Early Miscarriages - Elevated prolactin? Any other tests should I ask for?

[Coconutfeet]

I've recently had two early miscarriages, both at around 5 weeks.

I gave up BFing my ds only a couple of months ago but one of the things that made me think I might be pregnant the second time round was that I was leaking milk. This seemed very odd and on another forum someone suggested that it could be a sign of elevated prolactin levels which are incompatible with pregnancy. Of course it could just be a coincidence but I've not leaked at all at other times, so I'm wondering whether there is anything in this. Anyway, I think I'll get my prolactin levels tested at the GP. Can anyone suggest any other tests I should request while I'm at it? I think I might have to be quite specific about what I want, as unfortunately I suspect my GP may not be very helpful.

I don't know if it's relevent but before I had ds I also had a loss at 10 weeks due to an anembrionic pregnancy/blighted ovum.

I'm in my early 40s (another possible reason for the losses of course) so I don't really feel like I can hang around but I'm also worried that they'll laugh be out of the surgery for thinking I could still be in with a chance.

[Mamafoof]

Hi Coconutfeet - we spoke on the other thread and sorry i have nothing helpful to say but just wanted to bump your post so someone else could offer help and wish you all the best for your gp appointment and hope you get the answers you want xx

[MummyBellsAllTheWay]

Standard tests for fertility would be

FSH,LH,thyroid, prolactin and progesterone

get your fsh level tested you can get a guage of your ovarian reserve (one of thhe indicators if you are approaching menopause or not )

If the test is done early in your cycle ( day 2 is best) then you can compare the lh and fsh levels to see if they are the same. A ratio of 3:1 or higher can indicate the condition PCOS which sometimes leads to a higher incidence of miscarriage. It is treatable though and many women have it and have successful pregnancies without treatment. I believe there is thread on here for PCOS sufferers, I am sure they can give you lots more info.

The progesterone test is only really useful if you have the test repeated late in your cycle and have the levels compared. On day 21 or 7 Days after ovulation if you chart, you should be able to see that the levels are high enough to indicate ovulation occurred and that there is enough progesterone to sustain a pregnancy if fertilisation occured.

There are several sites online where you can look up your results to see if they are in or out of normal range, just google fertility blood test results. ( sorry cant link for you from my phone) normally blood test results are printed alongside the " normal range" values, so even your doctor should be able to work it out [ grin]

[sh77]

I had elevated prolactin, which was controlled using tablets. Prolactin is not incompatible with pregnancy (after all, it rises during pregnancy due to milk production) . It inhibits FSH and ovulation, which prevents pregnancy.

[Coconutfeet]

Thanks Sh77 and Mamabells. I'll try and get an appointment for the early part of my next cycle so that I can then follow up the progesterone test. I do chart so I know I'm definitely ovulating (and must be to get pregnant in the first place) and my cycles are very regular but I suppose the progesterone levels could be too low to sustain a pregnancy.

sh77 - How long did it take for your prolactin levels to go down to normal?

Mamafoof - Thanks for bumping for me. How are you doing?

[MummyBellsAllTheWay]

hi coconutfleet,

I dont know anything about elevated prolactin, my problem turned out to be stuctural rather than hormonal- and the doctors I saw wanted to spend an awful lot of time on blood tests looking at hormonal issues.

So having just read sh7's comment that prolactin is not incompatible with pregnancy i'd say its worth asking for some tests to check non hormonal issues too.

An internal scan done mid cycle but before ovulation (sometimes called trans vaginal) will tell you if your womb lining is nice and thick >8 mm is good) and you are more likely to be offered one if you say you have lots of pelvic pain

and an HSG will show if your uterine cavity and fallopian tubes are open and free of obstructions given if periods are absent or afer ttc over 1year

I think it really is worth being your own advocate and pushing to get whatever tests you feel necessary, getting a good diagnosis and proper treatment is really worth all the hassle that it takes. Dont give up till you get what you deserve xxx

[Coconutfeet]

Thanks Mummybells, that is useful. Do you mind me asking about your history. Have you had early losses or later ones? Have you previously had any children?

TO be honest, I've got no idea if the prolactin is that problem at all, but I think I should get it checked out. I was TTC while BFing and didn't get pregnant at all (due to raised prolactin caused by BFing, maybe), but then fell pregnant as soon as I gave up and also the following month, so I'm sure sure there's some kind of connection. That makes me wonder whether in my case it is hormonal but who knows. I think I need to go to my gp and see if I can get tested for both hormonal and structural problems.

[GrumpyFish]

Hi Coconutfeet. I can't really answer your question but think I may have had the same problem. Started TTC when DS was about 8 months old, still BF, regular-ish periods. No luck at all for 6 months, then had a chemical pregnancy (+ive test but lost before 4 weeks). Stopped BF, then got pg the next month, lost it at 5+3, got pregnant again immediately and lost it at 6+4, after days of bleeding. I went to my GP who did day 21 progesterone tests (repeated at various points during cycle, and I charted so could tell when I ov'd), which for 2 consecutive months showed progesterone levels not high enough to confirm ovulation (less than 20). Obviously I was ovulating because I was getting pregnant, but I think something was hormonally wrong because I kept having early losses, and I am suspicious that these were related to 15 months of breastfeeding.

Once I started charting I realised my luteal phase was short (less than 10 days). I had some accupuncture, took vit B6, ate really healthily and tried to relax a bit, and my luteal phase gradually got longer. Once it got to 11 days (4 months after last mc), we started TTC again, and the good news is that I'm now almost 19 weeks pregnant. I've also used progesterone cream during this pregnancy, although only a smidgen and on the advice of my accupuncturist.

Anyway, this doesn't really answer your question but I hope it helps a bit. I truly believe that breastfeeding had a big impact on my fertility and still had that impact after I stopped for a few months, although I didn't have my prolactin checked. I couldn't really find any medical profeessional who was prepared to entertain this theory (although my accupunturist who is a bit of a fertility expert thinks that that is what the problem was), but I didn't get as far as the consultant - by the time our appointment came through I was pregnant again.

[Coconutfeet]

Grumpyfish, Thank you for this and congratulations on your pregnancy! What you say is really interesting and it does sound like it may be the same problem or very similar. I BF my ds for nearly two years and like you I'm pretty sure that it's had an impact but it's really good to hear that it can have a happy ending.

I chart as well and while BFing my luteal phase was on the short side (12 days whereas previously it was 14) but not ridiculously so. I don't know whether it's got any longer as I've been pregnant for both cycles since stopping BFing so it's all been messed up. I started taking B6 a few months ago and I've just started acupuncture again, and I'm hopeful that these things will have an impact soon. I've read about natural progesterone cream and considered using some bit was a bit nervous about doing it on my own. Did you just start using it once you'd ovulated? How long did you continue to use it for?

Thanks so much for sharing your story. Although I'm sorry you had to go through all that, it's nice to have reassurance from someone else that I'm not mad and that BFing can have a major impact on some people's fertility for quite a while after they stop. Good luck with the rest of the pregnancy. How long after stopping did it eventually take?

[MummyBellsAllTheWay]

Hi coconut feet

good to see you have lots of info to go on there, Grumpyfish's story is probably a lot more relevant to you than ny own but here it is...

I have a DS who is 2, was conceived easily and no problems in pregnancy, during the delivery of the placenta I suffered a trauma ( the midwife yanked it out to soon not realising I had asked for natural third stage and hadn't had the injection) a month later I had an emergency ERPC, then no periods for 6 months despite not BFing. A year later I conceived but had a mmc detected at 14 weeks followed by an enormous amount of complications ( and tests) and no periods. It took three months and another ERPC to get a clear uterus and a further 6 months to get a diagnosis of Ashermans Syndrome (scar tissue at the cervix and uterus) i have now been treated and hopefully will be able to TTC again in a month or so.

During all the testing I had I heard lots of mention of polyps, fibroids, cysts etc which is why I mention structural issues.

If you are interested in learning more about testing for recurrent mc, I can recommend Lesley Regans book " miscarriage, what every woman should know" if you haven't seen it already.

Xx

[Coconutfeet]

RMummybells, you've really been through the mill. Sorry to hear that. I really hope it works out for you soon. I had a fibroid a while ago. I think it may be worth getting that checked again. I'll check out the book you mention too. Thank you. Good luck to you!