Infertility & Recurrent Pregnancy Loss

There are many causes of infertility and RPL. NaPro providers will do a thorough work up to look for all of them. 

Uterine Structural Causes: 

• Congenital uterine anomalies, eg unicornuate, bicornuate, sepate uteri
• Endometriosis
• Adenomyosis 
• Chronic endometritis (subclinical infection of endometrium) 
• Leiomyoma (fibroids)  
• Polyps 
• Intrauterine adhesions (scar tissue)
• Cervical insufficiency 
• Defective endometrial receptivity, eg: chronic endometritis

Thrombophilias: (thrombo = clot; philia = favor) 

• Factor VII Deficiency 
• Protein S & C Deficiencies
• Factor V Leiden mutation 
• Prothrombin mutation 
• MTHFR mutation 

Immunological Diseases: (Auto-Immune Disorders)

• Antiphospholipid syndrome (APS)
• Systemic Lupus Erythematosous (SLE) 
• Celiac Disease (even mild)
• Myasthenia Gravis  

Endocrine Diseases: 

• Diabetes Mellitus
• Thyroid Disease
• Hyperprolactinemia
• Polycystic Ovarian Syndrome
• Luteal Phase deficiency 

Genetic factors: 

• Aneuploidy- conditions with abnormal # of chromosomes, eg: Down Syndrome (Trisomy 21).
• Other chromosomal abnormalities, eg: Turner’s Syndrome (45X).

Male Infertility 

• Male infertility is believed to be solely responsible for approximately  20-30% of the infertility experienced by couples in the US. 
• Oftentimes I will recommend your husband has a semen analysis and a physical exam for the spouses. 
• Did you know that varicoceles (enlarged veins present in the scrotal sac) are present in 4.4% to 22.6% of the general male population, in 21% to 41% in men with primary infertility, and found in as many as 75% to 80% in men with secondary infertility? Varicoceles can also be easily treated by a urologist. 
• Learn more about Male Infertility here.

Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model System (CrMS) is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate. 

First Appt: I will take a comprehensive medical history and provide you with education about normal healthy reproduction and oftentimes about a condition I suspect you may have after we have talked a while. 

I will order a pelvic ultrasound which I will ask you to schedule on day 5 of your next menstrual cycle. I will order a series of laboratory tests. Click the "laboratory tests" button below to learn more. 

You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner (FCP)  by clicking the "Fertility Care Practitioners webpage" button below to learn more about scheduling an Introductory Session to get started. 

You will also be asked to begin taking a Prenatal vitamin if you have not already begun. After much thought and research, KLAIRE Labs Prenatal & Nursing Formula is my preferred prenatal vitamin. However, If you prefer to take the synthetic "Folic Acid" rather than the active metabolite (Metafolin, also called L-5 methyltetrahydrofolate), I would recommend Nature Made Prenatal + Folic Acid + DHA. Lastly, I do always recommend quality supplements and some of the larger conglomerate corporations my not be able to quality control their products well. Thus, there will always be unethical people who sell fraudulent products. For this reason, I will often create a FullScripts account for my patients, and recommend they purchase through this site. Once I create an account for you, you will be able to see my custom made NaPro "multi-patient" plan, which includes all of my preferred brands of supplements you may be offered. 

Please consider joining me as I pray for you here.

Second Appt:  You will be asked to return to the office in 2 mos for a follow-up appointment to review the results of your imaging and laboratory tests. Together we will also review your Creighton Model System (CrMS ) chart to look for specific biomarkers which will help me make a diagnosis. 

Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal. 

Please add the length of your post-peak phase and your mucus cycle score (MCS) to the R-hand margin of the chart. Your Fertility Care Practitioner (FCP) will calculate your MCS for you. 

During this appointment, you may be asked to begin some supplements and/or medications. We will also discuss drawing a full set of hormone panels. We will make a decision if you should have a peri-ovulatory estradiol panel, a post-Peak estradiol & progesterone panel, or both panels. 

 Hormone Panels: 

• Peri ovulatory estradiol panel: start on CD8, go to the lab EOD for an estradiol draw, until you have one draw post-peak. 
• post-Peak estradiol and progesterone panel: P+3, 5, 7, 9, and 11. See Handout #3 on the the Patient Handout webpage 
• Hormone panels require 2 mos of CrMS charting AND the patient must be able to confidently identify her Peak day.

Many patients will be asked to consider working with a dietitian or a nutritionist to help optimize your reproductive health. Oftentimes I may also recommend a mental health appointment to help with anxiety, depression and/or disordered eating habits. 

Third Appt: You will return to the office in 2 mos to review the results of your hormone panels as well as the biomarkers on your CrMS chart. Most often at this time I will have made one or more more diagnoses to identify the root cause of your symptoms. Together we will discuss a treatment plan, which will be implemented. 

Follow Up Appts:  You will return to the office every 2 months. During this time, I will conduct a comprehensive medical interview to ensure your symptoms have resolved, and to ensure you are responding well and not having any negative responses to the management plan. Depending on the individual patient and your individual diagnosis, I may need to monitor your progress with serial laboratory tests and/or serial imaging. 

After 6 -9 months: If medical management has not been successful AND we have not identified yet any other root cause for your problem, you may wish to move forward with a diagnostic laparoscopy. However, this would be your personal decision after we discussed benefits vs risks for your individual case. All surgeries present risks, which can sometimes be serious.  Oftentimes, we will have identified additional medical conditions which are treatable with supplements and/or medications. On occasion, I may come to know a surgical evaluation will be of benefit to you earlier on in this process, and an expedited surgical referral will have been recommended. NaPro surgeons typically book out 5 mos to 18 mos. At any time, if you feel you would like an expedited surgical referral, please feel free to discuss this with me. 

Please review my laparoscopy page. You will notice NaPro surgeries are done very differently as compared to laparoscopies done by mainstream medicine surgeons. We use a near contact approach and a near adhesion-free technique", which has been described as pelvic surgery of the pelvis.  

At any point in time, if a diagnosis has been made, treatment initiated, and/or you are satisfied with the medical management we have implemented, you can schedule annual or biannual visits, per your choice. 

For patients who have a diagnosis of Infertility or Recurrent Pregnancy Loss, we will pay attention to two very specific biomarkers: a) TEBB "Tail End Brown Bleeding (brown spotting at the end of your period) and b) a persistent "2W" mucus pattern in the post-Peak phase. Either biomarker may indicate a condition called Chronic Endometritis (C.E.) If you have either biomarker, we would discuss an option to schedule an endometrial biopsy, which can done in a local GYN office or preferably with a NaPro surgeon trained to recognize subtle signs of CE in the endometrium. The endometrial tissue should be sent for examination to look for signs of inflammation. A specific stain called a "CD138" must be ordered with this biopsy to correctly make the diagnosis of CE. About 78% of women treated for for CE with the appropriate antibiotic for 14-21 days are able to achieve a healthy pregnancy. 

On occasion, if the woman's TEBB does not abate with progesterone replacement and she has had RPL, we could have a discussion about "empiric treatment for CE".  This means, I will offer a course of doxycycline or clarithromycin be taken for 14 days to both the woman, which can sometimes resolve the chronic endometritis and allow the woman to achieve a pregnancy. Empiric Treatment will be done on a case by case basis. We do have data to show efficacy. 

 If you are interested in reading a few research articles discussing Chronic Endometritis click hereand here.