What Do I Do Next?


I am 39 year old female, my spouse has a male factor problem. I got pregnant 14 years ago and had a miscarriage. Did IVF with iccy procedure twice a few years ago with no success. I got pregnant, no IVF, same spouse, was 7 weeks pregnant: HCG 10,000, prog 3.6, fetal heart beat fine, 12/23. Started on crinone 8% gel supp every other night,12/27 prog. level 12 no fetal heart beat 12/29, had d&c 12/31. All my Infertility work up came back normal. My spouse did a right inguinal hernia repair in May since this surgery his erections are bigger and his ejaculations and orgasm are stronger. I don’t know if this could be related to me getting pregnant? Where do I go from here? HELPCheryl


Last Updated: July 24, 2013
I assume that you had the standard work-up evaluating for blood clotting problems that can be associated with frequent miscarriages–this is standard of care and most physicians will do these tests. I assume that these tests were normal. You have been able to get pregnant twice with your husband, suggesting that his fertility issue is not insurmountable. I would recommend a complete evaluation using NaPro Technology to determine if there is any other reason (aside from your husband’s fertility issue) that you would have difficulty conceiving. Potential problems include hormonal dysfunction, ovulatory defects, endometriosis, and structural problems (e.g. tubal dysfunction or obstruction). In addition, endometriosis has been suspected to contribute to miscarriages, as well as problems with conception. Aggressive treatment of any endometriosis (diagnosed by laparoscopy) would certainly be indicated. You should certainly receive progesterone support should you become pregnant–I would suggest that this be accomplished through intramuscular injection of up to 200 mg of Progesterone in oil injected twice weekly. This provides the most reliable absorption and blood levels. Dr Thomas Hilgers at the Pope Paul VI Institute in Omaha Nebraska has developed a protocol whereby your pregnancy can be supplemented and your progesterone levels can be monitored. You can contact the Pope Paul VI Institute through their web site to find a physician trained in NaPro Technology in your area.

John Gisla, MD

Answered By:

John Gisla, MD
Dr. John Gisla, Board Certified by the American Academy of Family Physicians, pracitces in the Sacramento Region.

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