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:  
• Endometriosis
• Adenomyosis
• Endometritis (subclinical infection of endometrium) 
• Leiomyoma (fibroids)  
• Endometrial polyps
• Intrauterine adhesions (scar tissue)
• Cervical insufficiency 
• Defective endometrial receptivity  

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)
• 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).

Your appointments at Natural Women's Health 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 Charting 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, order a baseline ultrasound which must be done on day 5-7 of your next menstrual cycle, and check blood levels for FSH/LH and estrogen which must be timed to day 3 of your next menstrual cycle. Depending on your unique story, I may a series of lab tests called a hypercoagulable panel" to look for Thrombophilias and autoimmune disorders that increase your risk of forming blood clots, which can be the underlying cause of your inability to achieve and/or maintain a healthy pregnancy (click the "laboratory tests" button below to learn more. 

You will be asked to begin charting your menstrual cycles using the Creighton Model System. Please choose a Fertility Care Practitioner by clicking the "Fertility Care Practitioners website" button below to learn more about scheduling an Introductory session. 

If you have a pre-existing diagnosis of Infertility or Recurrent Pregnancy Loss (confirmed by ultrasound) and/or if you have a history of failed IVF/IUI treatments, I may expedite  your referral to a NaPro surgeon. Trained NaPro surgeons typically book about 4- 6 months out from initial inquiries, and ALL will want to see at least 2 months of Creighton Model charting before booking your first appt.  Oftentimes, patients have very subtle endometriosis and/oror uterine pelvic adhesions (scar tissue) that can easily be removed during a NaPro laparoscopic surgery, permitting a pregnancy to be achieved thereafter. 

While you are waiting for your appointment, I will offer you NaPro "medical management" for the next 6 months. If you successfully achieve a pregnancy, the surgeon's appt can easily be cancelled. However, if we are unsuccessful after six months, you will be seen by the surgeon as soon as possible. 

Second Appt: You will be asked to return to the office in one month for a follow-up appointment to review the results of your imaging and lab tests. Together we will review your Creighton Model Chart and look for specific biomarkers in your menstrual cycle. Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal. 

A full GYN physical examination will be preformed (unless you have recently had a full well-woman annual exam), and additional laboratory and/or imaging tests may be considered to continue to guide your medical management (click the "laboratory tests" button below for more information). 

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 (CE), which we know causes recurrent miscarriages. If you have either biomarker, we would discuss an option to schedule an endometrial biopsy, which can done in the office. The endometrial tissue will be sent for examination to look for signs of inflammation. A specific stain called a "CD138" must be ordered with this biopsy in order to correctly make the diagnosis of CE. About 78% of women treated for for CE with the appropriate antibiotic for 21 days are able to achieve a healthy pregnancy. 

I am currently involved in a research trial looking at novel treatments for Chronic endometritis. If you are interested in participating in this research, please let me know and we will discuss the details. 

Third Appt:  You will return to the office in one month to review the results of your laboratory and imaging studies. At this time, we will consider ordering the progesterone and estrogen panels which will be specifically timed to your CrMS chart.  Click the "Laboratory Tests" button below for more detail. Depending on your results, you may be asked to start medications and/or perhaps make an appointment with another specialist such as an endocrinologist, dietitian, NaPro surgeon or counselor. 

Follow Up Appts:  You will return to the office every two months to monitor and/or make adjustments to your medications and treatment plan. 

After 6 months, if medical management has been unsuccessful you will be referred to Dr. Naomi Whittaker, MD who is a NaPro surgeon. You will undergo an evaluation. Dr. Whittaker will review your Creighton Model Charting as well as the medical management you have received during your visits with me. Together you will formulate a surgical treatment plan.