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The Top 10 Hormones Worth Testing for Fertility & The EXACT Results You Want to See

6/21/2018

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You know the drill when it comes to hormonal blood work; it’s a lot of poking and prodding on multiple days of your menstrual cycle. In my experience, my patients have had all the right testing done (mostly), but no one has taken the time to sit down with them and explain what the results truly mean. 


The biggest pitfall of serum (blood) hormone testing is that the reference ranges are MASSIVE. Which means it is highly unlikely that your results will be deemed “abnormal” even though you know something is wrong. So that’s what this blog is for; I’m going to break it all down for you and discuss what the results mean and the REAL range you’re looking for. Note: the following reference ranges are for women and are Canadian units. 


1) Estradiol
What it is: Estradiol, along with LH and FSH, stimulate follicle (egg) maturation. It’s also responsible for female sex characteristics, thickening of the endometrial lining, and bone protection. Estrogen can also be converted from fat, in both males and females, by an enzyme called aromatase. 
What it means: Low estradiol is present in peri-menopause and menopause. Elevated estrogen is present in early premature ovarian insufficiency (followed by low levels), and in estrogen dominant conditions like: PMS, endometriosis, PCOS, and obesity. 
Reference Range: 
Follicular 77-921 pmol/L
Luteal 77-1145 pmol/L 
The “real” range: The width of the above ranges is ridiculous! Estradiol should be tested on day 3 and should be lower than 200 pmol/L and higher than 80 pmol/L. A level higher than this is a sign that the body is trying too hard to stimulate egg development, and the ovaries are not responding. In this case, you will likely see elevated FSH too. 


2) FSH (follicle-stimulating hormone)
What it is: The name says it all. FSH is in charge of the development and maturation of follicles.  
What it means: High levels are diagnostic of menopause, ranging from 27-133 IU/L. When your body is pumping out more FSH than normal, it’s a sign that the ovaries are not responding (just like estrogen). Low levels of FSH are typically present in PCOS.
Reference Range: 
Follicular 3-8 IU/L
Mid-cycle 3-22 IU/L 
Luteal 1.5-5.5 IU/L 
The “real” range: Higher than 8 IU/L on day 3 (that’s the 3rd day of your period) is too high and the value is only going up from there. 6 IU/L is as good as it gets on day  three. 


3) LH (Luteinizing hormone)
What it is: Ah, the hormone everyone knows and loves! The LH surge triggers ovulation and is measured by urine strips. LH also contributes to the maturation of eggs. You may not know that estrogen surges right before LH, which can also be used to detect ovulation. 
What it means: On day 3, an LH to FSH ratio greater than 2:1 is indicative of PCOS. LH is elevated in PCOS for so many reasons I’ll need to dedicate another blog to it. Elevated LH also stimulates elevated testosterone production, and in turn estrogen production. Contrary to what you may think, high LH actually inhibits ovulation instead of stimulating it.  
Reference Range:
Follicular 2-12 IU/L
Mid-cycle 8-90 IU/L
Luteal 1-14 IU/L
The “real” range: LH should be almost equivalent to FSH on day 3.  6-8 IU/L is ideal.  




4) Progesterone
What it is: Most of the body’s progesterone is produced by the outer coating of the egg, called the corpus luteum. After you ovulate, progesterone levels increase to maintain the endometrial lining and prepare for embryo implantation. Progesterone also stimulates the production of a thick mucous that covers the cervix so no sperm can enter the uterus (FYI this is the basis of hormonal birth control). 
What it means: A low level of mid-luteal progesterone indicates anovulation and luteal phase defect (short luteal phase) and predicts implantation failure/ early miscarriage. 
Reference Range:
Luteal 4-50 nmol/L
The “real” range: On day 21 the minimum value is 10 nmol/L to have ovulated and 20 nmol/L to carry a pregnancy. Day 21 is arbitrary if you don’t ovulate on day 14. Progesterone is best-tested 7 days after you ovulate. 


5) Prolactin
What it is: The main function of prolactin is to stimulate breast milk production. However, elevation can also occur due to the following: benign pituitary tumor, periods of high stress, hypothyroidism, PCOS, and certain medications. 
What it means: Elevated prolactin inhibits the release of GnRH, which then inhibits the release of LH and FSH. Without LH and FSH, follicles will not develop. 
Reference Range: 
5-30 ug/L 
The “real” range: Prolactin levels as high as 50 ug/L can inhibit ovulation, but small increases by a few points are relatively harmless. One-time elevation should be followed by repeat testing. As mentioned, stress is a major influence on this hormone. 


6) DHEA
What it is: A precursor hormone to both estrogen and testosterone.  
What it means: DHEA is often evaluated in PCOS, as elevations in this hormone increase androgen levels. It may be prescribed to improve ovarian reserve (but not without fun side-effects).
Reference Range: <9.8 umol/L 


7) Androstenodione
What it is: Produced from DHEA, this hormone is the precursor to testosterone. 
What it means: Elevated androstenedione is found in PCOS and adrenal hyperplasia. Both conditions inhibit ovulation. It may be elevated in isolation, or with testosterone. 
Reference Range: 
Follicular 1.2-8.7 nmol/L
Luteal 1.1-8.2 nmol/L


8) Testosterone
What it is: You know this hormone for its role as the primary male sex hormone, but it’s important for women too! In the ovaries, testosterone is produced by the stromal cells and converted to estrogen. It participates in follicle growth and development, not to mention male and female libido. 
What it means: Too much is present in PCOS which is far from ideal, but too little can inhibit ovulation and egg development. 
Reference Range: 
Total testosterone 0.3- 1.8 nmol/L (some labs up to 4 nmol/L) 
The “real” range: Testosterone is extremely tricky to test accurately. Free testosterone is a better measurement than total and the reference ranges (depending on the lab) have huge variability. In order to test free testosterone you need to test total testosterone and sex hormone binding globulin. 


9) AMH (Anti-Mullerian Hormone)
What it is: It’s a hormone that can depict the female egg reserve because it is secreted by the eggs in the ovaries. The more eggs you have, the higher the value will be. Not surprisingly, AMH decreases with age. This is the only hormone test we have for predicting ovarian reserve. 
What it means: A lower value for your age means you have a lower number of eggs than the average female. A much higher value for your age is indicative of PCOS, as the cystic ovaries in PCOS secrete excess AMH. 
Reference Range: The numbers are averages based on age:
 < 33 = 2.1 ng/mL
33-37 = 1.7 ng/mL
38-40 = 1.1 ng/mL
> 41 = 0.5 ng/mL 
The “real” range: At any age, a value > 3.15 - 4.45 ng/mL warrants further testing for PCOS. A value of 6.8-10 ng/mL is diagnostic. 


10) TSH (thyroid stimulating hormone) & Antibodies (anti-TPO, anti-TG, anti-TSH)
What it is: TSH is released by the anterior pituitary, which then stimulates the release of thyroid hormones (T3, T4) from the thyroid gland. TSH above the reference range with symptoms present is diagnostic of hypothyroidism, and below is hyperthyroidism. TPO and TG antibodies cause the thyroid condition known as Hashimoto’s, anti-TSH is more commonly present in Graves’.  
What it means: Deficient thyroid function affects egg quality, embryo quality, and implantation rates. Combine that with thyroid antibodies, and there’s an increased risk of miscarriage. 
Reference Range: 
TSH 0.32-4.0 mIU/L
Antibodies should all be negative  
The “real” range: TSH should be < 2.5 to prevent miscarriage. A full thyroid lab panel (with individual thyroid hormones) is certainly necessary in cases of recurrent miscarriage.

Have more questions? Meet with me!
Wondering about your own lab results? Need a little help wading through the information and finding the useful parts? I offer a free 30 min consultation to all new patients. Click below to book yours today. I look forward to seeing you soon! 
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Written by Dr Caleigh Sumner ND

References

Zadehmodarres S, Heidar Z, Razzaghi Z, Ebrahimi L, Soltanzadeh K, Abed F. Anti-mullerian hormon level and polycystic ovarian syndrome diagnosis. Iranian Journal of Reproductive Medicine. 2015;13(4):227-230.

Wiweko B, Maidarti M, Priangga MD, et al. Anti-mullerian hormone as a diagnostic and prognostic tool for PCOS patients. Journal of Assisted Reproduction and Genetics. 2014;31(10):1311-1316. doi:10.1007/s10815-014-0300-6.
http://tests.lifelabs.com/Laboratory_Test_Information/Search.aspx
Huhtinen K, Desai R, Ståhle M, et al. Endometrial and Endometriotic Concentrations of Estrone and Estradiol Are Determined by Local Metabolism Rather than Circulating Levels. The Journal of Clinical Endocrinology and Metabolism. 2012;97(11):4228-4235. doi:10.1210/jc.2012-1154.
Kumar P, Sait SF. Luteinizing hormone and its dilemma in ovulation induction. Journal of Human Reproductive Sciences. 2011;4(1):2-7. doi:10.4103/0974-1208.82351.

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Cervical Dysplasia, HPV and Your Fertility - 5 Natural Treatment Options For Your Abnormal PAP Test Result - Dr Jennah Miller ND

6/15/2018

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If you’re an adult female, you’ve probably been getting a regular screening PAP test completed every three years since your early 20’s. You book that often-dreaded appointment with your gynecologist or family doctor, and bring yourself in for a quick sample of cervical cells to be collected and sent off to the lab. Most of the time, this is the last you hear about your cervical health, until you’re reminded three years later to do it all again. 
For women who have abnormal cervical cells, however, this process tends to look a lot different. You are usually contacted by your gynecologists’ office, and informed that you will need to have a repeat PAP test much sooner than expected, usually in 3-6 months time. Depending on the extent of cellular abnormalities, you may also be referred for a colposcopy and biopsy of your cervix (fancy words for fancy imaging procedures). 
But how does all of this impact your fertility and future conception? Does the health of your cervix play a role in subfertility and pregnancy outcomes? With rates of HPV and cervical dysplasia on the rise, it’s important to be informed and empowered about how your cervical health can impact your fertility, even if conception is not your immediate goal. Today I break it all down, and chat about one of my favourite women’s health topics; cervical dysplasia!  


What does my abnormal PAP mean?
Let’s start with the basics! My patient’s come in all the time, knowing nothing more than their PAP test result was “abnormal” – while this knowledge is important, it doesn’t tell us enough about how severe the cellular changes are, or how concerned we need to be about progression to cervical cancer. 
The presence of an abnormal PAP test generally indicates that you are experiencing some degree of cervical dysplasia – this means that under certain conditions and stressors, the previously normal cells of your cervix have mutated and become abnormal in size, shape, and/or function. The most common cause of these abnormal cellular changes is the Human Papilloma Virus (HPV), which has been estimated to be present in 80-90% of the North American Population at current. However, the interesting fact is that not all individuals who have been exposed to HPV will have abnormal PAP test results in their lifetime. A variety of factors seem to play a role in progression of HPV to cervical dysplasia, such as which specific HPV strain you have contracted (low or high risk), immune system function, sexual practices and HPV status of your sexual partners, as well as factors such as diet, smoking status, and long term oral contraceptive pill use.
When your PAP test results return as “abnormal” they generally have one of the following basic terms to indicate the severity or “grade” of the cervical lesions present:
  • ASCUS – atypical squamous cells of undetermined significance (some cells don’t look normal, but it’s unclear what the cell changes mean by looking at the PAP alone)
  • LSIL – Low stage intraepithelial neoplasia (the cells don’t look normal, but they usually aren’t precancerous)
  • HSIL – High stage intraepithelial neoplasia (the cells are abnormal or precancerous – the cells may develop into cancer if left untreated)
  • SCC – Squamous cell carcinoma (there are cancerous cells present)


Huh? What is cervical dysplasia?
Cervical dysplasia is a term used to describe the abnormal cellular changes that occur to the cells of the cervix. It indicates the presence of pre-malignant or pre-cancerous changes to the cervix, and if left untreated it may progress to cervical cancer over time. High stage lesions are more likely to progress to cervical cancer, while low stage lesions are less likely. The main causative factor is currently chronic HPV infection.


What is HPV?
HPV or the Human Papillomavirus is an infectious agent that is generally transmitted between sexual partners via direct sexual contact of the skin and/or mucous membranes. It is considered the main causative factor of cervical cancer worldwide. There are over 100 different strains of HPV, some of which can cause genital and non-genital warts, while others can cause cervical dysplasia and progress to cervical cancer. Low-risk strains of HPV (like 6 and 11) are more likely to cause external genital warts, while high-risk strains (like 16 and 18) are more often associated with cervical changes and progression to cancer. After your abnormal Pap test results, your gynecologist may assess for HPV strain using an HPV DNA test.


How does this impact my fertility? 
Now for the fertility talk! Presence of cervical dysplasia on it’s own has not yet been linked to any changes to fertility status, but the use of recommended conventional treatment options is a different story. The most common conventional treatment of cervical dysplasia is a surgical procedure called LEEP, where the abnormal tissue is removed from the cervix using an electro-cautery tool. Research indicates that those who undergo surgical treatment of cervical intraepithelial neoplasia are at in increased risk of subfertility, with prolonged time to pregnancy. Time to conception was prolonged in 16.4% of women treated via surgical removal of the cervical tissue, versus 8.4% in untreated women, and 8.6% of women who underwent colposcopy alone. 
The LEEP procedure may also impact the production of cervical mucous, which is an extremely important aspect of how the sperm is able to travel unimpeded to meet and fertilise the egg during your fertile window. The procedure has also been linked to stenosis (or narrowing) of the opening to the cervix, which may impact fertility and pregnancy outcomes – most common of which include increased risk of premature rupture of membranes, low birth weight, and pre-term delivery. Incompetence of the cervix, which can be caused by surgical trauma to the area, may also increase the risk for miscarriage. 
The good news, is that LEEP is not your only option when it comes to treatment of cervical dysplasia. Luckily, the clearance rate of HPV and cervical dysplasia is naturally quite high – about 60% of individuals with low grade cervical dysplasia will regress to normal within two years, with 33% of those with high grade changes following suit. The main issue that arises is HPV persistence – conventional treatment options only focus on removing the abnormal cells from the cervix, and do not focus on clearing the virus itself. As a result, the return of cervical dysplasia post LEEP procedure can be as high as 30%. Naturopathic treatment options that improve clearance of HPV as well as promote regression of dysplasia fill in the gaps of conventional care, while also being mindful of impacts to future fertility and pregnancy outcomes. 


Top 5 Naturopathic Management Options for Cervical Dysplasia and HPV 
So, what can you do to help prevent persistence of HPV and improve clearance of dysplasia without impacting fertility? Ongoing PAP tests in accordance with screening guidelines are particularly important – whether you decide to move forward with conventional and/or naturopathic treatment, continued cervical screening is crucial in monitoring potential progression to cancer. Repeat PAP testing may also be linked to increased rate of regression of cervical dysplasia, so keep up to date on those PAP tests, especially if they’ve been abnormal! ​


  1. Up the intake of cruciferous vegetables - Research looking at the intake of DIM (a compound rich in cruciferous vegetables like broccoli and Brussels sprouts) indicates that increased intake over a 12 week period can decrease the grade and severity of cervical dysplasia on PAP smear and colposcopic assessment. I generally recommend that my patients add 1-2 servings of cruciferous vegetables to their daily intake to mimic this.
  2. Drop some ‘shrooms – No, not the psychedelic kind! Intake of Coriolus or Reishi mushrooms has been shown to boost the immune system and improve clearance of high risk HPV strains. Dosing is important here though, so talk to your naturopathic doctor about whether you’re taking the right amount.
  3. Munch on even more veggies - Low intake of dark green and deep yellow vegetables was associated with increased risk of cervical cancer, especially in smokers. One study in particular found increasing intake of these types of foods was associated with nearly a 50% decreased risk of CIN3 (HSIL).
  4. Sip on green tea regularly – Green tea contains an active compound called EGCG. While the research is still a bit mixed, increasing your intake of green tea throughout the day seems to be a potential adjunctive treatment option due to it’s anti-viral effects on HPV and immune stimulating properties. 
  5. Consider a topical cervical escharotic treatment - This treatment is generally considered less invasive that the conventional alternative (LEEP), as it causes an “eschar” or scab to form on the top most layers of the cervix, which will slough off in between treatments (as opposed to surgical removal of dysplastic sections of the cervix). Many of the herbal components of the topical also provide anti-viral activity, which helps to improve clearance of HPV, and regression of cervical dysplasia, when applied locally to the area of abnormal cellular changes. This treatment is provided in-office by trained naturopathic doctors (like myself!), which eliminates the possibility of self-application error.

Have more questions about this topic? Meet with us!
We offer a free 30 minute consultation to all new patients. Come in and meet with one of our Naturopathic Doctors to discuss your options for promoting cervical health, while also preserving your fertility. Click the button below to book with us today!
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About the Author

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Dr Jennah Miller is a Naturopathic Doctor at the Toronto Reproductive Acupuncture Clinic. Read her full bio.


References 


De Vet, H. C. W., &amp; Sturmans, F. (1994). Risk factors for cervical dysplasia: Implications for prevention.Public Health,108(4), 241-249.
Tomita, L. Y., Roteli-Martins, C. M., Villa, L. L., Franco, E. L., &amp; Cardoso, M. A. (2011). Associations of dietary dark-green and deep-yellow vegetables and fruits with cervical intraepithelial neoplasia: modification by smoking.British journal of nutrition,105(6), 928-937.
González, C. A., Travier, N., Luján‐Barroso, L., Castellsagué, X., Bosch, F. X., Roura, E., ... &amp; Sacerdote, C. (2011). Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study.International journal of cancer,129(2), 449-459.
Kyrgiou, M., Athanasiou, A., Paraskevaidi, M., Mitra, A., Kalliala, I., Martin-Hirsch, P., ... & Paraskevaidis, E. (2016). Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. Bmj, 354, i3633.
Ciavattini, A., Clemente, N., Carpini, G. D., Gentili, C., Di Giuseppe, J., Barbadoro, P., ... & Liverani, C. A. (2015). Loop electrosurgical excision procedure and risk of miscarriage. Fertility and sterility, 103(4), 1043-1048.
Acharya, G., Kjeldberg, I., Hansen, S. M., Sørheim, N., Jacobsen, B. K., & Maltau, J. M. (2005). Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia. Archives of gynecology and obstetrics, 272(2), 109-112.
Bogdanova, J. (2008) Coriolus versicolor–innovation in prevention of oncogynecological diseases, especially HPV. Akush Ginekol (Sofiia). 2008;47 Suppl 3:51-3.
Ali, N., Roshdy, E., Sabry, M., & Al-Hendy, A. (2013). Green tea: varieties, production and health benefits. Food and beverage consumption and health (Eds. Wu, W.), Nova Biochemical, USA, 33-74.
Hudson, T., & Northrup, C. (2008). Women's Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness. McGraw-Hill.
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet#q2
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How the Right Diagnosis Can Prevent Miscarriage: The Top 10 Causes

6/12/2018

5 Comments

 
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There is so much that we don’t know about what it takes to carry a baby to term. If you’re working with a fertility clinic you’ll notice there’s a lot of observation during the first two weeks of your cycle, and once you’ve ovulated (or post embryo transfer) there’s not much monitoring after that! Rest assured, this article isn’t about what we don’t know but rather what we do! Fifty percent of miscarriages may not have an identifiable cause, but that means 50% of them do. 

Let’s go over the stats here for a moment. 

Recurrent miscarriage is considered two or more consecutive miscarriages, however diagnosis and treatment is often not suggested until three consecutive miscarriages have occurred. Not because you should have to suffer, or because your doctor doesn’t care, but because there’s a 15-25% chance of any pregnancy ending in miscarriage. The most common cause of miscarriage is fetal chromosome abnormality, which is about 60% of the time.

While we’re going over the terminology, a “chemical pregnancy” is considered a miscarriage before 5 weeks, however I still consider it a miscarriage. 


Factors to consider in miscarriage: 
  1. Did you have an early loss in the first trimester, or a late loss in the second or even third? Different diagnoses are more likely in late pregnancy versus early pregnancy. 
  2. Do you already have a child, and in trying to conceive again have a miscarriage? Having a baby already can rule out some causes of miscarriage. 
  3. Do you have a family history of autoimmune, hormonal, or blood disorders? That makes some of the diagnoses more likely. 

Factors NOT to consider in miscarriage: 
  1. You haven’t “stressed” yourself to the point of miscarriage. I promise!  
  2. Exercise is always healthy! You don’t need to avoid physical activity 
  3. Progesterone, in any form, is not always the answer. A 2008 Cochrane review found prophylactic progesterone to have no effect on preventing miscarriage, more on this soon. 

In my practice I don’t wait the “3-loss” rule to begin treatment and diagnosis, if you’ve experienced a loss and you want support, you deserve that support right away. 

Top 10 Most Common Causes of Miscarriage 

The majority of the list can be diagnosed with blood work or imaging. The entirety of the list can be treated! 


  1. Anti-phospholipid syndrome (and other causes of poor placental perfusion)
    This is a syndrome where antibodies attack components of your blood vessels. Anti-phospholipid antibodies include: lupus anticoagulant, anticardiolipin antibody, and anti-B2 glycoprotein. These antibodies interfere with uterine blood flow, more specifically the development of the trophoblast, which are the cells that form the placenta.
  2. PCOS
    The foundation of PCOS is insulin resistance, which interferes with ovulation, follicle maturation, and maintaining a pregnancy. Insulin resistance, and the corresponding hormonal imbalances, cause poor egg quality, pelvic inflammation, and progesterone deficiency – all which contribute to miscarriage. I will add that metformin has not been found to be beneficial in preventing miscarriage in PCOS, but there are many naturopathic therapies that have!
  3. Chromosome translocation (it’s not all about the woman!)
    This genetic condition can occur in men or women. If you have a chromosome translocation you won’t have any signs or symptoms, but some of the gametes you produce (i.e. egg or sperm) will also have the translocation. Unfortunately, if you’re conceiving naturally it’s a game of chance as to whether or not you will produce a viable embryo. IVF with PGS (pre-implantation genetic screening) can determine whether your embryo has a viable number of chromosomes.
  4. Hypothyroidism & thyroid antibodies
    TSH greater than 4.0 during pregnancy is associated with miscarriage, preterm birth, premature rupture of membranes, and placental detachment. Thyroid peroxidase antibody, found in Hashimoto’s thyroiditis, causes similar outcomes.
  5. Anatomical causes: fibroids, polyps, uterine malformations, cervix incompetence
    Anatomical issues are more commonly at play during second trimester losses, and the outcome depends greatly on the location of the finding. I won’t go into the details here as they are easily diagnosed, and quite obvious, through imaging and pelvic exam.
  6. Poor quality sperm (it’s not all about the woman!)
    The best test for measuring sperm quality is called sperm DNA fragmentation. Greater than 25% fragmented DNA indicates poor quality. In my experience, beyond lifestyle factors like diet and recreational drug use, medications are the most common culprit of increased DNA fragmentation. Anti-depressant medication, specifically SSRIs, cause statistically significant increases in DNA fragmentation as well as miscarriage.
  7. Poor quality egg
    If only we had a test for egg quality like we do sperm quality! Age is the number one predictor for egg quality, steadily declining after age 35 – lucky us! But don’t worry, there’s lots that can be done!
  8. Vitamin D deficiency
    One prospective cohort study identified vitamin D deficiency as a risk factor for miscarriage, preterm birth, and low birth weight. Adequate vitamin D levels, hard to come by in gloomy Canada, are extremely important when it comes to reproductive health. 1 nmol increase in serum vitamin D levels decreases miscarriage rate by 1%. Testing is clearly imperative!
  9. Inflammation & oxidative stress
    Conditions like PCOS, listed above, and endometriosis cause increased uterine inflammation and oxidative stress. Inflammation can also be elevated in the presence of other autoimmune diseases during pregnancy. However, there is significant research on specific anti-inflammatories and antioxidants increasing live birth rate and preventing miscarriage in these scenarios!
  10. Progesterone deficiency & hyperprolactinemia
    As I’ve already suggested in this article, progesterone supplementation only appears to be helpful when there is a progesterone deficiency. High dose progesterone supplementation is all too common and I often see the extremely uncomfortable side effects in my patients. It may be indicated in cases of recurrent miscarriage. I’ll also mention hyperprolactinemia here as elevated prolactin levels can suppress progesterone production and lead to deficiency. 


Honorable mentions:
  1. MTHFR deficiency & elevated homocysteine - MTHFR deficiency refers to a mutation in the gene “MTHFR”, responsible for metabolizing folate (a vitamin found in your prenatal supplement to prevent spina bifida).  When folate is not metabolized properly, a build up of an amino acid called homocysteine results. Elevated homocysteine can cause blood clotting and inhibit uterine and placental blood flow.
  2. Immunological cause - I’m going to throw out some pretty fancy terms here: HLA incompatibility, anti-paternal antibodies, and natural killer cells. They’re all terms for potential immunological conditions that cause miscarriage, meaning the woman’s immune system is attacking the embryo. Currently there’s insignificant research to suggest any of the above cause miscarriage, and the treatment is theoretical as well. 
  3. Vaginal infection - I’ve noticed many fertility clinics test for ureaplasma and mycoplasma, and treat both partners with antibiotics if present. There is no clear data that these infections cause miscarriage. I have mixed feelings about the results, as there are often comorbidities present in my patients who have been treated for these infections. However, untreated bacterial vaginosis can indeed cause early miscarriage. ​

Have more questions? Meet with us!
For any of the information we have provided, there are ways of diagnosing and treating these issues. You have options! We offer a free 30 minute consultation to all new patients Book yours today and lets get started! 
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Written by Dr Caleigh Sumner ND

 References

Iqbal, S., Ghani, F., & Qureshi, R. (2016). Frequency of Thyroid Peroxidase Antibody and its Association with Miscarriages Among Pregnant Women. Journal of the College of Physicians and Surgeons Pakistan, 26(10), 831-834.

Sundermann, A. C., Edwards, D. R. V., Bray, M. J., Jones, S. H., Latham, S. M., & Hartmann, K. E. (2017). Leiomyomas in pregnancy and spontaneous abortion: A systematic review and meta-analysis. Obstetrics & Gynecology, 130(5), 1065-1072.

Bärebring, L., Bullarbo, M., Glantz, A., Hulthén, L., Ellis, J., Jagner, Å., ... & Augustin, H. (2018). Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study. BMC pregnancy and childbirth, 18(1), 51.

Loss, E. P. PRACTICE BULLETIN.

EVALUATE, W. (2012). Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertility and Sterility, 98(5).

El Hachem, H., Crepaux, V., May-Panloup, P., Descamps, P., Legendre, G., & Bouet, P.-E. (2017). Recurrent pregnancy loss: current perspectives. International Journal of Women’s Health, 9, 331–345. http://doi.org/10.2147/IJWH.S100817

No, G. T. G. (2011). The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. April 2011.

Haas, D. M., & Ramsey, P. S. (2008). Progestogen for preventing miscarriage. Cochrane Database Syst Rev, 2.



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