2 m/c, low progesterone---luteal phase defect???

[ljbk]

i recently had 2 miscarriages one in may and the other in june both of which my progesterone and hcg levels were low.my LMP started july 4. I had a progesterone and prolactin level drawn on day 17 of my cycle prog 1.2 and prolactin 9.7 I then went for a endometrial biopsy on day 21 of my cycle which showed day 16 early secretory phase. I started to spot yest 8/3/07 and today I am bleeding heavier. I have no cramps so it doesn't even feel like my period. anyway my question is do you think this could be Luteal phase defect based on the info I gave you. My doctor said that if this doesn't show LPD then he's going to say that the 2 m/c and the low progesterone were just a fluke. I don't think that answer is going to be good enough for me. What do you think? Thanks for taking the time to read this.

[Forum-M.D.-SP]

Hi there. If I understand your dates correctly, day 21 would have been July 24? Remember that day 21 assumes a 28 day cycle, and day 21 is 6 days after ovulation which we assume happens on day 15 by convention. Since you had a 31 day cycle however, you oulated on July 20 so your endometrial biopsy was done on day 19. so really 4 days post ovulation. Also, the fact that your progesterone was low on day 17 agrees with the fact that you probably did not ovulate until after day 17. Thus, your endometrial biopsy is at most 2-3 days lagging. There are several problems that I find with luteal phase deficiency:

1) no one has ever proven in a properly designed research trial that luteal phase insufficiency is a cause of recurrent miscarriages.
2) a recent study comparing fertile to infertile women showed that FERTILE women were more likely than infertile to have endometrial biopsies that were lagging, which calls into serious question whether endometrial biopsies are abel to diagnose luteal phase defect - I do not believe that they can.

I think that your low progesterone and HCG levels during your miscarriage reflect the fact that the pregnancy was not normal, rather than being the cause of the miscarriages.

On a positive note, after two very early miscarriages (we call these biochemical pregnancies) the chances of your third pregnancy being healthy remain very, very high.  Since the chances are still so good, I think you have two choices - one is to just continue to try. The other is to get a full investigation to make sure something is not causing the miscarriages - this involves extensvie blood testing and either a saline ultrasound or hysterosalpingogram XRay to look at your uterus. I am not sure that two miscarriages so early on justify the full gamut of testing, which can cost thousands of dollars if you do not have insurance coverage, but you might want to discuss what this testing involves with your REI and decide if you wish to pursue any, some, or all of the testing. My experience after two early losses as you have experienced is that the testing usually comes back normal and you will eventually have a healthy pregnancy.

Finally, if you do get evaluated and everything is normal, even though I am not sure about luteal phase deficiency I have offered progesterone treatment since that is the treatment of luteal insufficiency. The only concern with this is that some doctors believe using progesterone may slightly increase the risk of boy babies having hypospadias (the opening at the end of the penis on the bottom rather than the tip of the penile shart).

[ljbk]

EXTRA INFO...... whether it matters or not Prior to my 2 m/c i used an ovulation kit and i found it very difficult to determine when i ovulated. I have a son who is 2 i had a healthy pregnancy with him (besides being diagnosed with Graves disease) and no problems conceiving. i also used the same brand ovulation kit with him and it was so obvious when i was ovulating. I just had TSH levels drawn and it was 1.04.

[Eliza101]

Have you had your thyroid function checked, particularly with the history of Grave's disease? A simple way of excluding one cause of recurrent miscarriage. good luck