Lauren Rubal, MD, FACOG

Thyroid problems can be the cause of your miscarriage and fertility issues! Thyroid abnormalities are relatively common and have an impact on essentially all of our organs . - TSH is released by the brain and talks to the thyroid gland. ... 1 It should be less than 2.5 in the first trimester of pregnancy 2 if it’s high, it is as if the brain is *shouting* at the gland to make more thyroid hormone (i.e. due to an underactive gland) . thyroid hormone is called T4 (the reservoir) and T3 (what actually goes into tissues to stimulate an effect). These levels interplay and affect TSH. . the thyroid is one of the most common targets of #autoimmunedisease 1 that’s friendly fire from our immune system mistakenly recognizing one of our own as enemy. 2 there are different autoimmune markers suggesting this, with anti-thyroperoxidase antibody (TPO) one of the most common. 3 we want TSH <2.5 in +TPO women to optimize miscarriage and fertility outcomes. . the fetus doesn’t make this hormone until about halfway through pregnancy so he or she is reliant on mom’s hormone until then! So it’s wise to correct if an issue is seen. . menstrual abnormalities are a really common manifestation of a thyroid issue. 1 irregular cycles 2 abnormal bleeding . . . #pregnancylossawareness #pregnancyandinfantlossawareness #pregnancylossawarenessmonth #rainbowbaby #recurrentpregnancyloss #recurrentmiscarriage #ttcsupport #thyroidproblems #thyroidhealth #thyroidwellness #fertilityawareness #holisticfertility #synthroid #hashimotosdisease #hashimotosthyroiditis See more

#Progesterone may win as Queen of hormones for miscarriage prevention. . pro*gestation* hormone = pro-pregnancy hormone. . studies clearly show it’s essential to maintain a pregnancy until the placenta takes over later in the first trimester (women who underwent ovarian cyst removal when they were early in their pregnancy and where the cyst *was* the corpus luteumresponsible for progesterone productionunderwent miscarriage soon thereafter ). ... . it can be checked in the blood or the urine to give an idea if there is a deficiency that is impacting fertility or miscarriage risk. . there are many different types of progestogens prescribed but the best is bioidentical micronized progesterone. It’s best given either vaginally (bc of an uterovaginal circulation that brings the hormone right to the endometrium) or as an intramuscular injection. Oral use isn’t as effective bc it’s extensively metabolized by the gut. . studies are mixed about progesterone use in #recurrentmiscarriage. Meta-analysis (a group of studies) support it as a way to potentially increase live birth rate (Ie having a live baby). But a randomized controlled trial in the #newenglandjournalofmedicine didn’t show a significant improvement in this. . side effects are similar or heightened compared to those experienced in pregnancy. Risks are low but include an increase in blood clot risk and possibly an increase in hypospadias (where the urethral opening is lower than typical) in boys. . ask your doctor if you should consider this in your evaluation or as part of your treatment strategy! . #pregnancylossawareness #pregnancyandinfantlossawareness #miscarriageawareness #miscarriageawarenessmonth #rainbowbaby #rpl #recurrentmiscarriage #recurrentpregnancyloss #holisticfertility #ttcaftermiscarriage #fertilitytips #fabm #naprotechnology #fertilityawarenessbasedmethods #progesteronedeficiency #progesteronesuppositories #progesteronesupport #fertilitytips #restorativefertility See more

A common cause of #miscarriage is an issue within the uterus. . How? . -... structural causes: 1 polyps or fibroids inside the endometrial cavity are common and overwhelmingly benign. But they can interfere with implantation or increase miscarriage risk. Thankfully, they can be removed with a minor procedure. 2 #uterineanomaly is a change in the shape of the uterus that some women may be born with. #uterineseptum is one type that is surgically correctable and can significantly increase live birth rates. 3 scar inside the uterus is an uncommon cause for miscarriage. This can be evaluated by your doctor. . - . infectious causes: 1 chronic endometritis is a chronic inflammation of the endometrium. There are different ways to evaluate for it and it can be treated with antibiotics. Check out my other post on this! 2 infections, such as bacterial vaginosis, can be associated with increased risks in pregnancy, including miscarriage. 3 reproductive microbiome is so important and, if abnormal, can alter fertility outcomes. . - . abnormal receptivity or relative endometrial progesterone deficiency. 1BCL6 is an interesting endometrial bio marker that may be elevated in endometriosis or with a swollen, closed tube. 2 endometrial receptivity is typically thought of as more important with implantation but if related to progesterone timing (more to come on this!) . - . It’s important to see your doctor if you have abnormal bleeding or a complex reproductive history so you can be evaluated to see if any of these issues applies to you! . #pregnancylossawarenessmonth #miscarriageawarenessmonth #miscarriageawareness #rainbowbaby #recurrentmiscarriage #recurrentpregnancyloss #uterinefibroids #endometrialpolyps #mulleriananomaly #reproductivemicrobiome #holisticfertility #bacterialvaginosis #intrauterineadhesions #ttc #pregnancyandinfantlossawareness #fertilitywarrior

#miscarriageawarenessmonth is here and I’m going to be highlighting some of the causes of recurrent pregnancy loss in the next few posts. . BUT the *most important* part is to remember the following: 1 this isn’t your fault. Really. Truly! 2 all the studies show that your next pregnancy is likely to be a baby. There is always hope! ... . - . I’ll be going live Friday 10/16 at 5:30 pm with a Q&A about #miscarriage ... stay tuned! . #recurrentmiscarriage #recurrentpregnancyloss #pregnancylossawarenessmonth #pregnancyandinfantlossawareness #pregnancyandinfantlossawareness #ttcsupport #rainbowbaby See more

Have you felt like the #infertility battle is just too much to bear? That #ttc is causing despair? . As a #fertilityspecialist , I want you to know that I’ve seen the impossible with my own eyes. It can happen and it sometimes doesn’t make medical sense. Of course, please always go to your doctor to help get as much optimized as possible. . But please also don’t give up hope. ... . Getting a drink at @bearcoastcoffee and saw this gem on their board outside, which made me immediately think of all my strong fertility patients . #fertilityjourney #fertilityawareness #infertilitywarrior #infertilityjourney #infertilitysupport #rainbowbaby #recurrentmiscarriage #mondaymotivation

Posted @withregram @shetalkshealth Do you feel like you are in the dark about your irregular menstrual cycle? In this episode of the She Talks Health Podcast, I brought on a Fellowship trained, board-certified OB/GYN, Reproductive Endocrinology and Fertility Expert, @laurenrubalmd Dr. Lauren Rubal to give you the 411 on your period, ovulation, and the most common reasons you could have an irregular or absent period. We talked about:... Why she made the switch from a traditionally trained IVF & IUI doc to an integrative practicer that supports women and couples with fertility and cycle issues holistically What a "normal" cycle looks like How you can use tools at home to detect ovulation and chart your cycle Why ovulation is actually the MAIN event each month The top 4 causes behind irregular cycles How you can partner with your doc for better period health What questions do you have for me and @laurenrubalmd about irregular cycles and ovulation? See more

Do you know a possible silent culprit in recurrent miscarriage and implantation failure / infertility? Chronic endometritis! (I figured this photo was the most beautiful representation of a bacterial #biofilm) . - It’s a chronic inflammation of the inner lining of the womb (the endometrium). This may be associated with ... inflammatory factors abnormal microorganisms changes in the #microbiome ... which is never good for fertility. . - Studies show the baseline rate of this in women is ~10% but in certain groups it may be increased: 15% of infertile women undergoing IVF 27 to up to 58% of women with #recurrentmiscarriage up to 42% of women with recurrent implantation failure . - it’s frustrating to figure out the diagnosis because: many have no symptoms or, their symptoms are vague: pelvic pain, abnormal bleeding, or abnormal vaginal discharge there are varying ways of diagnosing it, which impacts reporting within the literature . - but there is some evidence that treatment may improve pregnancy outcomes! . - it’s certainly something to discuss with your doctor to see if you are a candidate for evaluation. . - Throwing it back to a beautiful day at @chihulygg @chihulystudio in Seattle. . . - #holisticfertility #ttc #infertility #infertilitysupport #recurrentmiscarriage #recurrentpregnancyloss #fertilityjourney #chronicendometritis #uterinehealth #integrativehealth #fertilitytreatment #fertilitytips

Fun fact: did you know caterpillars are related to my line of work? (Not so fun fact: a pet is a pet, no matter its size. And its demise will cause much sadness, tears, and eulogy drawings, no matter the owner’s age) . - The caterpillar behaves like a free-living, eating, growing but developmentally repressed embryo. - Discover Wildlife’s website. ... . - isn’t that amazing?! There is initially a constant secretion of juvenile hormone that prevents it from undergoing metamorphosis. Eventually, it reaches a critical size and another hormone causes it to form the chrysalis. It then emerges as a butterfly. . - hormone feedback loops - not just for REIs! . . . . . Thank you @ptsquish for all the habitats, bugs, and advice! (Plus understanding the appropriate insect Pokémon counterparts) #themoreyouknow #metamorphosis #insectsofinstagram #reproductiveendocrinology #bugsfordays #rip

#dearintern : welcome to #medicalresidency ! . - It’s a defining time in your time. You will be tested and forged in fire. And you will experience firsthand what an honor it is to walk alongside people as they navigate some of their most troubling / scary / exhilarating life events. .... - My advice as an attending who oversaw lots of residents: 1 attitude is everything. 2 be proactive and a self starter. Even when assisting in the OR or in the office, be anticipating what is needed next. 3 be kind to patients and staff. They will honestly be some of your greatest teachers. 4 try to read as much as you can. I was always so impressed when a resident was prepared and knew the literature. . - My advice as a prior resident who lived through it: 1 be kind to yourself, too. 2 it’s normal to feel scared. I still remember getting called to my first code and comparing it to the classic scene in scrubs where they divert to a broom closet to wait it out 3 there’s more to medicine than the clinical part. You may be called to an alternative career- be it the business side, medical writing, legal expert witness. There are lots of routes to take post-residency. 4 Ask questions. I used to worry so much about being labeled if I questioned anything. Don’t. This is your time to ask others- it’s such a gift to have people around you to bounce ideas off of. And you may be picking up on something that was not seen! 5 be open to alternative explanations. #academicmedicine is an interesting and amazing space and (I’m biased) but I had the best mentors. With that being said, there are other viewpoints in medicine and validity in the worlds of #privatepractice, #complementaryalternativemedicine , #integrativemedicine and #functionalmedicine. . - And be friends with the nurses. They’ll be your best guides and also always have the best midnight potlucks . - Good luck and enjoy it!! Photos of my residency in the mid-aughts ... . - . . . . . . #tipsfornewdocs #medicalstudents #newdoctor #obgynresident #medicalstudent #newintern #mamasinmedicine #docsofinsta #holisticfertility #medschool #medschoollife #lacusc #keckmedicineofusc #keckschoolofmedicine @ LAC+USC Medical Center

I’m a huge fan of empowering women to understand their bodies - and a great way to do so is through #fertilityawarenessbasedmethods. . - Our #cervicalmucus , #bbt , and #urinaryhormones help predict the 6 days a month that a woman is fertile. .... - But what if you don’t have regular cycles?? . - I’m talking about what #abnormalcycles may mean and what we can do about them tonight! . - Sign up at https://tinyurl.com/ycutczvs ! . - #takingchargeofyourfertility #holisticfertility #irregularperiods #ttc #ttcsupport #ttcwithpcos #ttcjourney #fertilityawareness #fertilitysupport #fertilityspecialist #symptothermalmethod See more

Miscarriages can be devastating. And along with the mourning process, they raise many questions about when and how to best conceive again. . - I’m honored to be discussing this tonight at this free webinar with @mirafertility. .... - Check it out! . - #miscarriagesupport #ttc #rainbowbaby #fertility #fertilityjourney #fertilitysupport #fertilityawareness #earlypregnancyloss #fabm #reproductivehealth #reproductiveendocrinology #infertilitywarrior #infertility #infertilityawareness #infertilitysupport #infertilityjourney #infertilitycommunity #holisticfertility #dontlosehope See more

Do you ever feel like this is your brain & spirit when dealing with #infertility and #recurrentmiscarriage ? . - #mentalhealth , #emotionalhealth , and #spiritualhealth are all so important to address when undergoing fertility issues. .... - it may feel like you don’t have any extra headspace available when you’re already doing ovulation sticks and charts and timed intercourse, but this component is just as essential. . - did you know that infertility is associated with an increase in anxiety and depression? . - some studies show that different forms of cognitive behavioral therapy (even a mindfulness app) help with those feelings and may even impact pregnancy rates (though this is not consistently shown with every study). . - chronic stress can definitely change your reproductive hormones, which can lead to abnormal periods / ovulation / post-ovulatory phase... and this absolutely impacts pregnancy and miscarriage risks. It can also directly affect the hormones that are important in our brain to modulate these mood issues, thereby creating a vicious cycle! . - please seek help and support. There are group sessions (locally, @infertilityunfiltered is amazing), trauma informed mental support (looking at you, @uniquely_knitted ) , and professional therapists. For spiritual health, www.springsinthedesert.org is wonderful and there are usually good resources via your church/place of religion. (Not an ad, just a fan of all whom I mentioned). . - Regardless of how you go about it, please take that first step to address all the other parts of our health that get affected, too! . - let’s use this time to emerge as diamonds . - . . #ttc #ttccommunitysupport #ttcsupport #infertility #infertilitywarrior #infertilitysupport #recurrentpregnancyloss #holisticfertility #restorativereproductivehealth #mentalhealthawareness #spiritualwellness #catholicmindfulness #depressionawareness #anxiety #rainbowbaby PMID: 29946210, 26742022, 26072382, 25316451, 30328241

Diet is important for optimal #reproductivehealth ! And there are specific #foodgroups that have been shown to help. . - an optimal fertility diet consists of: 1 plant proteins from vegetables... 2 monounsaturated fats and omega-3 fatty acids (like that in fish) 3 decreased/absent processed foods and sugars (hello, soda and fast food) 4 decreased red meat intake 5 soy is fine! . - large prospective studies show preconception adherence to this diet (compared to those women with lowest intake of good fertility foods) significantly decreased chance of infertility . - this same Nurses’ Health Study II group’s data was used to calculate the chance that not following this fertility diet could be an attributable factor in 46% infertility cases . - folic acid is an important fertility supplement to also take: 1 it decreases risk of neural tube defects (open spine issues) in the baby, which is rare but always good to prevent! 2 higher levels are associated with decreased infertility, decreased miscarriage risks, and improved fertility treatment outcomes 3 fascinating studies associate low folate levels to an increased risk for depression 4 I recommend a methylfolate (for best absorption) 1000 mcg daily, best taken on an empty stomach if possible . - these recommendations are not just for women; sperm quality may be influenced by diet, too! . - I always say that every little bit counts, so modifying even 1 meal a week or making one change at a time is still wonderful! . - check with your doctor to see what lifestyle modifications are best tailored to your circumstances! . - #holisticfertility #ttc #fertilitydiet #fertilitysupport #fertilitydoctor #plantbased #infertility #pcos #infertilityjourney #integrativenutrition #integrativehealth #nutrition #folicacid #omega3 . . . . . . PMID: 17978119, 30109221, 28844822, 31513269, 12601225