One Possible Answer for Recurrent Miscarriage

Being unable to get pregnant when you're ready to have a child is difficult enough. Conceiving and then losing a pregnancy adds to the emotional burden. Going through early miscarriage more than once deserves medical attention. This, too, is the realm of a reproductive endocrinologist.

In fact, some of my patients at Houston Fertility Center don't consider getting pregnant their primary problem. For them, the mystery is “Why can't I carry a pregnancy?”

There are several possibilities, but much of what we know about the causes of recurrent miscarriage (RM) remains theoretical. Patients struggling with RM might take some comfort in the fact that it is a research arena of great interest.

A recently published study may shed some light on yet another possible explanation. Researchers in The Netherlands looked at the human endometrial stromal cells (H-EnSCs) of women with RM and fertile women. Their findings support their theory that, for reasons not yet fully understood, “H-EnSCs of fertile women discriminate between high- and low-quality embryos whereas H-EnSCs of women with RM fail to do so.”

In other words, while women with RM seem to conceive more readily than women without RM (a concept called “super-receptivity”), the lining of their uterus is more often facilitating the implantation of non-viable embryos. These pregnancies are destined to end from the start.

While you might feel callously dismissed by some who offer condolences like “It just wasn't meant to be” and “Don't worry, you'll have a baby the next time” – know that there are healthcare providers out there, like the Houston Fertility Center staff, who take your concerns to heart and offer the best that science has to offer.

~ Dr. Sonja Kristiansen M.D.

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Before Infertility Strikes, PCOS Is Common, Treatable, Even for Teens & Young Women

A little bit of facial hair in “the wrong places” can be normal, even if aggravating, for women near and after menopause. But for younger women, hirsutism (hair growth in abnormal patterns) can signal something to be worried about – polycystic ovarian syndrome.

image: freedigitalphotos.net

PCOS is one of the most commonly-presented female disorders in a fertility clinic. Not every woman with polycystic ovarian syndrome has infertility, but many do. In fact, not all PCOS sufferers have the same symptoms, which in addition to hirsutism might include:

• small cysts on the ovaries

• irregular menstrual periods

• weight gain for no apparent reason

• acne beyond the teen years

This article in UK's Daily Mail says that one in 10 British women are affected by PCOS. A fact sheet from the U.S. Department of Health and Human Services Office on Women's Health says similar numbers of affected women are found in the U.S., as many as 5 million of them, and that it can occur in girls as young as 11 years old.

This is a point I want to impress: PCOS is a hormonal condition, not merely a nuisance of facial hair and weight gain, and it begins in most cases during puberty. Unfortunately, most woman don't become knowledgeable about PCOS until it's created a problem for them – most of the time, that problem is infertility.

Most important to know is that infertility is not the only problem to which PCOS can lead. It's also been linked to a number of very serious metabolic disease-related health conditions like diabetes, high blood pressure, high cholesterol, and cardiovascular disease. So treating PCOS is something that should be initiated as soon as it's discovered, and not just for fertility-related reasons.

How can teens and young women know if PCOS is a worry for them?

• Develop an ongoing relationship with either a family practitioner or OB/Gyn.

• Keep close track of your menstrual periods and report on them to your physician annually. If you notice something different (for your body) happening – such as longer or shorter times between periods, more pain than usual, or periods that are heavier or lighter than usual – let your doctor know that you are concerned.

• If you have “male-pattern hair growth,” let your doctor know.

• If you notice extreme weight loss or gain within a brief period of time that cannot be explained by changes in your activity level or eating habits, tell your doctor.

There's more good information about PCOS specifically for young women on this website by the Center for Young Women's Health.

Finally, as a reproductive endocrinologist, I have a great deal of expertise and experience in treating hormonal conditions related to the reproductive system -- and PCOS-related infertility is indeed successfully treatable. If PCOS is your issue, the Houston Fertility Center can help.

~ Dr. Sonja Kristiansen M.D.

Obesity Impacts Your Reproductive Health Goals

The topic of weight and fertility is a sensitive one: Years ago, I mentioned patient's concerns about “fat phobic” doctors in a newsletter on “Weight & Fertility”, in which I gave a quick description of how a woman's weight impacts her ability to get pregnant. Now, The Endocrine Society has made available a free, downloadable booklet with more information on the topic.

“Obesity, fertility, and contraception: Disparities Among Women – 3 Perspectives” covers the entire fertility spectrum, explaining how body weight is not just an issue for women trying to get pregnant. Those who are trying to avoid pregnancy are also at risk – for weight-related contraceptive failures.

The booklet is complex and thorough, and offers the professional opinions of a basic researcher, a clinical practitioner perspective, and a clinical researcher. A few interesting points in the publication:

• Higher prevalence of obesity in African American and Latina women is an important factor in racial and ethnic disparities in reproductive outcomes. 

• Obesity adversely alters egg quality, in addition to the endocrine system, and is associated with ovulatory dysfunction and higher risk of miscarriage.

• Donor egg recipients who are obese do not appear to have lowered IVF pregnancy rates.

• Hormonal contraception may fail more frequently in obese women.

Body weight is not merely a matter of fashion, and reproductive endocrinologists are specifically trained and experienced in applying the latest research-based knowledge to the related fertility needs of patients in the clinic.

The staff of Houston Fertility Center and I offer all fertility patients the opportunity to access helpful nutrition counseling, whether it is for weight-loss, maintenance, or weight-gain – whatever is healthiest for their situation and will promote the greatest fertility treatment success.

Speaking of Infertility Awareness: The Question of Age + Pregnancy = Never-Ending Confusion?

Advanced maternal age and how it gets in the way of pregnancy is in the news again. This time, the focus is on how so many women have the misunderstanding that assisted reproductive technology can defeat age as a barrier to conception.

How many times have I heard, "Dr. Kristiansen -- I hate that term! Can't we use something different to refer to my age?" Sorry -- it's a rather tacky-sounding medical terminology shortcut that means "chronologically older than average for optimal fertility".

Here's a message that needs to be heard during this National Infertility Awareness Week:

The fact: Without intervention, most women in their 40's (and many in their 30's) would not get pregnant.

Another fact: Yes, IVF is incredible technology worth marveling at, and one of the reasons is its ability to facilitate conception in women who otherwise would not get pregnant.

The Big Myth: IVF is so effective, you can wait until you're of "advanced maternal age" to try and get pregnant -- and have a high likelihood of succeeding by way of fertility treatment.

That myth IS a fact for some women. But only for some women. Are you one of them? There's a good chance that a thorough diagnostic workup by a reproductive endocrinologist can provide clues to answer that question. Can we guarantee it? No.

I don't think either the media or fertility experts intend to confuse women about the question of age and pregnancy. But the confusion among women is apparently prevalent and ongoing.

Just as it would be overkill to suggest that all women in their teens or early 20's run out and get fertility testing to prepare for the future, it is unreasonable to recommend women put all their eggs into that future basket by expecting ART to be their surefire answer to pregnancy. (There is the option of freezing your eggs, a different but related story...)

So, the simple truth: If you're delaying conception until your late 30's or older with the intention of simply walking into any fertility center and getting pregnant easily on the first try, you're automatically decreasing your odds.

If you're like many of my patients and have delayed pregnancy for lifestyle reasons like not finding Mr. Right, wanting to give your all to your career before parenthood, or because your finances aren't in order yet, you can take heart in knowing that virtually any safe and effective technique will be made available to you here at Houston Fertility Center. Not only that, but the treatment will be delivered by a team of experienced, compassionate women.

We know how much you want a baby. We applaud your courage and tenacity in the pursuit of parenthood. We'll educate you about every treatment option. We'll be your cheerleaders in the journey. And we'll be honest with you, too.

~ Dr. Sonja Kristiansen M.D.




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