Wednesday, November 23, 2011

Investigating miscarriage

This is a response to another comment left on my 'Science of Infertility' page

Hi, my husband and I have been ttc for almost 2 years. I've had 2 m/c in the past year and am desperate to figure out bloodwork came back normal and now i'm scheduled to have an hsg test in the next week or 2. I had to beg my gynecologist to put an order through for my Vitamin D levels. Finally she did and they are low (18L). Do you think this could be why I've been miscarrying? Should I still do the HSG testing?? Thanks for any help/advice! 

This is an impossible question to concretely answer. Most doctors would shrug and say, who knows? Me, I try to wildly speculate. But you need an incredibly detailed medical history to speculate and I do not have it for the commenter.

I can only offer my first miscarriage (the one that is still a complete mystery) try to speculate if vitamin D had a contributing roles.

This is a basic checklist one goes through, of examining risk factors for pregnancy loss. All issues were not tested, the full RPL panel covers more ground.

1) Was the embryo chromosomally normal? --Yes (no issue of mixup as was male)
2) Was there a structural uterine abnormality (determined by Ultrasound/hysteroscopy. I'm not sure if an HSG can contribute) -- No
3) Was diminished ovarian reserve a contributing factor miscarriage risk -- No, lots of eggs left
4) MTHFR mutations? -- unlikely, My homocysteine level was super low.
5)Autoimmune issues
Lupus anti-coagulant-No
Anti-phopsholipid antibodies- borderline positive then repeat negative so unlikely
Thyroid autoimmunity-yes
6)Progesterone Issues:  No, levels were excellent
7)Luteal phase defect:  borderline...11 day luteal phase in similar cycles.
8) PCOS:  Yes.

I do not know why my baby died, but I do know that a vitamin D deficiency is a risk factor for PCOS, all autoimmunity(including thyroid) as well as luteal phase defect. After becoming vitamin D replete, my ovaries are no longer poly/multicystic (My antral follicle count came down from 30-34 to around 16-18). More importantly, I consistently have a 14-16 day luteal phase.

Based on what was 'wrong' with me, do I think my D3 deficiency possibly contributed to my miscarriage? Yes. Can I be certain? Hell no. There is no way to know anything for certain.

About whether a HSG is useful: It can only be useful if it helps reveal anything about your uterus (not so sure about this) and tubes. So if you have not had this investigated, do so, because it is something off the checklist that must be crossed off.  

Also, this is by no means infallible or a comprehensive list,  but this is what I would suspect was a more likely cause depending on WHEN pregnancy loss happens.

Very early pregnancy loss risk factors: Bad egg quality (hindering growth of the embryo),  and immune factors that hinder implantation such as activated NK cells and T cells.

Mid-late first Trimester loss risk factors: Chromosomal/genetic abnormalities, anti-thyroid antibodies, and god knows what else.

Second trimester loss: autoimmune issues, anti-phospholipid antibodies, clotting issues.


  1. I suspect, and heavily encouraged my RPL doctor to investigate further on the Vit. D front. I had my only known non-chromosomal loss and the current critter hanging in after three years of pooping out at 6-7 week gestation.

    I think I've told you, but in case I hadn't, it was your own experiments with your D3 levels that prompted my own maverick supplements. Which I still think has helped get me here. So one huge thank you for having a blog and sharing your story. It may be nothing related, or it may everything. I only hope that there are more studies on it in the future.

  2. At my HSG for RPL I was told that it does diagnose most uterine cavity abnormalities such as septums, masses etc.  They were concerned about a thin septum in my case, but the uterine cavity was normal.  I'm now 24 weeks along with pregnancy #6, and hopefully this will result in a take-home baby.  

  3. I would also like to see more research...the cynical me says that because vit d can't be patented (and therefore sold for a lot money) there aren't the research dollars behind it. The less cynical me just puts it down to the fact that we're still in the dark ages as far as what we know about miscarriage. (which I guess is still pretty cynical).

  4. Its true that big pharma will not fund Vitamin D studies, but the good news is that it does not really make any difference- the people who would be studying this are the basic science folks in academia (like me). And Vitamin D research is a decent hot button topic for funding, so if you look at pubmed, more and more studies are being done :)

    But still, I think the real issue is public awareness and the willingness to listen, both among patients and in the medical community. Some smart doctors are catching on and testing this proactively- the rest (like the doctor mentioned by the commenter) have to be whacked on the head in order for them to listen.

    Ditto with patients. I know this girl whose immune system is a mess. She is either getting infections or autoimmune flareups. Vitamin D is an incredibly important regulator of the the immune system, and over 70 % of people with lupus autoimmunity (or even just the autoantibodies) were found to be deficient. I advised her to get her D levels checked out and treated.  She is kind of a ditz, she gave me a smiley, vague answer and has probably forgotten about it, and I cannot do anything more there. I also warned another friend with Type 2 diabetes about this- he paid a little bit more attention, but will probably take about 6 months to get it checked out and treated.