back to back missed miscarriages
35 y/o (turning 36 later this month), my husband is 1.5 years younger than me. I am a normal weight, eat healthily, and have an active lifestyle with an active career getting 10k steps per day at least and exercising 30-70 minutes on most of my off days. I have Hashimoto's and my antibody levels are controlled with 4.5 mg naltrexone q hs. My thyroid labs are also in good range with 30 mg NP Thyroid aned 5 mcg Cytomel daily. I am also homozygous for MTHFR mutation C677T. I was diagnosed with moderate to severe dry eye by an optometrist in Nov. 2024 and I found out in February that I am anti Ro SSA Ab positive so I probably have Sjogren's though no official diagnosis (awaiting rheumatology appointment). ANA negative. I also have very high EBV antibody levels without active infection. My EBV Nuclear Ag is beyond what Labcorp can read at >600 units/mL and my EBV VCA was most recently 176 units/mL down from 190.
I got married in November 2025 and I became pregnant on our honeymoon. I found out at 5 weeks at which point I had blood work at that point and my progesterone level was 8.6 ng/mL and my homocysteine level had nearly doubled from where it had been pre-pregnancy to 13.1 from 7.3 two months prior. I knew at the resulting of this blood work that I probably would not be having a pregnancy that carried to term, became fixated on missed miscarriage, and ended up having a missed miscarriage that would found at my first OB appt/US for confirmation of pregnancy at 10w2d. They said the embryo stopped growing at 8 weeks based on size. I did 3 doses of misoprostol over the course of 2 weeks and continued to have retained products of conception and required suction curettage on Jan 27. I got my period back a mere 13 days after the D&C. I had all symptoms associated with my typical periods. I purchased and utilized an Inito device to confirm my hormone levels and that things were proceeding as expected. I had an LH surge on Feb. 23 and had a positive pregnancy test 10 days later. Since I had low progesterone with my first pregnancy, my functional medicine provider prescribed me 200 mg vaginal progesterone ovules to be used nightly starting 3 days post ovulation. I didn't start them until 6 DPO. At 10 DPO, my progesterone level was 33.5 and HCG was 41 mIU/mL. I couldn't do repeat blood work in the recommended time frame since I left for vacation the next day but had the bloodwork when I returned 12 days later and my progesterone was then 35.5 and my HCG was 7648. It seemed indicative of a robust pregnancy and I was feeling positive. I requested that my first US for confirmation of pregnancy be at 8 weeks due to my loss of my first pregnancy at 8 weeks, and the US tech said my embryo was measuring 8 weeks with a heart rate of 110. Due to my history of loss, the provider wanted me to have a fetal HR check the next week. At that appointment yesterday (9w4d), the embryo was measuring 7w4d and no longer had a heartbeat. I am scheduled for a D&C on Monday since misoprostol was ineffective for me and I have no signs of miscarriage and continued pregnancy symptoms.
I am feeling confused, betrayed by my body, and wondering if anyone has any ideas or suggestions. I feel like I do everything right and everything to help myself as best as possible. My OB is referring me to a rheumatologist to address the untreated Sjogren's as they seem to think my autoimmune issues are what it causing the recurrent miscarriages. I had chorionic villus sampling sent for pathology with my first D&C but I was in the 0.1% who gets no results, nothing grew, I guess it was a bad sample. I saw the local high risk group after my first loss and they were basically like, "Why are you here? Keep taking the low dose naltrexone, there is absolutely no reason to stop it. We don't need to see you again." My friend is going to get in touch with a different doctor at the same high risk OB group to try to get me in with the doctor that helped her have a successful live birth of a healthy child after recurrent miscarriages. It seems that I need to be on Plaquenil and probably Lovenox. What else should I do or ask for? I am going to ask my functional medicine provider to order blood work for anti phospholipid antibodies. What else? I appreciate any and all insight. My husband and I want a family and I would love to be able to carry the pregnancy myself and I also don't want to be reckless with life. I am considering the possibility of trying one more time myself and if it is unsuccessful properly medicated and monitored, I will consider the possibility of hiring a gestational carrier.
I take a long list of supplements and have reproductive acupuncture weekly.
TL;DR: I have had back to back missed miscarriages that both stopped developing at about 8 weeks and were both found without a heartbeat at about 10 weeks. What can I do to help my chances of a healthy pregnancy? I have Hashimoto's that never led to out of reference range TSH despite nearly all hypothyroidism symptoms, homozygous MTHFR C677T, very high EBV antibodies without active infection, positive anti Ro SSA antibodies, and likely have Sjogren's without an official diagnosis.