Immunological Infertility & Secondary Infertility

Infertility Case Study

I believe that immunological infertility is seen more often in secondary infertility cases. This may be because the body starts to make more antibodies during the prognancy. We know this is the case in recurrent miscarriage, so it makes sense that this increased production of antibodies may be a factor in secondary infertility. In the clinic, one of my most common patient profiles is a woman looking to improve her fertility after 40 years of age, who has a 3 year old child and easily conceived this baby in her late thirties.

In this case study, we're looking at my patient with immunological infertility due to positive anti-phospholipid antibodies, specifically elevated phosphatidylserine IGM autoantibodies. Also, she has a case of secondary infertility, which I believe is due to a combination of low functioning thyroid, the antiphospholipid antibodies, and her C-section.

Female Age: 40

Births: Daughter born 2 years ago by C-section

Miscarriages: 1 miscarriage at 6 weeks, 6 months ago

TTC: 1 Year

Menstrual Cycle: 26 - 28 days longs, minimal PMS, 7 days of flow from heavy to spotting, color from red to brown at the end, no cramps but achy, some clots.

Hormone Tests: CD3 FSH dropped from 15.3 to 8.38 with acupuncture over 3 months, CD3 LH=5.50, CD 3 Estradiol=48.6, 6 DPO Progesterone ranged between 8.61 to 18.8, Prolactin=11.80, TSH=2.99, Free T3=2.71, Free T4=1.06, T4=7.47

Blood Tests: LDL=140, HDL=51, Triglycerides=61, Glucose Fasting=75, Phosphatidylserine IGM Autoantibodies=51 (factor in immunological infertility)

Functional Tests: Hysto-salpingogram=clear, Sono=hystogram=clear

ART Procedures: IUI without gonadotropins, but with trigger shot last month. Result, no pregnancy, but short and weak luteal phase.

Medication: Synthroid for hypothyroidism

Health History: Bouts of insomnia, history of severe sore throats, significant leg swelling during last pregnancy, small bladder syndrome since C-section, tendency towards constipation, some fainting, body runs cold, immunological infertility due to elevated phospholipid antibodies.

Dietary History: Diet sodas in the past, gave up coffee and replaced it with green tea, minimal alcohol, generally healthy diet, but not eating enough or regularly.

Lifestyle: Formerly a school principle and teacher, lots of stress in a big city, wrote a book, now working as a trainer, juggling work, travel, mothering a 2 year old and TTC, not exercising, no meditation, generally happy disposition, too much worry.

TCM Treatment Plan: Weekly acupuncture, personalized Chinese herbal formulas, dietary therapy including cooked barley for breakfast, increased fresh fruits and cooled veggies, organic meats/eggs, no green tea, no alcohol, no processed foods, fish oil, bee pollen, and royal jelly and lifestyle adjustments including daily meditation, bed by 10 PM, and daily exercise like yoga.

Male Age: 41

Sperm Test: Volume=2 ml, Count=90 million/ ml, Motility=55%, Forward Progression=1.6, Morphology=3.5%

Blood Tests: LDL=144, HDL=38, Triglycerides=83, Glucose Fasting=108, TSH=2.22, Free T3=4.18, Free T4=.97, T4=7.21

Dietary History: Irregular meals, skips breakfast, too much fast food, 2 cups of coffee in the morning, scotch in the evening.

Lifestyle: Works as a lawyer, high stress level, bedtime 1-2 am, no exercise, doesn't "feel" healthy in this lifestyle, mood is good.

Male Treatment Plan: Weekly acupuncture, personalized Chinese herbal formula, anti-oxidants, amino acids, dietary therapy including a warm cooked breakfast, more home prepared meals, no fast food, no coffee, no alcohol, and lifestyle adjustments including bed by 10 pm and daily vigorous exercise.

Outcome: This patient immediately jumped on board and did everything in our holistic fertility plan. Her charting was impeccable and we would see the improvement in her ovulation, cervical mucus and luteal phase cycle by cycle. She did continue to have the brown spotting through CD 8, which was frustrating. I believe this was due to the hypothyroidism. Her phosphatidylserine IGM autoantibodies (antibody involved in immunological infertility) did remain elevated. In the 9th cycle, we had these test results and were going to address them herbally, but then she was pregnant the next cycle and we didn't get to see the effects of herbs on these antibodies. After 10 menstrual cycles this patient was pregnant. So much for immunological infertility!

Her husband really jumped on board the program during cycle 9. I believe that the foundation laid out by my patient finally paid off when her husband started addressing his health issues. He had only been taking his herbs and supplements for a few weeks when she got pregant, which again shows the resilience of sperm and their quick response to herbs, diet, and lifestyle adjustments.

This patient has had an uneventful pregnancy, which is exactly what we want! There's been no morning sickness, bleeding, or leg swelling like in the last pregnancy. After seeing a specialist, she did start taking heparin for clotting and there have been no side effects. She is currently gearing up for a VBAC (vaginal birth after cecarean) and I'm sure that with plenty of positive support from her birthing partners, she will have an empowering vaginal birth.