fbrad - if you got 10mm then that’s sounding promising! The lining needs to be measured before ovulation for a true measurement - after ovulation it starts to change under the influence of progesterone, but if you had 10mm then you won’t have had a thin lining pre ov. And the lining will have been starting to break down and compact so would ignore the 5mm one completely
Products of conceptions is such an awful term, I’m sorry. I have three histology reports which all say retained products of conception, it’s awful (and one wasn’t even a proper pregnancy - it was only a chemical! but still couldn’t get rid of the tiny amount of pregnancy tissue!)
If you can get an NHS hysto then terrific - I’m lucky that although BUPA don’t cover anything to do with fertility or pregnancy, they DO cover miscarriages (and general gynae, so we could say the investigations were to do with abnormal periods), so my private hystos were covered
Although as we’re over £30,000 down on fertility treatment and investigations (still no bloody baby!), it’s just as well we managed to save money somewhere along the line!!
Yes, you have to wait 2 full cycles before you can have the Coventry biopsy
I haven’t had it, as I’ve been doing treatment solidly since my first miscarriage in March - and since my second, I’ve had a copper IUD in. And even after it’s removed, I have to wait at least one cycle before I can have it done
As I don’t have natural cycles, and I don’t respond to HRT to be able to do an HRT cycle, the only way I can grow my lining to have the biopsy (and to have periods) is to do stimulated ovulation induction cycles. Which at £500 a month on drugs and scans (and we can’t TTC naturally as there’s too many eggs to risk it - not that we’ve tried naturally since Aug 2015, as we’ve been doing tx solidly since then). My gut says I’m low inflammation and Coventry would say no pred and intralipids for me - because I got further without immunes tx than I did with the meds, and because we have a good idea as to what HAS been the underlying cause of my losses of chromosomally normal embryos. So my gut says to strip things back for my next cycle with no immunes meds - I’m thinking about asking my consultant about Neupogen, but no prednisolone or intralipids this time, just clexane and aspirin.
BTW parental karotyping rarely throws up anything (not always, but it’s unusual) - so most people who do PGS aren’t doing so because of a parental chromosomal issue. Most embryo aneuploidy isn’t structural, it’s just random and comes from the egg or sperm’s genetic integrity
Also worth noting than Rai is misusing the terms very slightly. PGD (pre implantation genetic diagnosis) is genetic testing for a single inherited genetic disorder (like CF or Huntington’s) and doesn’t actually test whether the embryo has the right number of chromosomes to become a person - for that you need PGS (pre implantation genetic screening), which counts the chromosomes to check for embryo aneuploidy. It’s a subtle difference but important, I think
You may be able to get a PGD cycle on the NHS if you have an eligible genetic disorder, and need the genetic screening to avoid passing it on to a child. You absolutely can’t get PGS on the NHS, and can’t top up a cycle to add it on - it’s only private. And tbh very few clinics have a well established genetics programme to be able to do PGS
For me with PGS the cost broke down as follows for one round:
IVF (freeze-all for PGS) - £4500
Stims - £1500
PGS - £3000
Embryo freezing - £1000
FET for transfer of a PGS tested embryo - £1600
FET meds - depends on the meds - if you use intralipids & clexane that bumps it up: pred is cheap as chips though
So one cycle has cost me about £12,000 ish - but that’s a sample of 1, other clinics will charge differently. That’s London prices - OFU are doubtless cheaper. Europe cheaper still!
That doesn’t include any of the recurrent miscarriage tests - but I wasn’t eligible for any RM tests on the NHS because they’ll only do them after 3 recurrent losses.
It’s why I wouldn’t consider IVF unless you really had to. If you can conceive naturally, and your issue is staying pregnant rather than getting pregnant, I would explore options like Coventry first. BTW Prof Brosens and Quenby will tell you PGS is a load of crap, to add to the confusion of differing medical opinions!
pink when you say you had the NK cells blood test, which lab did it go to? There’s only a very few labs in the US who do the test - most labs can do the basic concentration of NK cells in the blood, but that’s not really useful as it’s the killing power of the NK cells that’s the important bit (if you believe peripheral blood gives any indication of what’s going on in the uterine environment, which Shehata does and Coventry don’t)
If you’ve had the NK cells assay then it should have information about the killing power (the cytotoxicity), and should have information like “50:1, 25:1, 12.5:1”, which shows what percentage of target cells your NKs killed off within two hours. If you didn’t have this, then you haven’t had the blood NK cells tests that Drs like Shehata consider meaningful for RM
I would personally go with Coventry - cheaper and arguably much more useful.
My plan is to wait for my period and then we are taking the IUD out, so we can do a mock FET cycle so that we can do the ERA (endometrial receptivity array) biopsy, which is a test for IVF frozen cycles. CD2 I will start injecting stims again to grow eggs (to grow my lining, because I don’t ovulate naturally). CD 2-5 the coil will come out. CD8-10 I will have my first cycle scan, may have 1 more before we decide when to trigger. We’re also doing another endometrial biopsy, but that’s just for histology, because of my crap lining. Bloods before I trigger to check for prematurely rising progesterone. Start progesterone at 1 dpo. Then at 5dpo we do another endometrial biopsy that gets sent off to Spain to see when my implantation window is. Then we wait for my period, and possibly then go again with a frozen cycle.
So maybe an embryo transfer some time in March? I don’t want to do pred again as I said, just Clexane and aspirin. But we have a likely reason for my losses, and it’s unlikely to be NK cell related.
Your latest loss pink would be considered a chemical pregnancy. That’s a positive test initially but doesn’t progress, and is lost before anything could be detected on ultrasound - ie usually around 5ish weeks.
Entirely a personal decision, but to you both -having done 4 rounds of IVF, I wouldn’t wish it on anyone. It’s the hardest thing emotionally I’ve ever done (and I’ve nursed my dying mother).If you can get pregnant naturally, I would explore every RM option before moving to IVF. It’s simply not an option for me as I can’t get pregnant. But IVF with PGS doesn’t solve my miscarriage problem as my losses aren’t chromosomal. So it gets me to a similar place, but thousands and thousands of £ down and still no bloody baby!!