Did Low Progesterone Cause Miscarriage?

Q. Our gestational surrogate was pregnant with non-identical twins and 7-week ultrasound showed normal size (sac and embryo) with normal cardiac activity. The week before her ultrasound, her progesterone level was 24. It was then 16 for the next two weeks in a row and at the 10-week ultrasound, both had miscarried. Could this have been related to low progesterone levels? We are getting chromosomal analysis after her D+C -- are there other tests we should consider?

A.Low progesterone levels do not cause miscarriage. The low levels are the result of a failing placenta. Giving progesterone does not fix the problem with the placenta or pregnancy. My guess is that this was related to problems with the embryos. Either the wrong number of chromosomes, damage to a single gene on a chromosome or a condition called apoptosis where the cells just start dying. The latter two conditions are not usually detectable by standard testing.

As I do not know your history and the surrogate's history it is impossible to advise you as to possible additional testing.
[Note from HTMAF Editor -- read more about genetics and infertility by Dr. Linda Randolph here.].

The Pill & Test Results

Q. I am on the pill (Ortho Novum 777) and my regular doctor had a blood test for my Estradiol level, which was 15! I have an appointment with a fertility doctor, but have to wait a long time to see them. I didn't have the FSH test -- I know that is important and I am going off the pill for future tests. I am really stressing and was hoping you could shed some light on the test result I had and if the pill effected the results.

A.I'm not sure why an estradiol test would be done. That test may or may not recognize ethinyl estradiol, the type of estrogen in the pill.

The Meaning of Mid-Cycle Spotting

Q. I bleed/spot when I have intercourse around day 12 or 13 of my cycle. Fibroids, polyps, etc. have been ruled out. My doctor says that this indicates ovulation. So, in months when I don't bleed/spot mid-cycle, does this mean that it's an anovulatory cycle? I'm 38.

A.This is not an unusual occurence. In many cycles, after the midcycle LH rise to trigger ovulation, the estrogen level drops. This can cause the spotting you see. No, it does not mean you are not ovulating if you do not see the spotting.

Ibuprofen & Sperm

Q. My husband has been taking three Ibuprofen 3x a day for a swollen gland in his throat. I was wondering if this would interfere with our trying to conceive this month. We have two children and are trying for our last. I have had two miscarriages in the last three years and don’t want any outside influences adding to this. Please let me know if we should wait until next month.

A.It should have no effect on your husbands sperm.

Post-Varicocele, Clomid-Assisted Chances

Q. I was on 2 amps of Gonal-F for 10 days. My estrogen level was 1500 when the hCG trigger was given. I had back-to-back IUI's with "OK" sperm. Three months ago my husband had a varicocele repaired and this sperm looked better then all of the other times we did an IUI.

Before this I tried 7 cycles of Clomid - 5 of which were ovulatory. I have a son who is 2 years old and he was conceived with bromocriptine and 50mg of Clomid on the second try.

I am wondering what the chances were for me if I had 6 to 7 mature follicles and back-to-back IUI's with good sperm. It seems like it would be impossible to not get pregnant. I am currently 2 days past the second IUI and am still very crampy. If you have any numbers or words of advice, that would be greatly appreciated.

A.It might seem that not getting pregnant is impossible, but the statistical reality is different. At best, this approach is successful about 20% of the time, even with everything perfect.

Prior to the varicocele repair your husband's sperm may have had high levels of DNA fragmentation which might make pregnancy nearly impossible. It takes a minimum of three months after surgery to get normal DNA back. So, treatment may have been ineffective initially. I would test for DNA fragmentation with the SCSA test - see www.scsadiagnostics.com to learn more.

Many Questions from Down Syndrome Pregnancy

Q. I am a 33 old woman who recently had an abnormal extended AFP results (Risk was quoted 1 in 50 for Down Syndrome). Subsequent level 2 Ultrasound revealed a 1.63cm Omphalocele. Amniocentesis FISH results showed Trisomy 21 and the full amniocentesis tests confirmed the same. Our genetic counselor and OBGYN doctor gave us the pros and cons of having this baby with probable multiple disorders requiring multiple surgeries and so finally we decided to terminate this pregnancy at my 21 weeks of gestation. The abortion operation report confirmed Down syndrome baby with the single deep crease in the center of the palm…

BTW, I have a healthy 5-year-old child born prior to this pregnancy. There was no history of miscarriage earlier. I am 33 years old and my husband is 36 years. We are originally from India but currently in California for the past couple of years.

I have a number of questions:

• I notice the doctor who did the procedure has noted down "Molar degeneration" in the Op report. What does this mean? Do I have to undergo any further tests?
• Can I conceive again? Are there any risks because of the prior chromosomal problem?
• How long do we have to wait before we try again for a pregnancy?
• How can I determine if I can still produce healthy babies? Are there any tests that we can undergo to rule out age related chromosomal abnormalities?
• My mother says she experienced early menopause around 43 years of age. Am I in the same track and can this be a reason that my baby had chromosomal disorder?
• My husband’s aunt (paternal side) had a son who had some sort of mental retardation who died at the age of 15. We do not know if it was Down syndrome as there was no diagnosis done in India. Can there be any genetic linkage between this and what happened to my child?

A.This comment "molar degeneration" is not unusual and does not mean you had a molar pregnancy requiring further monitoring. Yes, you can conceive again. This risk of recurrence is low, but the most accurate prediction should be calculated by the genetic counselor. I would suggest your revisit with the counselor and determine whether special testing is needed, or whether you should consider IVF with PGD to avoid recurrence of this type of genetic anomaly. Usually one to two months should be a sufficient wait period before trying again. For your questions on age related or other chromosomal disorders and incidences, you should speak with your genetics counselor.

I have no way of knowing the details regarding your question relating to your mother's age at menopause. I would suggest you consider a clomiphene challenge test to learn more about your ovarian reserve, see www.ivf.com/ovarianreserve.html.

Dr. Mark Perloe is an innovator in the use of Internet communication for educating patients via his groundbreaking site, IVF.com. Perloe is director of reproductive endocrinology, infertility and in vitro fertilization at Atlanta Medical Center and Medical Director at Georgia Reproductive Specialists, and is noted for the individualized and in-depth attention he gives to his patients in their efforts to conceive.

Subscribe to The Blueprint to be notified of his future Q&A responses.