What to do after fertility workup and miscarriage?

Question

What should I do after fertility workup and miscarriage? I am 38 and my husband is 36. We have been trying to get pregnant for almost two years. I chart and have regular cycles 26-28 days with a clear temp rise and a luteal phase of 12-13 days. I have always had very poor cervical mucus and use presead. The tests: day 3 FSH-9.1; 6 DPO Progesterone- 14.8; T4-6.8 (range of 4.7-13); TSH normal 2.68; sperm work up was above normal in all areas. Ultrasound and HSG were normal. The post coital test showed almost 100% dead sperm and the endometrial biopsy was ok, but showed an acute and chronic infection in the uterus. After 1 month of antibotics I became pregnant. At six weeks I miscarried after seeing a heart beat (slow, but it was there), which was more than four cycles ago.
I would like to take the next step, but I don’t know what that might be. The infection was in the uterine wall and the report did not say much else. I have asked if I should have another biopsy and they say that since treated with Cipro for about a month that should kill anything, so no need to retest. I also took tetracycline. I had no symptoms of the infection, but do have history of vaginosis, yeast, and UTI’s. Have had all three since Cipro treatment, but doctor said unrelated to uterine infection.

I have looked at many of the posts, but do not see my questions. I live in Peru, and doctors are quite good, but not what I could get in the states. I would be happy to pay for an online/email ‘consultation’ if there is a doc I could send all my test results and history to.

Thanks so much, Eury

Answer

Last Updated: September 25, 2013
The next step would be to get a comprehensive hormone profile. To do this you should be charting using the Creighton Method. Then targeted hormone evaluations are done by blood samples taken every other day starting about cycle day five and continuing until peak plus eleven. The pre-peak blood draws are for estradiol only, the post-peak draws are for estradiol and progesterone levels. Estradiol and progesterone levels can be boosted, if needed.

You might also want to get a “near-touch” laparoscopy to evaluate for and treat endometriosis as a large percentage of infertility patients have it. This might not be available in Peru.

You may also want to consider mucus enhancing agents such as amoxicillin, vitamin B6 (pyridoxine), guafenesin or prednisone. All of this is best accomplished under the guidance of a medical provider trained in NaProTechnology. Visit the Pope Paul VI Institute web site to learn more.

George Delgado, M.D., F.A.A.F.P.

Answered By:

George Delgado, M.D., F.A.A.F.P.
President and Founder of Steno Institute and Medical Director of Culture of Life Family Services (COLFS), San Diego, is a Professional Member / Supporter of CANFP. Board certified in both family medicine and hospice and palliative medicine, Dr. Delgado received his medical degree from the University of California, Davis, and completed his residency at Santa Monica Hospital/UCLA. Dr. Delgado is a Natural Family Planning Medical Consultant, trained in NaProTechnology.

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