The patient: A well-known 30-something actress on the Broadway stage, I will call her Samantha, had what she thought was a great diet and exercise regime.
Why she came to see me: After a successful run on Broadway, Samantha and her husband wanted to start their family and were saddened and confused by her miscarriage at six weeks of pregnancy. Another woman in the production who was having problems with irregular cycles and mood disturbances had come to see me and had great results, and she referred Samantha to me. (Samantha also loved the fact that I had been a stage hand in college and held a union card for 10 years.)
How I evaluated her: Samantha’s gynecologist had given her a complete physical, including a pelvic exam and bloodwork, and she brought the results to her visit with me. I pointed out that her total cholesterol of 130, which was described as excellent, might be too low to sustain a pregnancy. I ordered a comprehensive hormone panel based on a sample from a 24-hour urine collection to evaluate the entire cascade of sexual and adrenal steroid hormone made from cholesterol.
The results showed that it was quite probable that her low-fat diet was interfering with her ability to produce adequate amounts of hormones, specifically progesterone, that had contributed to her miscarriage. We discussed how pregnancies are particularly vulnerable to miscarriage at the six-week mark to this deficit.
How we addressed her problem: While we were waiting for the test results to come back from the specialty lab, Samantha collected diet information for me, began recording her first morning temperatures, and started a supplement regime that supported better cholesterol management. She began eating two poached eggs every morning and instituted a bioidentical hormone-repletion regime consisting of transdermal progesterone and transbuccal DHEA.
The test results confirmed my suspicions that her low-fat diet was impairing her ability to carry the pregnancy. There were a number of findings other than the marginal progesterone that were also contributory. Based on the results we adjusted the prescription of hormones and modified the supplement regimen.
The patient’s progress: Her first morning temperature over the next few months showed a steady increase in hormonal vigor. After four months, I counseled her that I believed she should try again to become pregnant and helped her to identify her period of peak fertility. Samantha is now seven months pregnant! Although I had trained in obstetrics in medical school and delivered my son at home, I thought it wisest to pass on performing a home birth for her, and leave this part of her care to “more capable hands.” She is being managed by one of our ace obstetricians here in Southbury, Connecticut.