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TRANSCRIPT

[00:00:00] Today's episode is dedicated to those who've experienced late term pregnancy loss after 14 weeks. It's incredibly painful and often overlooked chapter in pregnancy journey. And if this has happened to you, please know you are not alone. There are meaningful steps you can take to understand what happened and support your body.

Moving forward, we're going to the functional nutrition, functional medicine perspective, and how to uncover potential causes and highlight important tests that are often missed. We're going to talk a little bit about the conventional side of things too, and share practical lifestyle and healing strategies designed to help regain balance and increase the chances of a healthy pregnancy.

Let's go.

Welcome back. I'm Sarah Clark, founder of Fab Fertile. For over a decade, my team and I have helped hundreds of couples improve their chances of pregnancy success, whether naturally or through IVF. We specialize in supporting those with low going to, high FSH, diminished ovarian reserve, premature ovarian insufficiency, and recurrent [00:01:00] pregnancy loss

through functional testing and personalized fertility strategies. Today we're diving into late term pregnancy loss and the functional strategies to improve pregnancy success. This episode is for you is if you've experienced a loss after 14 weeks and are seeking deeper understanding and support.

You want to explore the both conventional and functional approaches to uncover underlying causes, and you're looking for practical lifestyle testing and healing strategies to improve future pregnancy outcomes. Thanks so much for listening.

I'm so thankful that you're here. Make sure you hit subscribe or follow, and if you know someone else who's on the fertility journey, please share this podcast with them.

Okay, so let's get into the episode. Today we're talking all about late term pregnancy loss. I'm going to be going through a lot of stats and giving some studies to you. If you've experienced this, my heart goes out to you. Definitely check out the episode we did on early term pregnancy loss and there's a lot of emotional

devastation going through this and trauma. So it's really important to, to work with someone on that. So [00:02:00] today we're talking about some of that, but really a lot more about the functional side of things, of how we can be our own detective, really be our own advocate and take our health into our own hands.

So first we'll talk about the thrombophilia panel. I've done a deep dive into the Thrombophilia panel, so definitely check out that episode. So clotting disorders, we like it after one pregnancy loss. Sometimes they're going to wait for you to have multiple losses to be able to dig into this.

And this could be a reason why there's pregnancy loss and then there's things we can do to help. So you want to rule this out and so this can, impair your placental blood flow and increase the risk of second trimester lost. So that factor V leiden the prothrombin gene, the anti

thrombin III deficiency. The protein C and protein acids is what's in the thrombophilia panel, the lupus anticoagulant,

And the Beta-2 glycoprotein antibodies. And so there are studies found that 15 to 20% of women with recurrent pregnancy loss may have a [00:03:00] thrombophilic conditions. And they noted a higher prevalence of antiphospholipid antibodies in late term pregnancy loss.

This is essential if there was placental insufficiency, growth restriction, or multiple losses. So really look at that and then you can check out that episode I did for a deeper dive. Inflammation and immune markers. Autoimmunity, we see a lot of people with autoimmune disease. Celiac and Hashimotos are the ones that we predominantly see.

But autoimmunity and chronic inflammation can impair implantation, trigger clotting cascades, and damage the placenta. We run blood work as very extensive panels. As part of our team, we have a OB GYN with functional medicine background. He's our medical case reviewer. Functional nutrition practitioners that review our testing.

We have fertility mindset coaches that help reset your nervous system. So looking at high sensitivity, c-reactive protein looking at an ANA panel, I did a whole deep dive into that. So you don't necessarily need to have autoimmune disease. [00:04:00] It maybe you have a positive ANA. Looking at natural killer cells.

So looking at ESR, that can measure how quickly the red blood cells settle in a test tube. Over one hour at a faster rate is going to suggest more inflammation in the body. A cytokine panel, it's a blood test that measures level of immune signaling proteins to assess inflammation and immune system activity, which can impact pregnancy outcomes like miscarriage . Natural killer cells.

So that can be an indication that there could be some immune activity going on. I'm going to link some of these studies in the show notes, but demonstrated the role of elevated NK cell activity and inflammatory cytokines and recurrent pregnancy loss. So everything we do from a functional medicine, functional nutrition standpoint is going to be able to help to address these different inflammatory markers.

And then also the explored autoimmunity. With late fetal demise. So sometimes there's an autoimmune factor going on here that's been missed. And so many times in conventional medicine they're not talking about [00:05:00] the vaginal microbiome or infections, but infections microbiome imbalance can lead to premature rupture of membranes or interuterine inflammation.

So it's really important to screen for the bacterial vaginosis, the ureaplasma, the mycoplasma group strep b do that TORCH panel. So I did a whole deep dive. Check out the early miscarriage talking about the TORCH panel. And so basically making sure you're

the I is and crossed the T's and looked at those toxoplasmosis rubella, CMV, herpes. If there's infections, that could be why we're having loss. Some studies here that vaginal dysbiosis is linked to preterm birth and pregnancy complications also showed that some infections are often subclinical and then can present in late loss.

Like we talked about at the beginning the stress piece of this obviously going through pregnancy loss, but maybe you had stress like a lot of us do beforehand. [00:06:00] So your cortisol and your stress hormones. So chronic stress can impact our hormone production, your immune balance, your uterine receptivity.

We use the DUTCH test. I do caution, just doing one DUTCH test and feel like you've done everything. We need to dig deeper that could look at our adrenals, look to see which pathways the hormones are going down using urine over the course of 24 hours. Sometimes our cortisol is just flatlined.

It should go up in the morning. We can just see it all over the place. Sometimes just seeing it in black and white can be helpful. Studies here found higher levels of cortisol correlated with an increased risk of early pregnancy loss.

Also, dysregulation of the HPA axis can compromise placental development and immune tolerance. So really resetting your nervous system and getting the cortisol piece addressed beforehand. Work on a food sensitivity, kick out the parasites, but if we haven't regulated the nervous system because obviously the trauma of going through pregnancy loss, or maybe it was like years and years of chronic stress you've been dealing with, maybe trying to conceive for years and years.

All this pressure you're [00:07:00] putting on yourself, feeling impatient, feeling frustrated. The doctors are telling you've gotta rush . This pressure, right? And so it's being able to give yourself grace and to know that your body wants to procreate that the majority of us can get pregnant

naturally. There's things we can do in a very targeted manner. So having a team around you, but ultimately really listening to your body. You know your body best and if something is out of balance. We all have intuition and being able to employ people around us but listening to our body because she has given us signals every day.

And then looking at a full blood chemistry panel. So assessing your nutrient status, thyroid function looking at your homocysteine. I've done podcast on that. Looking at your ferritin. So we want to have that between 80 to 100 going into an IVF cycle, looking at your iron and your TIBC's, your total iron binding capacity, it was a blood test that measures the blood's capacity to bind and transport iron. And so in the context of miscarriage so abnormal iron levels reflected partially by the [00:08:00] TIBC. That can be an indicator of pregnancy health and increased risk of complications, including miscarriage.

We need to look at this beforehand. Vitamin D I've done many podcast episodes on vitamin D, making sure that is in the optimal range, 60 to 80. We see a lot of people being told it's normal and it's at a 30, or maybe it's not normal and it's low and you're supplementing, but why is it low?

Is it because you have a gut infection? So we need to dig deeper on that part. The majority of us have only had a few people over the years of doing this that have had higher magnesium and that can be from sometimes people are in their water, they're putting too many minerals in there.

It could skew it the other way, but most of us because of our soil, are deficient magnesium. Then we can have deficiencies in zinc and copper. You need to be careful about supplementing zinc and copper by yourself because each one needs to be balanced. So you could throw it out of whack.

We see that methylation issue and that's where we do our genetic testing so we can really personalize this with more B vitamins and methylfolate. Making sure you have that, the building blocks for hormones. Looking at your blood sugar. So your [00:09:00] glucose, your insulin, your A1C, the measure of your blood sugar over three months.

Done podcast episodes on that. We have got to make sure you're not on this blood sugar rollercoaster using a continuous glucose monitor and digging deeper. The full thyroid panel. I have done so many episodes on the thyroid. This is something I deal with myself. So having hypothyroidism, so really being able to look at the full thyroid panel, including antibodies, and we don't want the TPO above 10 or the TBG above 30. And if it's trending in the a hundred, 200, 300, 400, and they're pushing you for an IVF. It could work, but then you could have a loss.

So we've got to get the thyroid in the best possible shape beforehand, and there's definitely things we can do from a functional nutrition functional medicine standpoint to improve that. Low vitamin D is associated with miscarriage. Thyroid dysfunction, especially the anti TPO antibodies are linked to second trimester loss, even with normal TSH.

Don't just say, Hey, I've been told my thyroid's normal. They looked at my TSH. No, we've got to look at the full panel, including antibodies. We see thyroid dysfunction [00:10:00] across the board with low AMH, high sation, DOR and POI and recurrent pregnancy loss. Elevated homocysteine. So inflammation in your body associated with miscarriage in MTHFR

So a lot of times people haven't been tested for that, but you could have the MTHFR gene variant. You need support with your methylfolate. Maybe you have underlying genetic or methylation issues. So like the methylation we just talked about. So this can impact your clotting, your detoxification, your hormone metabolism.

That's where we run the genetic testing and it can improve pregnancy outcomes, prevent gestational diabetes, prevent preeclampsia. Looking at the MTHFR, looking at the COMT, the MAO, the other SNP's. It's extremely comprehensive genetic panel. I've done a whole deep dive with one of the practitioners with the test that we use. There's 10 different pathways, and then there's some simple diet and lifestyle strategies.

This is all about personalization. So we know if you've got some of these SNP's, what can we do? It's not just oh wait, my whole family has this, [00:11:00] I'm doomed for a specific disease. No from epigenetics, there's diet and lifestyle specific strategies you can do to prevent that.

And this could be a factor as to why you're dealing with the late term pregnancy loss. So MTHFR mutations can raise homocysteine, increasing clotting and miscarriage risk. That could be it. That could be the reason for you. No one's dug deeper and they keep telling you to keep going.

And this is really important. During our protocol they're following a protocol, they're making these changes, and we don't want them to try to conceive during that time, especially if you've had pregnancy loss because the body can fire itself back up and then we go and have another loss that sets you back even further.

Obviously you're an adult, you can do exactly what you want, but we want you to tell us how you're feeling and we can adjust the protocol each month. But it's really important to give the body some time to repair so it can sustain. We have many people that we're like, let's pause, then we'll give you the green light so you can start [00:12:00] going again, and this time you can see success because keep going and going.

And they say, just go for another IVF when you've had all these losses, is even had one loss without looking deeper. Is to me the definition of insanity. But we never want to blame ourselves. I have not personally gone through miscarriage, but many of our team members have. And so the emotional heartache with this, we cannot downplay if someone hasn't been through it, they do not understand.

We can't walk in your shoes. We can walk alongside you. Giving voice to this, being able to honor the pregnancy loss. So we've got to be very mindful of this piece. And especially your partner. There's many support for women. Men don't have a lot of places to go for this.

They're not going to be talking to their buddies about the, the baby they've lost. And so it can be very isolating. It can be very hard on a couple. And so having someone to really walk alongside of you with this and get it off your chest so then you can start to heal, to move through it, to move through the pain.

Is it an [00:13:00] MTHFR gene variant and then the karyotyping to reveal those balanced translocations that can contribute to late loss. So that's what you do at the fertility clinic. The karyotyping, but that's only 10%. So a lot of times that's missed. They're like, oh, I've done the karyotyping.

You forgot all the other epigenetic side of things, and doing a deep dive into that. Looking at your stool tests, I don't think your REI is going to say, Hey, let's look at your stool tests, see if there's infections . With functional medicine, functional nutrition, this is the first place that we look at.

And the gut microbiome plays a key role in inflammation, immune tolerance, nutrient absorption. We can look at your zonulin levels. Maybe you got a leaky gut. So all those antibiotics and stress and hormone birth control that you were taking for years, that's then impacted your gut health. And now you've got intestinal permeability.

And you do a food sensitivity test, you're intolerant everything on the test. Because you have leaky gut, but we need to repair, address the infections, and then we repair. Looking at those pathogens and the H pylori. So I've done many episodes on that too, with the H pylori [00:14:00] being a factor that we see.

You're passing it back and forth via saliva, and then you're not absorbing the nutrients . It's not that you have high stomach acid. You have low stomach acid. People are taking all these anti-acid blockers and you've got GERD and acid reflux. No, your acid's too low. Or maybe you catch every cold and flu and so your secretory IGA is low and your immune system is compromised.

And then your beta glucuronidase. So your estrogen is recycling and that can be a reason. The beta glucuronidase is an enzyme involved in phase two of liver detox and elevated levels in the gut. Often seen in our stool test that we do can signal that gut dysbiosis and that estrogen reabsorption and the context of pregnancy loss that contribute to estrogen dominance, inflammation impaired detox.

So can disrupt your hormone balance increasing pregnancy loss. Particularly in early pregnancy as well. And so supporting gut health and liver detox pathways is key to lowering the beta glucuronidase and [00:15:00] improving your hormone regulation. So there's things we can do.

So dysbiosis may alter estrogen metabolism, immune balance during pregnancy. Zonulin, like we talked about, that the leaky gut piece elevation indicates leaky gut, which is tied to autoimmune response. So studies indicating there for pregnancy loss. And then really if you've experienced a late term pregnancy loss investigate the clotting and the immune function.

Look at your hormone balance and your stress piece. We've got to get support on the stress side of things. Speaking to someone about this and working through the loss you've been through, and then even the other stress in life that you're dealing with.

If you're working too many hours you're putting all of your effort into this and everything just feels tight and stress and worry and impatience. The body could just not feel it safe. So we need to address that piece. Give yourself grace. Going through this.

If you haven't been through it, people just don't understand. We need to be able to honor our loss and really have your partner as part of this too. As part of our fab fertile method, we have [00:16:00] couples coaching. And being able to have both of you work through this together is key.

So optimizing your nutrient status, your detox pathways looking at your gut balance. So this episode is focusing on late term loss, so this episode focused on late term pregnancy loss.

I did an episode on early term pregnancy loss, so definitely check that out. If you've experienced a first term trimester loss, many of the testing we explore today can also apply but the patterns and the priorities can shift depending on where you are. Hopefully this episode was helpful for you to really be your own advocate and you can dig into your health and get that team around you to help.

So you wanted to have our eyes on your specific situation. Send me a message at hello@fabfertile.ca. Subject line FERTILE and we can give options to improve pregnancy success. Take care.

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How to Get Started With Functional Fertility Support

Book your call here to get your personalized plan and options to help improve pregnancy success either naturally or with IVF treatment. 

Check out our Fab Fertile functional fertility program here and learn how to improve AMH levels naturally.  We work with couples that have low AMH, high FSH, diminished ovarian reserve, premature ovarian insufficiency and recurrent pregnancy loss.

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Frequently Asked Questions

What causes late term pregnancy loss?

Late term pregnancy loss (after 14 weeks) can be caused by clotting disorders, immune system issues, chromosomal abnormalities, infections or hormone imbalances. Functional testing can uncover hidden contributors like inflammation or autoimmunity.
Read: Miscarriage Before 12 Weeks – What Most Doctors Miss

What tests should I do after a second-trimester loss?

A full approach includes the thrombophilia panel (Factor V Leiden, Prothrombin), antiphospholipid antibodies, autoimmune panels (ANA, NK cells), vaginal microbiome testing (ureaplasma, BV), stool testing and a full blood chemistry panel.Read: The Clotting Connection: Hidden Causes of Implantation Failure and Miscarriage

How does low AMH affect pregnancy?

Low AMH means diminished ovarian reserve but doesn’t mean pregnancy is impossible. It often means you need to address inflammation, oxidative stress, nutrient deficiencies, and hormone balance to improve egg quality.
Listen: Low AMH? Why ‘Normal’ Vitamin D Levels May Still Be Hurting Your Egg Quality

What is the role of the vaginal microbiome in pregnancy loss?

An imbalanced vaginal microbiome - low Lactobacillus, high ureaplasma, or BV – can increase the risk of second-trimester loss and preterm birth. Testing and a customized protocol can reduce these risks.

Explore: Before Your IVF Transfer, Test This First

Summary: Main Points

If you’ve had a late pregnancy loss and been told “everything looks normal,” there is more to explore. A functional fertility approach will give you insight into immune health, inflammation, vaginal/seminal and gut microbiomes, hormone function, and nutrient status. Whether you’re trying naturally or preparing for IVF, these tests can be the missing link to your next successful pregnancy.

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RESOURCES

📩 Get your free 10-day elimination diet plan! Email hello@fabfertile.ca with the subject line 10 DAY to receive your guide and take the first step toward reconnecting with your fertility.

Causes of Miscarriage Before 12 Weeks: What Most Doctors Miss

The Clotting Connection: Hidden Causes of Implantation Failure and Miscarriage

Autoimmune Roadblocks to IVF: How ANA Affects Fertility

How To Prevent and Reverse Autoimmune Disease and Get Pregnant

Before Your IVF Transfer, Test This First

Low AMH? Why 'Normal' Vitamin D Levels May Still Be Hurting Your Egg Quality

Why Addressing Homocysteine Levels Can Boost Egg and Sperm Health

How MTHFR and methylation affect fertility with high FSH and low AMH

How Iron Deficiency Impacts Fertility, Egg Quality & Low AMH

1. Factor V Leiden & Prothrombin Mutation in Late Fetal Loss

Martinelli I et al. (2000, New England Journal of Medicine) This study found that women who carry Factor V Leiden or the prothrombin G20210A mutation have a 3.2× greater risk of late fetal loss, likely due to impaired placental blood flow. https://www.nejm.org/doi/full/10.1056/NEJM200010053431405

2. Antiphospholipid Antibodies & Late Fetal Demise

Branch DW et al. (1992, Obstetrics & Gynecology) This foundational paper established the connection between antiphospholipid antibodies—such as lupus anticoagulant and anticardiolipin—and late pregnancy loss. https://pubmed.ncbi.nlm.nih.gov/8602296/

3. Elevated NK Cell & Cytokine Activity in Recurrent Miscarriage 

Kwak-Kim JYH et al. (2003, American Journal of Reproductive Immunology) Researchers found that women with recurrent pregnancy loss often show elevated natural killer (NK) cell activity and inflammatory cytokines like IL-6 and TNF-alpha, suggesting immune dysregulation as a key contributor. 

https://pubmed.ncbi.nlm.nih.gov/32992208/#:~:text=Different%20authors%20have%20described%20an,Reproductive%20immunology;%20Uterine%20NK%20cells.

4. Vaginal Dysbiosis & Risk of Preterm Birth

Aagaard K et al. (2014, Science Translational Medicine) This study highlighted how reduced Lactobacillus dominance in the vaginal microbiome increases risk of preterm birth and pregnancy complications, including second-trimester loss. https://pmc.ncbi.nlm.nih.gov/articles/PMC5782380/

5. MTHFR Mutation & Homocysteine in Recurrent Miscarriage

Nelen WL et al. (2000, Fertility and Sterility) This meta-analysis showed that MTHFR mutations can lead to elevated homocysteine levels, which are associated with increased risk of recurrent early and late miscarriage due to vascular and clotting issues. https://www.sciencedirect.com/science/article/pii/S0015028206030706#:~:text=An%20elevated%20plasma%20homocysteine%20concentration,using%20a%20comprehensive%20literature%20search.

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