By: Taylor R. Atkinson
Editor’s Note: As we continue Pregnancy and Infant Loss Awareness Month, we are featuring a patient interview that highlights the importance of early diagnosis and referral for appropriate treatment. Taylor Atkinson, who participated in the FACTS elective, interviewed a patient about her fertility journey, which emphasized the benefits of observing various biomarkers and the utility of different fertility awareness-based methods (FABMs).
The video call starts, and I’m immediately greeted by Lauren,* an enthusiastic female patient who introduces herself as a 40-year-old engineer, wife, and mother. Currently 23 weeks pregnant, she informs me that her journey to this pregnancy has not been an easy one.
Lauren and her husband were married seven years ago, and she conceived her son shortly after their wedding without any difficulty. Fortunately, she had a healthy pregnancy at age 33. The only complication during labor and delivery was mild postpartum hemorrhaging that did not require transfusion of any blood products. However, in the postpartum period, she rapidly lost all the weight she had gained while pregnant and began to feel jittery. She soon discovered that her thyroid gland was overperforming, a fairly common condition among new mothers.
Shortly after the diagnosis, she began to feel groggy. Before her pregnancy, Lauren had tracked her cycles with the Sympto-Thermal Method (STM) of family planning through the Couple to Couple League, and turned a closer eye to the method biomarkers. She quickly noticed her basal body temperature (BBT) measurements were lower than usual, prompting her practitioner to recommend she have her thyroid hormone levels rechecked. Lab results determined her thyroid hormone levels were now low. Lauren was eventually diagnosed with Hashimoto’s thyroiditis. Presently, her hormone levels remain well controlled with levothyroxine, a pure T4 synthetic thyroid medication.
Several years after the birth of their son, the couple decided they were ready to expand their family and began trying to get pregnant again. They were still utilizing the Sympto-Thermal Method, and Lauren conceived within their first cycle. Sadly, this turned out to be a nonviable pregnancy. As Lauren miscarried, she lost an excessive amount of blood and was rushed to the hospital. She hemorrhaged once again and this time underwent transfusion of three units of blood. Fortunately, all the tissue passed on its own and no operative procedures were required.
Lauren’s miscarriage was understandably traumatic for both her and her family. They decided to seek a different approach to monitoring her health and fertility. She began seeing a new physician trained in NaPro, or Natural Procreative Technology. NaPro is based on the principle of restoring a woman’s natural fertility through medical and surgical interventions and utilizes the Creighton Model of tracking cycles based on cervical mucus biomarkers. At the recommendation of this new clinician, Lauren underwent numerous labs and procedures based on the findings of her cycle charting. She continued to conceive easily but still struggled to keep each pregnancy past the first few weeks. The couple experienced five early pregnancy losses, the last of which was ectopic and required treatment with methotrexate.
“NaPro Technology is based on the principle of restoring a woman’s natural fertility through medical and surgical interventions and utilizes the Creighton Model of tracking cycles based on cervical mucus biomarkers.”
The emotional and physical toll was unimaginable, and after the ectopic, the couple stopped trying to conceive. Lauren continued charting her cycles with the Creighton method, monitoring her BBT as a double-check, and timed intercourse to avoid pregnancy. Her doctor continued running tests, including recurrent miscarriage panels, with no conclusive answers. At this point, Lauren and her physician decided together to seek a second opinion; he was out of ideas.
Lauren next met with a local reproductive endocrinologist, but the couple’s goals did not align with those of the specialist. They found themselves back at square one. She was then referred to another NaPro-trained physician a little farther away geographically. Despite the distance, Lauren connected well with her new physician and the majority of their visits took place virtually. Following a series of more in-depth labs and tests, they were eventually able to decipher the problem.
Lauren was ultimately diagnosed with a 4G/4G PAI-1 (plasminogen activator inhibitor-1) gene polymorphism; her blood clotting process is defective and she is prone to excess clot formation. This condition was interfering with the fetus’ ability to implant safely into the uterus and causing her early pregnancy losses. Treatment with Lovenox, an anticoagulant, allowed the fetus to finally implant successfully, and Lauren is now approaching her third trimester.
Lauren’s story was the perfect way to wrap up my experience learning about fertility awareness-based methods (FABMs) through the FACTS elective. It is one thing to hear different lecturers and clinicians discuss patient cases but quite another to hear patients themselves tell the story firsthand. Lauren’s witness reminded me that she is not just another patient in the lineup; her entire life and family are on the line, and it was incredibly powerful to hear about the struggles and successes from her perspective. She definitely had her persistence and patience tested, but it was all worth it to her to build the family she and her husband had always envisioned.
“Lauren’s witness reminded me that she is not just another patient in the lineup; her entire life and family are on the line, and it was incredibly powerful to hear about the struggles and successes from her perspective.”
*Name has been changed to respect the privacy of the interviewee, and all information is shared with permission.
ABOUT THE AUTHOR
Taylor Atkinson, DO, MBA
Taylor Atkinson, DO, MBA, is a first year family medicine resident at the University of Minnesota-Woodwinds Hospital. She is a graduate of Kansas City University, where she participated in an online FABM elective course through Georgetown University. Taylor is excited to utilize these methods with her patients.
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