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Secondary Infertility

by Hope
(Brisbane, Australia)

Hi, we have had a lot of problems both getting pregnant and then staying pregnant. We are very lucky to have one beautiful six yearold boy, who was conceived naturally a couple of months after a natural miscarriage. Our little boy was a twin pregnancy, however the other baby was lost very early on. Our surviving child was diognosed with single umbilical artery at 18 weeks gestation, however fortunately he has suffered no ill effevts as a result of this. I have suspected for a long while that I suffer from a hormonal inbalance and am hoping you can point me in the right direction regarding what tests to get done etc. My son was born via emergency c section as I didnt go in to natural labour and then failed to dilate despite having maximun dose of syntocin and my waters broken 14 hours prior. I also got my period back immediately following birth and fell into an immediate 28 day cycle, despite exclusively breadtfeeding. 18 months following the birth of our son we saw a fertility specialist as we were unable to fall pregnant. He diagnosed stage 4 endometriosis and surgically removed it. We have now done 17 cycles of IVF and only have had 2 additional pregnancies, 1 ectopic and 1 miscarriage at 8 weeks. The miscarriage showed my progesterone dropping every couple of days. I have just had some additional tests done and my estrogen appears to be really high. What do you think these tests mean? Could it be sugestive of a hormonal imbalance, early menopause or something more sinister? Thanks so much for taking the time to read my incredibly long story. I forgot to mention that I suffer from extreme insomnia and my mind doesnt switch off, possibly suffer anxiety as well. Results as follows, taken on day 4 of a 25 day cycle.

Testosterone 1.4 nmol/L
FT4 15.8 pmol/L
FT3 4.7 pmol/L
TSH 3.4 mIU/L

LH-10 IU/L, Progesterone - 4.8 nmol/L, Oestradiol - 998 pmol/L, FSH - 6.5.
AMH test done two years ago was 16.3

I also tested positive for staphyloccus aureus and streptococcus agalactiae b group. My intauterine biopsy and blood tests showed very high levels of natural killer cells cd56 - 43.1% {75th centile 9.5%} and cd57 - 20mm2 {10mm2 is suggested by research as being abnormal}.

Comments for Secondary Infertility

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May 29, 2013
 Secondary Infertility
by: Wray

Hi Hope You have had a journey and a half! I suspect most of it caused by a lack of progesterone and very low vitamin D. Pity they did the test on day 4 as it's meaningless. It should be done ±7 days after ovulation or before bleeding. Progesterone is always low in the follicular phase. Oestrogen can range from 110.13 - 1468.4 pmol/L, but on day 4 to be as high as 998pmol/L is extraordinary. It only rises exponentially about 50 hours prior to ovulation. It makes another peak mid-luteal phase, as does progesterone, which is when the test should have been done. You've been through 17 IVF cycles, did they give you ovulation induction drugs, or oestrogen? Which could account for your high level. If you have a 25 day cycle, you should ovulate on day 11, which means the test should have been done ±day 18. Has anyone checked you for PCOS? Your LH is higher than your FSH which makes me suspect it. I wouldn't be surprised, as both PCOS and Endometriosis are caused by oxidative stress. A lack of vitamin D is a major factor, please have a test done. It's probably low, as you live in Australia where you are advised to cover up in the sun. Both Progesterone and Vitamin D help sleep, see here and here. And here, here and here. Progesterone does suppress natural killer cells, see here, here and here. It appears there is an 'upside' to NK cells, but only if they are controlled, see here. An excess would make implantation impossible. This is a long but excellent paper on implantation, see here. Continued below
May 29, 2013
 Secondary Infertility Part 2
by: Wray

Hi Hope I would suspect a low vitamin D could be responsible for the presence of the staph and strep. A mind that doesn't switch off makes me suspect low tyrosine levels, you could consider taking it. Start low with about 250mg/day and increase gradually, too much causes the same symptoms it's trying to help. Although a non-essential amino acid, tyrosine is one of the most important. It's the precursor to the neurotransmitter dopamine, and the stress hormones adrenaline and noradrenaline. It's also the precursor to the two thyroid hormones T3 (triiodothyronine) and T4 (thyroxine), plus melanin, the pigment found in hair and skin. It's part of the enkephalin peptide involved in regulating and reducing pain, and increasing pleasure. Tyrosine is essential for any stressful situation, cold, fatigue, emotional trauma, prolonged work, sleep deprivation, it improves memory, cognition and physical performance, and is used for weight loss treatments. Lack of protein and stress lower tyrosine levels, with a subsequent reduction in dopamine. Dopamine is essential for motivation and vitality, it's also essential for a normal sexual response. A drop in dopamine increases levels of prolactin, the hormone of lactogenesis, but also an inflammatory hormone. increased prolactin causes a drop in libido. Acute, uncontrollable Stress depletes dopamine, leading to depression and a rise in cortisol and prolactin, tyrosine reverses this. The rate limiting step in dopamine synthesis is the enzyme tyrosine hydroxylase. Insufficient levels of vitamin D inhibit tyrosine hydroxylase, resulting in a disturbance in the dopamine pathway. Please have a vitamin D test done, levels drop with stress. I would class 17 IVF treatments as highly stressful! Ironically it seems your doctors know nothing about vitamin D and IVF, as they've found it increases the chances of success, see here and here. Continued below
May 29, 2013
 Secondary Infertility Part 3
by: Wray

Hi Hope Low progesterone levels are found in ectopic pregnancies, see here, here, here, here and here. Although they believe it's a result of, which I disagree with, I think it's a possible cause. Both low progesterone and vitamin D can cause miscarriages. Both are essential for a successful Pregnancy, for conception and the growth of the foetus. Please have that vitamin D test done. We also have a page on Anxiety you could look through. Take care Wray
Apr 28, 2016
 high progesterone
by: Anonymous

Dis is my 18months of try to conceive after my first child of 2 and half years ,have done the neccessary test but was told my progesterone is high 35.5ng/m,prolactin 14.12ng/m,LH 2.13,FSH 2.97.these test was done on the 21day of my circle .pls am any assist

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