IVF, MCs and an ERPC- it feels like I'm back to square one. Anyone else trying to work out next steps?

[RoseBud2016]

Our story so far:

TTC: 23 months.
Me: 32, severe PCOS, no ov.
DH: 38, low count and morphology.
Diagnosis: After numerous other fertility treatments failed, we were told IVF is our only chance of success.

1st IVF Feb 2016 at Reprofit Czech Republic. BFP- not viable at 4+4. MC at 5 weeks.

1st FET May 2016 at Reprofit Czech Republic. BFP- not viable at 8 weeks (only measuring 5+4). ERPC at 8+1 on 8th July 2016.

It's very early days after the ERPC but I'm a planner and having a plan is the only thing that keeps me sane.
We are at a crossroads and don't know what to do next- Do we plough on with FETs (we have 4 untested blasts left on ice) Do we start further investigations? Do we do another fresh cycle but this time with PGS? Who knows!!

Anyone else at a crossroads and fancy discussing options together?

[bananafish81]

Hi lovely Rose

Know we have spoken elsewhere but just wanted to chip on for extra MN support

Hope you're doing as OK as you can be: I say that within the context of the situation, as I know post ERPC I was physically OK but emotionally I was in bits. However like you, I found it helped me to deal with it by throwing myself into thinking about next steps

I wanted to leave no stone unturned after my miscarriage, and wanted to be as thorough as possible with further investigations before putting another embryo back

Stuff I did:

• thyroid function tested
• infection testing (ureaplasma and mycoplasma)
• hysteroscopy
• level 2 immunes

Immunes wise I had already had all the level 1 immunes before my cycle - I didn't actually need the level 2 immunes tests insofar as my Dr prescribes empirically for failed implantation or miscarriage, so the treatment would have been the same with or without testing

However for my own peace of mind I wanted to understand if there were any major immunes red flags - eg if I had significantly elevated NK cells, would that suggest a higher dose of prednisolone might be indicated

I had my level 2 immunes tests done with Locus Medicus, the Athens lab who Serum use - their tests are identical to the Chicago tests, except that they use intralipids instead of IVIG for the NK cells cytotoxicity test, but significantly cheaper. I paid €300 for a three in one panel - which was about £300 including blood draw and overnight shipping to Athens.

They also do the thrombophilia tests for level 1 immunes, although if you have a kindly GP, they may agree to do them (officially NHS won't do any investigations for miscarriage until you've had 3 consecutive losses, but some posters on FF have been able to get the tests done after 2 miscarriages)

An alternative to consider would be the uterine NK cells biopsy with Prof Quenby and Brosens at the Coventry recurrent miscarriage clinic - I believe it's something like £350 and you can self refer

As you know from other threads, we decided to have our frozen embryos PGS tested. The main reason for this was because the tissue testing of the products of conception after the ERPC showed the baby was chromosomally normal - the problem was with the soil not the seed. From a diagnostic POV, we could do everything possible to work on the uterine environment, but if we had BFNs or more miscarriages, we wouldn't know if we had addressed the problem with the soil or not

Moreover, as we had miscarried a normal embryo, we reckoned if we'd already transferred a decent one, the chances of the next transfer being a dud seemed higher.

Our clinic said they were increasingly doing PGS testing on frozen embryos - there is obviously an increased risk because the refreezing and rethawing process puts additional stress on the embryos. However they also said that in their experience, euploid embryos generally survived the thaw

Here to support you on the next step of your journey whichever route you take

[RoseBud2016]

Hello my lovely Banana!

Your reply is like a tick list of things I can focus on doing- love it!

So I sent off my blood sample today to Serum for the hidden infections tests. I went for the 7-1 life code tests plus the hidden C one. I'm freaking out a little though about my little package going off in the regular post with tracking! I hope I packaged it up well enough

Currently Reprofit are saying that they won't add immunes to my protocol empirically because "both embryos have implanted" This was from my coordinator rather than the consultant though so I'm waiting for him to reply before I throw my toys out of the pram!

Can I ask where you got your thrombophilia tests done and how much they were? I'm waiting for the GP to give you a definite answer about doing this for me but I've got a funny feeling the answer is going to be no!

They have also send they won't redo my thyroid bloods so soon after the last lot (April), which came back as 4.something. I do have a prescription for 25micrograms of levothyroxine though from back in April which I haven't taken...... Do I start taking it?!

Decisions decisions!

How's the oestrogen patches going? X

[bananafish81]

Hi rose

I do like a list!!

I did my level 1 immunes via Blue Horizon - paid online and got the blood drawn at one of their labs. They're not cheap, and Locus Medicus will do some - if not all - of these for cheaper. My GP won't do anything for me to do with fertility, but deffo worth trying

These are the panels I had done:

Thrombotic Risk Profile : http://bluehorizonmedicals.co.uk/PrivateBlooddTestforrThromboticRiskk_Profile

Auto antibody profile 1 :
http://bluehorizonmedicals.co.uk/PrivateBlooddTestforrAutoantibodyProfilee_I

Immunes are just as valid for miscarriage as they are for failed implantation - so deffo would get onto your Dr and see what they say about prescribing empirically!

Thyroid wise, my TSH was 2.7 and my consultant started me on 50mg thyroxine to get it down to

[bananafish81]

(The Iinks seem to have posted weirdly on the app - if they're broken then just Google the names of the profiles and the right links should come up!)