So my MC's were not technically unexplained, but I believe that's because I was fortunate to be tested for some things that aren't normally tested for (as far as I can gather.) I’ll give you the heads-up… this is going to be long, but in my story I mention a few often overlooked causes of MC’s. If this information I’ve discovered on my fertility journey helps even 1 woman, I will consider it a blessing!
I got married at age 40 (my DH is almost 3 years younger), so after a little over a month of marriage my husband and I turned our attention toward TTC. I got my BFP on our third try (my third cycle) right after I turned 41. Unfortunately, that pregnancy ended in a missed miscarriage at about 6 weeks gestation. I took Misoprostol (with Lortab for the pain, as Ibuprofen doesn’t work well for me.)
Three tries later and I was pregnant again. Then I MC'd at about 8 weeks. My OB/GYN at the time and I had some evidence and suspected that it was actually another MMC at just under 6 weeks that came out on its own at 8 weeks after my plane landed on vacation.
With 2 MC's in a row I was now considered to suffer RPL, and my OB referred me to a world-renowned RPL specialist, RE, Dr. William Kutteh in Memphis, TN, where I lived at the time. After a litany of testing over the course of a month they discovered I had an overgrowth of the bacteria ureaplasma in my endometrium. Two weeks of antibiotics (Doxycycline) later for my husband and I and to my relief I was infection-free. OFTEN OVERLOOKED #1: My understanding is that most RE’s do not test for ureaplasma/mycoplasma infections. So if you’ve had 2 or more MC’s at around 6 weeks, make sure someone tests you for those!!! Dr. Kutteh definitely will, and he will see long-distance patients (after an initial in-person visit I believe.) I think it’s a vaginal swab test, but don’t quote me.
My weight had crept up about 18 lbs after marriage and 2 (failed) pregnancies. I tested pre-diabetic at this point. Dr. Kutteh put me on Metformin and told me to lose 10 lbs. I went on Phentermine (my idea) and lost 12 pounds rather quickly. I got retested and was no longer pre-diabetic. (Do not take Phentermine while TTC, as it can cause birth defects.)
We were given the green light to try again, and just before my 42nd birthday we conceived on our first try! My RE kept me on Metformin throughout the pregnancy as a precaution. I was also on Progesterone vaginal suppositories 1x/day until 10 weeks gestation. OFTEN OVERLOOKED #2: Low Progesterone is also one of those things that can cause a MC (and at a different time than you got tested!) So if you've had early-term (under 10 weeks in this case) RPL, once you're pregnant again it's best to go on Progesterone vaginal suppositories 100mg probably 2x/day (which is what Dr. Kutteh's office told me recently) until 10 weeks.
Our beautiful healthy DS was born 10/28/14. I started trying to wean him after he turned 2, as I had no sign of my cycle during the whole time I was breastfeeding. When he was almost weaned at 2 years 2 months, my cycle returned (and he was completely weaned 2 months later.) I was now 1 month shy of 45. We started TTC #2. After more than double the amount of tries in the past (3rd, 3rd and 1st try, respectively at age 41) we conceived on our 7th try at my age 45. I went on oral Progesterone 200mg 1x/day (but would honestly go on 100mg 2x/day vaginal suppositories if I were to conceive again.) At about 8 weeks gestation I had another MMC. I took Misoprostol like I did for the 1st MMC.
We started trying again, but I realized at this point that some changes had started happening in my body around the time I turned 45. All of a sudden I needed reading glasses. I was more fatigued, desperate for an afternoon nap. I had low energy throughout the day, brain fog, low concentration and forgetfulness. I started getting acne around my jaw line (which ended up greatly reducing after starting Omega3 TG by Athletic Greens), my lower cheeks began feeling rough, I started getting crepiness and lines under my eyes, my skin seemed looser and little bumps developed on my thighs. My hair was not filling back in after the normal hair loss that comes with having a baby and may have been thinning more, and my eyebrows were thinning. I felt more anxiety and couldn’t fall asleep as easily anymore. My body felt stiffer, and my libido was lower. I was also gaining weight (and around my belly for the first time ever) and feeling hungry when I shouldn’t be. I couldn’t lose the weight by my normal methods in the past. I wasn’t sure if all this was normal “aging” or if I was starting to have hormonal issues that possibly could be corrected.
The Holy Spirit put in my life my (much younger) friend from church, who had infertility for 5 years. She went to a highly-rated, NaPRO Technology-trained OB/GYN in Memphis, Dr. Michael Podraza, and was told she had issues with estrogen, prolactin and thyroid (2-3 years after an RE in my RE’s office told her after undergoing testing that she had unexplained infertility.) After just a handful of months under Dr. Podraza’s care, she got pregnant and last month had a healthy baby boy!
Even though I had already moved to Atlanta, going on my 7th try since my MMC last year I decided to drive the 6 hours back to Memphis to have a consultation with Dr. Podraza. He started my testing, and I continued it with 4 M/W/F visits to LabCorp here in the Atlanta area. This was a lot more hormonal testing (ironically) than my RE did back in 2013.
A couple weeks later Dr. Podraza’s nurse called me to relay 2 issues:
1) My T3/RT3 ratio was 9.8 (should be 20), and my FT3/RT3 ratio was 3.8 (should be 10.) My inactive Reverse T3 (RT3) was super high, not allowing T3 into my cells. The first month I was put on the generic Liothyronine pill (synthetic T3), working up to 15 mcg, 2x/day, and starting my second month have been on the compounded time-release version of the same. Thyroid issues can cause infertility and MC, and there's a very good chance that's what caused my last MMC.
2) I was also told my Progesterone drops too much too fast so I'm on a graduated amount of Progesterone pill: 200mg before bed on P+3 through P+6 (P=peak cervical mucus, which is the estimated day of ovulation or the day after your LH surge), 400mg P+7 – P+11 and 200mg P+12 – P+14. Then I test for pregnancy, or I’ve already started my period. My understanding is the Progesterone will help with the thickening of the uterine lining for implantation.
I told Dr. Podraza during my consultation about my history and also about having been prediabetic just a couple pounds above this same weight, going on Metformin, etc. and that I should probably be retested. His response was basically for me to start taking Chromium Piccolinate, which I am.
He also has me taking the supplement CortiSolv for adrenal support because he said “adrenal issues tend to go hand-in-hand with thyroid issues” and the supplement Ovasitol for egg quality. (I was on OvaBoost when I got pregnant last time.)
On my own I started taking 3 fertility supplements (not sure why this text is double-spacing):
1. Vitex (which is Chasteberry, for hormonal support)
2. Maca (for hormonal support)
3. Royal Jelly (for egg support)
I also have been on for awhile:
1. Benfotiamine (fat-soluble vitamin B1; there’s some promising research about preventing Down’s Syndrome)
2. Vitamin B6 (for quality cervical mucus, a supplement Dr. Podraza also recommends)
4. Garden of Life Certified-Organic Whole-Food Prenatal Multivitamin/mineral (taken at least 4 hours after/before a thyroid pill due to iron)
5. OptiZinc (taken separately from my prenatal multi)
6. The Omega 3 I mentioned previously
Since starting the thyroid pills I do feel I have more energy, I’m maybe 50% better and do not desperately need an afternoon nap most days (but some days I do, albeit shorter ones.)
Dr. Podraza said he would have me retested after 3 months, but a couple months into taking the synthetic T3 I realized I needed to do some more research into underlying causes of thyroid issues and determine if I should be making some lifestyle changes such as what I’m eating and what supplements I should be taking (or avoiding.) Once again the Spirit led me to the next step… StopTheThyroidMadness.com. I won’t get into all the details, but if you are having symptoms like: brain fog/low concentration/forgetfulness, unexplained weight gain, fatigue/low energy, depression and/or anxiety, etc., definitely check out this site! OFTEN OVERLOOKED #3: Most conventional doctors only test your TSH level when testing your thyroid (mine was in the "normal" range), but you need at least your Free T4, Free T3 and Reverse T3 tested as well! There are some others you might need too.
Through a Yahoo group that website runs I was able to access their “Good Doctors List” (very few of whom are Endocrinologists.) Some of the practitioners are MD’s, and some are DO’s, PA’s, NP’s, etc. Most of them practice Integrative (or Integrated) Medicine (IM) or Functional Medicine (FM), and most don’t take insurance so they won’t be subject to insurance company rules when treating you. After researching the 5 or 6 in my area, I chose Dr. Satish Cuddapah at BetterLiving MD in Sandy Springs, GA. I went to him just 8 days ago, and I go back for my results, evaluation and treatment plan 5 days from now. Sure enough… he tested me for MANY more things, including: cortisol, candida, vitamin D, iodine, selenium, hemoglobin a1c, the 4 irons (ferritin, total iron, % saturation and TIBC) and the thyroid antibodies (and I’m sure I’m forgetting some.) He also reran all thyroid tests from 2 months ago.
I hate I have thyroid and maybe other issues, but I’m grateful to have them diagnosed and treated. In the meanwhile, based on some more research I’ve also added in 1000mg Pantothenic Acid and 1000mg Vitamin C (but no more C than that because it can dry out your CM.) I’m looking forward to getting my health back and prayerfully having a 2nd little miracle in the near future.
Sending prayers for this group too!