Trying to Get Pregnant after Miscarriages
Question
I have been trying to get pregnant for almost three years. In that time I have had two miscarriages, the first a blighted ovum and the second I miscarried at eight weeks after seeing a heartbeat the week before. With both miscarriages I have had D&C. Eight months ago I had a lap and had endo removed. This was not attached to my ovaries or tubes, but was on my uterus. This was removed. Two months after surgery I got pregnant for the second time. We have now been trying again for the last five months. In this time my periods have changed from a 30 day cycle to a 27 day cycle. I am also having spotting from CD18 thru to my period. Can I get pregnant while spotting? I have Day 21 tests which have been ranging from 30-50.2, so I am ovulating. I am worried that my endo has come back already. What is going on with my body? Is there anything I should be asking my specialist to investigate now? Is there any medication I can take to stop the spotting because in my heart I feel that pregnancy isn’t likely when I am bleeding so early on. PLEASE HELP!!!
Answer
The investigation would start by charting the type and amount of flow to see how many days of premenstrual flow you are experiencing. Naturally, any post-menstrual spotting and bleeding (tail-end brown bleeding) would be charted and characterized. Progesterone is the predominant hormone of the postovulatory phase and has characteristic increasing and decreasing levels throughout this phase. A spot progesterone level would not be sufficient in your case because it appears that the overall levels throughout the phase are too low to maintain the endometrium. Low progesterone means spotting and bleeding. You may be ovulating but perhaps the size of the follicle is not normal (a smaller follicle produces less estrogen and less progesterone). In one study, 60% of the women with endometriosis had ovulation defects by ultrasound. Also, over 50% will have luteal phase defects and most will have poor cervical mucus production. Endometriosis is highly associated with difficulty in becoming pregnant.
The reason in going through this is that there is good news. Because a lot of research has gone into this, the problems can be identified and corrected. Yes, the endometriosis may be back. Unfortunately, it may have not all been corrected. Dr. Tom Hilgers (Ob/Gyn at Pope Paul VI Institute) has developed a technique in treating endometriosis called “near contact” laser surgery. Through the laproscope, he and all the physicians he has trained, look for microscopic endometriosis as well as the larger blebs. He has had very good success with this technique.
In addition, one has to consider laboratory analysis to rule in or out other health disorders such as thyroid dysfunction. I would want to check the thyroid, estrogen coming into ovulation and both progesterone and estrogen after ovulation for a specific number of days. There are additional tests such as beta-endorphins, too. Getting an ultrasound of the ovary coming into ovulation would help with anatomy. Cultures of the cervix would be in order to rule out endometritis (infection of the endometrium). Some physicians have discussed some incidences of antibiotics being effective even when cultures are negative.(AAFCP Academy Meeting, 7/04).
These are some things to discuss with your physician. If he/she is unfamiliar with the afoermentioned techniques and testing, Pope Paul VI Institute could help you find a local Ob/Gyn who perhaps could give you a second opinion. It may take some more time and patience, but it would be nice for you to have a clearer definition of your situation and possibly a permanent resolution.
I hope that this may help you in some small way and that you will soon know the joy of motherhood.
Dr. Marsh
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