Assessment of Recurrent Pregnancy Loss
A 29-year-old G3P0 female patient presents to your outpatient family medicine clinic. She has suffered three pregnancy losses between the 8th-to-12th week of gestation over the past three years. She does not have any known diagnosed health disorders but has not visited primary care over the last ten years. She has a menstrual history in-keeping with oligomenorrhea ever since menarche at age 12: although some of her menses occur 28 days after her prior menses and are preceded by molimina, most of her menses occur after cycle day 40 without molimina. Her husband of five years is 56 years old. She denies dyspareunia, galactorrhea, abnormal hair growth/loss, deep vein thrombosis, contraceptive use, sexually transmitted diseases, significant abdominal trauma history, current urinary and gastrointestinal symptoms, allergies, consanguinity with her husband, surgical history, alcohol use, and smoking. Her description of her regular use of large quantities of cannabis is in-keeping with cannabis dependence. She also consumes 1L of brewed coffee daily. She takes a prenatal vitamin regularly. She does not use other pharmaceuticals. In an effort to assess the cause for her recurrent pregnancy loss (RPL) and oligomenorrhea, she has paid for a laboratory serum assessment in the United States during a recent trip there.