Still Think Something is Just Not Right

Question

I am 26 years old and my husband and I have been practicing NFP since we married two years ago. Right after getting married, I became pregnant. I miscarried shortly after finding out I was pregnant. The next month I accidentally got pregnant again. This time I stayed pregnant for over two months before I lost the baby. I’ve had two or possibly three other pregnancies since then, but always miscarry very early.
Last summer was my last miscarriage and after that we decided that I absolutely had to see a doctor. I went back to a doctor I’d seen in the past when I had Lyme Disease. She happened to be a women’s health specialist and ran a battery of tests on me. My progesterone was very low, thyroid a little low, and testosterone too high. I got on Armour thyroid and a progesterone cream she prescribed, and took measures to lower my testosterone levels. A few months later we re-tested and everything we did seemed to be a success; my progesterone levels were in range, thyroid was perfect, and testosterone levels were also in range again (progesterone and testosterone were both on the low side of in range, but in range none-the-less!). She said everything was fine and all I am on now is the thyroid meds (we waited to test everything until I’d been off of the progesterone cream for a month+ to make sure things were at the right range without medication).

My husband and I are trying to avoid pregnancy for just a couple more months before we can get some work issues taken care of, but I am extremely confused and distressed about my cycles because I do want desperately to have a baby. My doctor says I’m fine and should be able to conceive but I have my doubts and here is why: I will experience ovulatory pain, have very obviously fertile cervical fluid and cervical position/feel/opening and increased sex drive around day 12-14, like I’ve almost always had (typical cycle for me is 28 days with a 14 day luteal phase). But for several months now I’ve lacked the normal temperature shift that *should* occur at this point, which I always experienced even before I had any hormone therapy. Instead of experiencing all those symptoms and then having a temperature shift immediately afterwards, I now will not see a shift for three to eight days. That being the case, doesn’t that likely mean that my progesterone isn’t kicking in soon enough after I ovulate, so that if I did become pregnant, the lining of my uterus wouldn’t be sufficient to sustain a pregnancy? I’m extremely confused as to why this might be, seeing as how my hormone levels are so much improved since last summer.

Any thoughts?

Thanks, Meg

Answer

Dear Meg,

First, my condolences at the loss of your babies. I think you are quite reasonable to be concerned about entering into a pregnancy without more reassurance. I hope that I can be of some help so you may enter future pregnancies confidently.

Lyme Disease can contribute to miscarriages if a woman is pregnant at the time of the disease, however, the rate of miscarriage and birth defects is uncertain. I am not aware of information about miscarriages occurring in women with prior disease. I am assuming that you have been cleared of any of the infectious agent and that it is not a factor in this case.

Thyroid dysfunction does affect your cycles but once stabilized, the cycles are usually back to normal. I would be interested in the other thyroid levels besides the TSH now that you are on thyroid replacement. In my experience and those trained in the Creighton Model of NFP, the TSH can be normal but the actual active hormone is not.

The main question is why your hormones were abnormal and will the progesterone and testosterone stay normal without further treatment. There is some indication that Lyme Disease can affect thyroid and other hormones but the long term effects are not reported with certainty. I am suspicious though of polycystic ovarian syndrome (PCOS) which can cause mid-cycle pain, prolonged pre or post- ovulatory phases, hormone imbalances (usually low progesterone, elevated testosterone,), facial hair, acne, hypertension, impaired fasting glucose all in various combinations and severity. Endometriosis is also highly associated. Unfortunately many young women are placed on birth control pills which only mask the symptoms and are associated with elevated blood pressures and impaired glucose tolerance, two of the very things that PCOS potentiates anyway.

While your progesterone levels are normal now, I would be very concerned that you will slide back to low again as I have seen with several of my patients. In fact, I have two patients who sound very much like you. They were about the same age and developed many of the same symptoms. One has been successfully treated for PCOS with metformin which is a diabetes medicine but works well for this. The other patient was treated with progesterone and easily became pregnant but miscarried. She later had a successful full term pregnancy. Her cycles have shortened again to the point where she has no post ovulatory phase. She will possibly need to be maintained or at least monitored on progesterone throughout her next pregnancy.

From what you describe, I think you may be forming a follicle but ovulation is not clear. The follicle many times is not of sufficient size to produce enough progesterone for maintaining a pregnancy especially if ovulation did not occur. This happens in various degrees with PCOS. Perhaps the progesterone treatment was long enough to reset your hormone levels (involving two areas in the brain and the ovary) for now.

PCOS is diagnosed many times with ultrasound but sometimes with laparoscopy (belly-button surgery) and with blood tests that you had. Treatment includes losing extra weight, metformin, and progesterone if not normalized by the metformin.

Doctors trained in the Creighton Model of Natural Fertility Care are especially trained in this area. I would strongly suggest that you seek an additional opinion regarding your hormone levels before entering into another pregnancy.

I sincerely hope that this has helped. I wish you and your husband all the best.

Gretchen V. Marsh, D.O.

Answered By:

Gretchen Marsh, D.O.
Dr. Marsh graduated from Western University of Health Sciences in 1987 in Pomona, CA and is board certified in Family Medicine by the American Osteopathic Board of Family Physicians. She has been certified as a NaProTechnology® Medical Consultant (NaPro) and Creighton model Fertility Care System (CrMS) teacher since 2001. She and her husband, Jon, have 5 sons and live in the Reno region, where she sees patients in person, in addition to her telehealth services offered via MyCatholicDoctor.com

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