Dear Dr. Ramirez,
I am 40 years old and from Pennsylvania. I am currently undergoing a miscarriage at 7 weeks. I also had a missed abortion a year ago at age 39 for which I had a D&C. Before having my three children at age 34, 36, and 37, I also had two miscarriages. My first child came after a round of Clomid. My fertility specialist told me the lining of my uterus was getting too old because I had irregular cycles with a period anywhere from every six to ten weeks. Although my cycles were still just as long and irregular after my first child, and I was breastfeeding, I conceived and carried #2 and #3 with no problems. My cycles are a little more regular now and occur every five to six weeks. I seem to get pregnant as easily as ever. I still seem to have good temperature rises when I ovulate, and I used a natural progesterone cream supplement during my most recent pregnancy which I lost. My thyroid always tests okay. Progesterone is the only hormone I have ever heard of being problematic when it comes to miscarriages, so I was wondering if there are other hormones that can play a part as well? Can FSH or LH be problematic when it comes to miscarriage? I do understand that my eggs are aging and that could be the only cause for my miscarriages, but I was curious about the hormonal aspects. I appreciate any light you can shed on this subject.
Hello Melodie from the U.S. (Pennsylvania),
The main "hormone" involved in implantation and then maintenance of the pregnancy is progesterone. Other important hormones in this process are estrogen and HCG. All of these can be taken a supplements. Progesterone is mainly used in patients that might have an insufficiency, called luteal phase defect, that can lead to recurrent pregnancy loss. However in your case, I would think that "old eggs" is the main reason for the miscarriages. In patients with RPL, options for treatment include: IVF with PGS (preimplantation genetic screening) and/or supplementation with estrogen, progesterone, medrol, heparin and low dose aspirin. It will be up to your doctor to counsel as to what is the appropriate treatment.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
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