Functional med. dr. for pregnancy help w/Hashimoto's & older age

Hi Mama, Our family is seeing Dr Chris Holder with Wild Oak Medicine in Santa Rosa. But mostly it can be Zoom. I find his personality lovely to engage with, direct, and helpful. He seems expert level and we feel well held. Best of luck!

Hi! I have Hashimotos and worked with Dr Korza at Berkeley Naturopathic Medical Group prior to getting pregnant. She really helped me identify appropriate labs to request from Kaiser (that dug deeper into more than just TSH) and provided supplements to help me on my fertility journey. I found her to be wonderful in her holistic support. It isn't cheap, but was well worth it for me. 

Hi, I hear you as I’m also a Hashimoto patient suffering with infertility and approaching 40. I have a wonderful endocrinologist, Dr Nathan Becker, and highly recommend him. He is not a fertility specialist per se, but deeply understands the way fertility and hypothyroidism interact. He doesn’t take insurance and is pretty expensive, but he’s incredibly thorough and is usually able to nail things pretty quickly. He operates out of UCSF Parnassus in the city. Good luck, I know what you’re going through. 

I'm so sorry to hear that you're going through this, it sounds really hard. Miscarriages can be so devastating. 

I don't have much insight into Hashimoto's and pregnancy, but just wanted to pop in and say that I worked with Carly Wertheim, who is a holistic health practitioner and runs a practice focused on prenatal nutrition. I think she's incredible – she's so wonderful to work with, and provided me tons of detailed and evidence-based tips on how to address issues I was experiencing. She's based in Marin, but I believe she does Zoom sessions mostly! 

This is her business: https://www.monarchandmilkweed.com/about

I recommend Dr. Stephanie Daniel https://functionalmedicinesf.com/  She has an office in Berkeley.  She helped me get pregnant and stay pregnant.

Her price went up when I needed to see her again, but I discovered the amazing Dr. Marcey Shapiro.  http://marceyshapiromd.com/ She's moved from Albany to New Mexico but is doing Zoom appointments.  She ran labs for me that others had not ordered before and discovered I have adrenal PCOS, which I'd likely been suffering with my entire life.  Knowing how to address it has been life-changing, to say the least.

I'm not sure if she practices anymore or just writes books, but Dr. Sara Gottfried used to practice in Oakland.  https://www.saragottfriedmd.com/  

I'm no expert but it sounds like you are low in progesterone, which happens as we age but is also the hormone responsible for holding a pregnancy.  

I really feel for you! I am a mom who personally had 4 miscarriages, and I am a family physician who regularly counsels women about fertility concerns.

There is a functional medicine physician I used to work with that I respect tremendously: Dawn Jacobson, MD (virtual visits through Parsley Health) https://www.ifm.org/practitioners/dawn-jacobson-md/

It is great news that you were able to get pregnant 2x so quickly. That is very lucky and much better than many women over age 35. Last I looked, only about 87% of women got pregnant even 1x in a year.

Unfortunately, miscarriage is incredibly common, and 3 miscarriages per woman is actually expected! There is a “recurrent miscarriage” workup that includes looking at antibodies and other factors that cause clotting problems. However, that workup starts after the third miscarriage, based on what is expected vs unexpected. 

Research studies show that as many as 25% of all pregnancies spontaneously abort (miscarry), even though many of those pregnancies were not even really known - thought to be a late or heavy period, etc. Even more frustrating is that miscarriage rates are expected to increase even more after age 35, continuing to increase gradually every year. Most miscarriages happen due to genetic abnormalities, and this is considered a natural part of the aging process for eggs.

This means that miscarriages are actually expected a lot after age 35. If you were pregnant 3x in 1 year, it would not be surprising if 2 of the 3 pregnancies ended in miscarriage.

Sometimes we “speed up” the recurrent miscarriage workup - and fertlity interventions - with a person over age 35 and definitely over age 38. However, there are very few interventions that affect rates of miscarriage. Certainly things like smoking cessation and using anticoagulants for women with clotting issues can help a lot; but that is not the majority of women. 

Not that knowing what to expect makes this makes it any easier emotionally! Miscarriages are frustrating and painful. Having a constructive conversation about what interventions may help vs those that are known to help for certain patients is key. Hope is important, and so is being practical and setting realistic expectations. Understanding the rates of successful pregnancies at a given age can help couple decide on how patient they are willing to be vs how much intervention they are willing to accept - and to set the time frames for re-evaluating their approach. Time passing is important.

Your gyn provider may already have mentioned this, but support groups and individual counseling with someone experienced in miscarriages and fertility concerns can be extremely helpful for individuals and for couples.

Hang in there!

I'm so sorry to hear about your struggles with your health and fertility. You only mention your Kaiser OB. If your OB hasn't referred you to the Kaiser fertility department at this point, they are not doing their job and you need a new OB and a referral quick. They should have referred you after 6 months of trying and definitely after 2 miscarriages.

That being said, Kaiser fertility was super backed up when I tried working with them 6 months ago. I was diagnosed with Hashimoto's also after doing the bloodwork for Kaiser fertility. Since I couldn't get a fertility appointment for months and really wanted to get pregnant quickly, I started working weekly with Sean Brown of http://ebacupuncture.com and then also worked with https://springfertility.com. Both were recommended on BPN. I'm 39 and am 17 weeks pregnant now. I'm happy to discuss more details via private message.

I have Hashimoto's.  I tried to get pregnant at 39-40, no luck.  The fertility doc at Kaiser said that many women with Hashimoto's also have an ovarian autoimmunity, and that nobody with my hormonal profile would ever get pregnant with her own eggs.  This was many years ago, and I don't know whether a doctor would come to the same conclusion now especially regarding ovarian autoimmunity.  Skimming through the abstracts of medical articles on thyroid function and infertility, I get the sense that the mechanism (or mechanisms) of the relationship isn't completely clear.  (I'm not a doctor, just a biologist.)  We started down the donor-egg IVF path, and the IVF doc said I needed fibroid surgery (not that they had ever bothered me). After that, I stopped developing a sufficient premenstrual uterine lining.  The treatment for that was more surgery.  By that time we were beginning to understand what "high-risk pregnancy" can mean when a friend of ours had a premature baby.  We had one of those 4 a.m. conversations where we decided we could not continue on the IVF path. That kid has since grown up to be a disabled adult.  I went into full perimenopause not long thereafter, so I would say that in my case, thyroid-related early ovarian failure was for real.

In the end we adopted.  I won't pretend that adoption is easy, but I can say we have a healthy smart delightful kid.