Have PCOS, Hashimotos and Just Had 2 Miscarriages

I have recently suffered back to back miscarriages (1st at 8.5 weeks, 2nd at 5 weeks).  I have one healthy child and have been able to conceive all 3 pregnancies naturally.  I do believe I ovulate as I have used OPK's and have healthy progesterone levels.
I am scared and confused about "what next?"  We are eager to conceive again soon and I don't want to wait long and am fearful of clomid, etc.
I am working with a RE.
What are my options and what do you recommend?

[Elaine Brown, MD]

Hi!
You definitely want to have your Hashimoto's in good control, but your RE or GP should be able to help you with that. Most of what I have read about pregnancy and miscarriage and thyroid disease pertains to Grave's Disease.  Low thyroid levels should definitely be supplemented.
If you have PCOS and want to conceive asap, your best bet is going to be with ovulation induction.  If you ovulate monthly one your own, you may not need to go that route.
If I were going to recommend a medication to help with ovuation, I would recommend Femara.  The risk of multiples is  smaller, although it is also low with Clomid, and the side effects on the uterine lining and cervical mucous are decreased.
Your RE may also recommend IUI, as that has also been shown to increase pregnancy rates.
I would consider starting you on daily low dose aspirin (81mg) now, and possibly heparin prophyllaxis once you conceive.  I would also supplement with progesterone when you do conceive, and follow levels.
One other thing to consider is Metformin--this helps reduce insulin sensitivity and increases ovulation in women with PCOS.  There are also some studies showing a decrease in miscarriage rate when it is continued through the first trimester.

Hope this is helpful!
Dr B