Infertility/Fertility/miscarriage

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Question
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.  

Sincerely,

Melodie Parker

Answer
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.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at info@montereybayivf.com.  This service will allow you to have your own personal on-demand infertility expert.

Infertility/Fertility

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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