recurrent miscarriages

[lavatea]

Hey ladies. I've tried to research on some threads before posting, but I don't have a lot of time tonight and don't seem to be finding answers.

Here's my story:

I am 27 years old. I miscarried last November at 18 weeks. Heard HB at 13 1/2 weeks but baby probably died just after that based off of US measurements. M/c at home with no D&C. I got pg again in Feb but m/c at 4w6d. Conceived again in May. M/c again at 6w3d. I was on progesterone cream with the 3rd pregnancy (started just after 2nd m/c began).

I have 2 children already and no history of m/c until the 3rd pregnancy. Had my oldest child when I was 21. She was term, delivered vag, weighed 9#13oz. I was 23 when my second was induced early at 34w6d due to PIH. Induction failed and he was delivered via c/s, weighed 3#9oz (IUGR r/t PIH).

Because I was on progesterone cream with the 5th pregnancy but miscarried anyway, I sort of ruled that out as my problem. Had my thyroid levels tested, but they came back normal. The PA suggested doing a saliva test to test progesterone levels even though I was on the cream. Told me the creams may not have delivered enough progesterone.

Got my saliva test results back today. Have not gone back to the PA. Was hoping you guys could help me interpret these and would like your opinion on where to go from here.

*estradiol (saliva) 1.1 pg/ml (luteal phase range norms 1.3-3.3)
progesterone (saliva) 125 (luteal phase range norms 75-270)
ratio pg/e2 (saliva) 114 (optimal range: 100-500 when e2 1.3-3.3 pg/ml)
testosterone (saliva) 31 pg/ml (normal range for ages 16-30 is 18-55)
*DHEAS (saliva) 2.9 ng/ml (normal range for ages 16-30 is 6.1-18.6)
cortisol morning (saliva) 8.1 ng/ml (normal range 3.7-9.5)

The symptom form I filled out with the saliva test suggested that I have high cortisol. The lab recommended that I do cortisol tests throughout the day to see if the levels possibly go out of whack later in the day, since my morning levels are normal, but I reported symptoms that fall in the high range. They also said that chronic low DHEAS may suggest adrenal fatigue, especially if cortisol is low. But my cortisol isn't low or even anywhere near low.

I did some internet research and couldn't really find much about low estradiol during the luteal phase. Low DHEA is also linked to hypopituitarism, which has poor pregnancy outcomes. Not sure how to go about finding out if that's the problem.

Any other suggestions? TIA.

[eepster]

Originally Posted by lavatea

Had my thyroid levels tested, but they came back normal.

Did that include tests for hashimotos?

[lavatea]

Originally Posted by eepster

Did that include tests for hashimotos?

As far as I know they just tested the T3 and T4 levels. I didn't get a report that time. They just told me over the phone that the levels were normal.

[eepster]

Originally Posted by lavatea

As far as I know they just tested the T3 and T4 levels. I didn't get a report that time. They just told me over the phone that the levels were normal.

Hashimotos is a positive or negative thing, not about levels (though it typically will cause high or low levels,) so they probably didn't. Do you have any thyroid symptoms other than miscarriages? It is a simple blood test, so easy to either rule in or out, but you usually have to convince them to run it.

[lavatea]

I had them test for low thyroid function because I went through some online quizzes and had about 1/2 of the listed symptoms. Plus both my grandmother and mother have hypothyroidism.

Is the test for Hashimoto's a blood test? My levels could be normal and I could still have it?

[eepster]

Originally Posted by lavatea

I had them test for low thyroid function because I went through some online quizzes and had about 1/2 of the listed symptoms. Plus both my grandmother and mother have hypothyroidism.

Is the test for Hashimoto's a blood test? My levels could be normal and I could still have it?

Hashimoto's is basically an autoimmune response to the thyroid. When your immune system is assaulting your thyroid, it either is unable to produce enough hormone or it may over compensate and produce too much hormone. At other times, your immune system isn't attaching and your levels will return to normal. Basically, a person with hashimotos can have low levels one week, high levels the next week, and normal levels the week after that, so hashimotos is often first caught when testing levels, but can easily be missed.

[lavatea]

Well, that's good information to know. I should call and see if they tested for that as well, though I doubt they did. Are there any hallmark s/s that scream Hashimoto's? Or would you swing between the hypo- and hyper-thyroidism s/s?

[eepster]

Originally Posted by lavatea

Well, that's good information to know. I should call and see if they tested for that as well, though I doubt they did. Are there any hallmark s/s that scream Hashimoto's? Or would you swing between the hypo- and hyper-thyroidism s/s?

The symptoms are most often just identical to hypothyroid, only some people get the hyperthyroid as well. In my family (strong genetic link) of the 4 of us who have or had it, my mom was the only one who had the hyper symptoms as well as hypo. My grandma, my sister and I only had hypo symptoms.

[Lady Lilya]

What have your folate and homocysteine levels been like?

[lavatea]

Originally Posted by Lady Lilya

What have your folate and homocysteine levels been like?

I have no idea. I take an 800 mcg folic acid supplement daily, but I've never had my blood levels tested. What might that tell me?

[soso-lynn]

1. Progesterone creams are not very useful. The absorbed dosage can vary tremendously. The best delivery method is IM injection, followed by intra-vaginal, then had oral and then the cream.

2. Have you had any ultrasound or hysterosonography to determine if any scar tissue from your c-section is problematic?

3. Your miscarriages happened at different times during the pregnancy so it would be quite possible that the first one had a genetic defect, the second one was a chemical pregnancy and the third was an early miscarriage for some other reason. I am not suggesting that you stop investigating but do keep in mind that there may not be any problem.

4. When patients have recurring pregnancy loss, there is a standard panel of blood tests that most fertility specialists will do. You should start with that as it isolates many problems. The most common are clotting disorders that can be resolved by injecting blood thinners during the pregnancy.

[purplepaisleymama]

I am not sure how much my story will help you, but here it is..... I had 5 pregnancies with no real issues other than hyperemesis (constant vomiting for months in the pregnancy with weight loss). My kids are all about 2-3 years apart and despite nursing my kids for years I still conceived with no issues. I had term pregnancies with my first 3 kids, then my 4th was 37 weeks (technically term but still on the cusp of early). My 5th was born at 35 weeks gestation, I was under alot of stress but felt physically not well when I went into labor, I had felt similar with my 4th at the end of pregnancy.

After my 4th and 5th children I had weird symptoms, ranging from painful(like not being able to walk) feet, exhaustion, weight fluctuation and insomnia. All of the practitioners that I saw, MD, Chiro, OT all said that the majority of the symptoms were from having kids so close together and that I should try to get some rest by putting the kids in school/daycare.

We tried after our youngest was 8 months old to get pregnant, it took a few months and i had a mc, then two more mc's in the next four years. I was miserable, no doctor or midwife that I saw would discuss what was the problem, they all just said that mc's happen and that I needed to rest and concentrate on my kids.

I got pregnant (finally) this January, fully expecting that I would have another mc, at 10 weeks my neck swelled...... three times it
s normal size! I called my mw (CNM who I was seeing for backup care at hte beg of pregnancy), she had mentioned that I had a slight goiter at my first visit a few weeks before but had said that it was not usually a big deal.
I ended up going to 3 different endocrinologists, to find someone who I could trust and who trusted me. I was told that I had Graves disease by the first endo, Hashimoto's by the second endo and the third has said that she is not sure which I have but that regardless we are treating the now hypo numbers and symptoms and will visit the dx when my thyroid does whatever it does after the baby is born.

I have been really tired this pregnancy, whether that is because of the thyroid issues or that I am older this time, I don't know

I do know that the doctors that I saw for years before this was finally recognized never tested for all of the thyroid tests. If someone had listened to me 15 years ago I might have had a very different life health-wise. I am just thankful that I am finally having another little one now..... I hadn't thought that it would happen. I will say that my cpm now and I are both convinced that my last two kids have had thyroid issues that showed a breathing issues after birth and that this time we will be very aware of the baby's overall health.


I hope that you get some answers soon, it is so hard to not be believed and trusted.
~laura

[lavatea]

Originally Posted by soso-lynn

1. Progesterone creams are not very useful. The absorbed dosage can vary tremendously. The best delivery method is IM injection, followed by intra-vaginal, then had oral and then the cream.

2. Have you had any ultrasound or hysterosonography to determine if any scar tissue from your c-section is problematic?

3. Your miscarriages happened at different times during the pregnancy so it would be quite possible that the first one had a genetic defect, the second one was a chemical pregnancy and the third was an early miscarriage for some other reason. I am not suggesting that you stop investigating but do keep in mind that there may not be any problem.

4. When patients have recurring pregnancy loss, there is a standard panel of blood tests that most fertility specialists will do. You should start with that as it isolates many problems. The most common are clotting disorders that can be resolved by injecting blood thinners during the pregnancy.

You're thinking along the same lines as me, which reassures me that I'm not as crazy as I was beginning to think. I've mulled over #2 and #4 as possible reasons for the m/cs. The practitioners looked at me like I was a little cracked. They seemed to think that those are both very rare possibilities. I started taking aspirin after the 3rd m/c. I thought even if a clotting disorder wasn't my problem that it might help prevent me from getting PIH again (read somewhere about a study to that effect).

I have considered your third point at some length as well. I just keep thinking that it is such a coincidence. But the first m/c especially seems like an outlier. So who knows.

We don't have insurance or much money. I self-paid to see the OB that delivered my first two children (I started working with a midwife for the 3rd pregnancy) after I had the first m/c. She did a Pap and a routine exam. Said everything looked fine. Then my midwife suggested the progesterone cream when it looked like I was going to m/c the 2nd time. So I was on that until after the 3rd m/c. That's when I started taking the aspirin. I've run out of aspirin and haven't conceived since I was taking it, so I don't know if it would have had any effect or not. After the 3rd m/c is when I really started researching any possibilities for recurrent pg loss that I could find. So I went to a group of PAs and had them test my thyroid (although they said right away that it was probably progesterone levels). When those levels came back "normal" I went ahead with the saliva test. Now I'm trying to decide if I want to fork out more money to the PAs and see what they suggest next, or if I should just wait until I'm working and have insurance. If I wait until that point (but who knows when that might be - even if I get a job just after December graduation, it could be up to 3 months until I have insurance), I could go see a NaPro doctor.

[lavatea]

Thanks for your story, purplepaisleymama. Congrats on your new baby!

[Lady Lilya]

Originally Posted by lavatea

I have no idea. I take an 800 mcg folic acid supplement daily, but I've never had my blood levels tested. What might that tell me?

The reason I ask is:

About 1/3 of people have a variation in their MTHFR gene that makes it hard or impossible for their body to make use of folic acid. What we need is folate, as is found in green leafies and lentils and stuff. Folic acid is the synthetic form in most supplements. If you take folic acid, your body will absorb less folate from food, thinking it has enough, but then it can't use it.

Shortage of folate causes homocysteine to rise, which leads to micro-clots. The blood vessels involved with the placenta are very tiny, and the micro-clots can often block them, leading to miscarriages. So, often those with MTHFR variations have frequent miscarriages. The key to avoiding them is to get lots of folate itself. (Thorne now makes a supplement. It is called 5-MTHF)

I was curious, so I asked my doc for a test of my MTHFR gene status, and I have the "worst" combination. Yet my levels are fine. Probably because I eat a ton of leafies, avoid synthetic folic acid, and take folate.

[lavatea]

So would stopping the folic acid and just increasing folate ingestion hurt me if I wasn't one of the people with the gene variation? Or would baby aspirin therapy work as an alternative to that?

I'm just scared to not get enough and cause some type of neural tube birth defect.

[bri276]

I have 2 children already and no history of m/c until the 3rd pregnancy.

Is this the same father?

[lavatea]

Originally Posted by bri276

Is this the same father?

Yes.

[Lady Lilya]

Originally Posted by lavatea

So would stopping the folic acid and just increasing folate ingestion hurt me if I wasn't one of the people with the gene variation? Or would baby aspirin therapy work as an alternative to that?

I'm just scared to not get enough and cause some type of neural tube birth defect.

Folate hurts nobody. If you have folate, you don't need folic acid. Folic acid is a substitute.

If I were you, I'd switch to the 5-MTHF supplement by Thorne to be sure.

If you are one of the third of people with the gene variation, folate is what you need to prevent midline birth defects. Not folic acid.