Constant cramps and TTC

Hello Drs.,
I am 34 y/o and TTC#2. We have been TTC for over a year now. I have had constant uterine cramping since July '07. Saw my OB in August who performed a pelvic u/s and found uterine polyps and a small fibroid. Had a D&C in Oct. '07 to remove polyps. Became pregnant in late Nov. but m/c at 12 weeks. Had a second D&C in Feb. for the missed m/c. Cramping continued following both D&Cs and during my pregnancy. My OB assured me that the cramping was not the reason for the m/c (baby had a significant cystic hygroma), and she does not believe that the fibroid is impacting my fertility or is causing the cramping. I am on levothyroxine for hypothyroidism as well as cabergoline for a micropituitary adenoma. Both conditions are well-managed on medication. I also see an regular endocrinologist who was not concerned about the cramping and referred me back to my OB for follow up.

As for the nature of the cramping, it is fairly constant, though signficantly worse during and after ovulation. It resolves somewhat after my period is finished. It does not seem to favor a side. It seems to be accompanied by facial break outs, fatigue, and bloating, again which seem to resolve somewhat after my period. I am not significantly overweight. My cycles are fairly regular at 30 days with LH surge on day 16. I have been monogamous w/my husband for over 14 years, though my OB did test for STDs anyway which all came back negative. Any thoughts on why the constant cramping and could this impact my fertility, my chances at another miscarriage, or the health of a baby? My OB does not seem concerned and said I just may be overly sensitive to the prostaglandins (sp?) produced after I ovulate. Does that sound right? Any help is greatly appreciated.

[Shayne Plosker, MD]

Dear Shacar216-

I agree with your Ob that if the fetus had a cystic hygroma it was probably not normal genetically as the reason for the miscarriage. Regarding the polyps, it would not hurt to have either a saline ultrasound or a hysteroscopy to re-evaluate your uterine cavity for polyps. Most fibroids to not affect infertlility - to be sure the fibroid should not be in the uterine cavity or distorting the cavity under any circumstances or regardless of size; a saline ultrasound can determine this. Also, if not in the cavity unless it is really big (more than 5 cm) it is probably not a factor in your infertility. It could be a factor in your cramping. Finally, if the cramping is concerning, you could discuss a laparoscopy.

Many maybes or possibles. Since you did indeed get pregnant after the D&C, and at age 34 you still have "wiggle room" from a biological clock perspective (fertility really starts to decline after age 35), you might also want to just start trying again for a few months.

All of these options are appropriate and there is no right or wrong approach - if you have been trying for more than a year, at age 34, it might not hurt to see a Reproductive Endocrinologist/Infertility specialist to discuss all of this.