Is there any link with endometriosis/polyps and pneumonia and recurrent miscarriage?
Dear Prof. Robert,

Is there any link with endometriosis/polyps and pneumonia and recurrent miscarriage?

I am 42 years old and am experiencing secondary infertility.

I was due to have uterine polyp removed but found out I was pregnant with my first and only child at 38. I had a wonderfully easy pregnancy and birth at 39.

My periods returned after 14months and 4 months later I became pregnant. I miscarried at 10weeks and had emergency d&c. 2 months later I had an acute case of suspected pneumonia. I have since had 2 more miscarriages around 5-9weeks and all ended up with d&c.

Since my last miscarriage my periods are extremely light. I usually am spotting for a week and then I’ll have about 5 days of a very very light flow. I have also failed to become pregnant. I have had my progesterone checked and my last cycle I had progesterone of 42 n/mol on day 28 of my cycle followed by my ‘period’ on day 31 (2days early).

After my second miscarriage I went to a fertility clinic and my partner and I had all the tests including karotype and anticardiolipin antibodies and all came back “normal”. Only our age was to ‘blame’.

Of course, I am desperate to find answers to my infertility. I am a healthy, active 42 year old with normal weight, bmi and have never smoked. I feel like I’ve been left to just deal with it. But I suspect that I might be suffering from either Ashermans syndrome Or endometriosis? I say the latter because I recently read that endometriosis can affect the lungs and so made my own connection to the pneumonia I suffered with. Plus, with my first miscarriage I noticed I was very short of breath for a week before it happened.

Do you think there could be any connection? Is there any other line of inquiry that I could push for before giving up on my dream to have another child?

Thank you so much for this service. I really appreciate your time and expert advice.

Niamh

 

Dear Niamh

I think it very unlikely the suspected pneumonia is relevant unless you had another unlikely problem such as a pulmonary embolus. Endometriosis can affect the lungs but this is exceptionally rare and in any case endometriosis is not associated with the kind miscarriage you are describing.  I suppose there is a faint possibility of adenomyosis – which is a form of endometriosis of the uterus – but your symptoms are not typical and I suppose this could be checked with an MRI of the uterus.

I fear the real problem is indeed age related. At your age, you may well be ovulating, but over 50% or more of pregnancies miscarry and at least your normal pregnancy is a strong indication there is probably nothing systemically wrong which can be treated.  I don’t understand why you think you have Asherman’s syndrome?

You don’t need to give up.  Your best chance is simply to keep trying with normal regular sex.  But I have to tell you that human fertility is much lower than most people realise at 42 and I think this is by far the likeliest problem.  Very understandably this is very difficult to accept when everybody knows of a sister or an acquaintance has a baby at 45.  But most people don’t – and actually can’t. I am sorry to be negative.

My best wishes,

Robert Winston