/2 a page of the comments/replies and don't see anything that fits my situation so I thought I'd ask.
  
  I have had 2 natural pregnancies, carried full term and no pregnancy issues. These were 13 and 15 years ago. I had my tubes tied after my second child.
  
  I decided to undergo IVF treatment last year over a tubal reversal. I had 7 eggs retrieved, 5 fertilized normally/conventionally and had 3 transferred. At 9 days past ovulation/retrieval I got a positive on my HPT, and the next day I got a positive as well. After that, negatives until BETA was tested and it was also under 5, considered negative.
  
  I was tested some more and found to have 2 copies of the MTHFR gene mutation, and put on medication for this (metanx), as well as baby aspirin, a prescription prenatal and extra B6. I had 14 eggs retrieved, 12 fertilized conventionally and 4 transferred. Out of both cycles, the embryos were 6 cell or less at day 3, and none made it to the 5th or 6th day freezing stage.
  
  I got a positive at 8 days past transfer (11dpo) and went on to get 4 consecutive positive BETA's that were doubling correctly. At 6w2d my BETA was negative.
  
  What could be the problem with me carrying a pregnancy past that first few weeks? I've had saline sonograms, FSH was 6, and the other test I've been given to judge age and quality of my eggs are all positive for my age (35).
  
  Just trying to figure out what exactly could be going wrong after 2 natural pregnancies. Oh and my cycles are 22-33 days and always have been that way.
  
  Thank you!

   

• At Tue Aug 11, 12:43:00 PM 2009,  Anonymous said…

  Hi,I'm 37, my husband and I have been trying to concieve for five years and have an 'unexplained' diagnosis. I've had four iui's and 1 ivf, all negative. i wonder if you can offer me some advice.
  Two weeks ago I got a positive test from an ivf cycle, then a week later it turned to a negative and my period arrived. I think this is called a 'chemical pregnancy'.
  I was wondering if this will affect my chances of a successful pregnancy in the future? Also, my periods have always been fairy regular although quite painful, do you think i could have a hormone problem?
  Sorry to ask so many questions, any advice would be appreciated.

   

• At Tue Aug 11, 12:50:00 PM 2009,  flower said…

  Hi
  My husband and I have been trying to conciev for five yaers, I'm 37. Weve been diagnosed with 'unexplained inf'. After 3 iui's and one ivf were negative i finally got a positive the other week from my 2nd ivf. However after a week it turned neagtive and my period came. i think it is called a 'chemical pregnancy'.
  i was wondering if this will affect my chances of achieving a successful pregnancy in the future, or does it indicate that i have hormonal/immune issues? My periods have always been fairly regular, although painful.
  Am so frightend that this will happen again.
  Any advice would be greatly appreciated.
  Thank you.

   

• At Tue Sep 29, 07:08:00 PM 2009,  tota said…

  hi dr.
  please help i am going mad i am married for 2.5 years same partner my husband is 30 years old and i am 26 years old ihad 2 chemical pregnancy in a row my hcg was 31 then start bleeding i suspect more chemical pregnancies that i did not recognise had hysterosalpinogram done all as normal also blood test for hormones and infections normal also please tell me what to do
  thanx tota

   

• At Wed Sep 30, 11:01:00 AM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Tota: At your young age, my simple response would be to tell you to relax and keep trying. The odds are in your favor that you will have a successful pregnancy. If not the next time, then let me know what specific studies and results have been done to date and then I will offer some more suggestions. Best wishes and thank you for writing.
  Dr T

   

• At Mon Nov 02, 05:29:00 AM 2009,  Anonymous said…

  Hi, I am 26 and Just Married. I have been taking mycrogynon ED for the last 2years. (one man).
  Been off the pill since september 12th this year(2months now). since i got off it, the monthly flow has been so heavy. the last one (28th Oct-1st Nov) was accompanied with painful breasts which r still painful to now!!! i realised a dark brown discharge.
  
  I have also failed to concieve during this time been timing ovulation.
  
  could i be having a problem?
  Joana

   

• At Mon Nov 02, 07:02:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Joana Nov 2: Your body is just getting used to the restoration of normal hormone levels again after being suppressed by the birth control. But I would recommend you get a pregnancy test done if your breasts are still tender!
  Dr T

   

• At Tue Nov 10, 03:07:00 PM 2009,  Buer said…

  Hi Dr.
  I'm 31 and my partner is 34. I have miscarried four time. They all ended up before 5th weeks of gestation. In last two pregnancies, my beta-HCG stayed around 70 on day 12 after ovulation, then dramatically dropped to 8-10 two days later. As a result, I had my "periods" on the days I was supposed to have them. Never needed a D/C for my miscarriage. I keep recording my body basal temperature s. They do show apparent ovulating phase and luteal phase.
  I'm just wondering if it could be resulted by hormonal imbalance or more likely a genetic problem?
  Thx! Dr.

   

• At Wed Nov 11, 02:11:00 PM 2009,  Anonymous said…

  HI hoping you may be able to help us. Been ttc for 5 years, had 2 miscarriages 5w 6d and 3 ectopics around 6w mark resulting in loosing both tubes, have had 4 failed IVF treatments with period starting 2 days before test day and 2 FET, 1 successful, saw heartbeat at 6 weeks, heartbeat stopped between 6 - 8 weeks. I have Rhesus neg A blood group so had anti-d injection after each ectopic. Have tested positive for MTHFR and equivical on Lupus.
  Have been taking aspirin and on last IVF treatment was given Fragmin and pyridoxine. Is there anything you can advise to help? Any other tests, drugs etc.. we have one last attempt with FET next year?

   

• At Thu Nov 12, 04:35:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Buer Nov 10: I think it would be best if you looked for a specialist in Reproductive Endocrinology and Infertility to help evaluate you. Your 'infertility' could be for ANY reason at this point, hormonal, chromosomal, immunologic or inherited thrombophilia, or even a uterine malformation. After you get some more information, let us know what you found out. Best wishes!
  Dr T

   

• At Thu Nov 12, 04:40:00 PM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Nov 11: Other than supplemental folic acid and the low molecular weight heparin, I am not sure what else I would recommend. Have your doctors tried giving you a course of Lupron for 3-6 months before getting you ready for the FET? One other option you might consider is trying to find a 'surrogate' to carry your baby for you. Your REI specialist can usually help you find someone unless you have a good friend who would be willing to try. Best wishes.
  Dr T

   

• At Thu Nov 12, 06:09:00 PM 2009,  JMPhil said…

  Hi, I would like your opinion. I am 28 years old. I have a four year old. My husband and I would like to have our 1st child. In May I was diagnosed with a blighted ovum at 11 weeks and got a d&c. I then had a chemical pregnancy in July. The dr. said we could start testing but we chose to try one more time. I've kept track of my cycles and my luteal phase is 12 days. Ovulating somewhere between 15-19. My charts:
  http://www.fertilityfriend.com/home/261be3
  My cycle last month had a 15 day luteal phase. I took hpt and had very faint lines. I called the dr. to get a blood test because I wasn't sure if it was a real line or ghost(evap) line. It was a Friday and she told me to call on Monday if I didn't get my period. The next day it showed up. So now as I reflect I really think I had another chemical pregnancy. What do you think? Should I start testing? Or see what happens next time. I'm due for my period tomorrow. So far negative tests with no faint/ghost line. I also had a coloscopy this month that came back normal. Any thoughts would be greatly appreciated!

   

• At Sat Nov 14, 08:44:00 AM 2009,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To JMPhil: I am presuming your current partner did not father your first child. Under those circumstances, and at your young age, I would probably suggest waiting to do a big work up until you have had another clearly documented pregnancy. If you miscarry that baby, consider chromosomal studies on the pregnancy tissues. In the interim, consider simply having a screen done for thyroid disease and perhaps a serum prolactin level. Since you are having a slight prolongation in cycles, some physicians might also try an empiric course of Clomid for 3-4 cycles (but I would not recommend any more than that without a more thorough evaluation). Best wishes...
  Dr T

   

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