Recurrent Miscarriages - What/when to investigate? NHS vs Private

[chocapic]

Hello all

I have been reading posts here for some time now, which have been of great help through my conception journey so far, so I was hoping I could get your thoughts and experience on my own circumstance. Besides my DH, I have only spoken to my mother about this, and she, having had my sister and me in no time, isn't really equipped with experience fortunately. Apologies for a lengthy post in advance and thank you for taking the time!

I am 30 yo and my DH and I have been TTC for#1 for 8 months. We started somewhat scared that it would happen right away and we wouldn't be "prepared", but little did we know that it would be a much more difficult journey than we imagined.

Got a BFP on the 3rd cycle in Dec 2018, but had an early MC about 7 weeks (no scans). It happened naturally, I was told by the early pregnancy assessment unit that I was just unlucky that the first pregnancy was a miscarriage and sent home. 2 weeks later I had a private doctor appointment - I had an ultrasound and some blood tests and all was confirmed normal, so I calmed down, and really pinned it on being unlucky.
Started TTC again immediately after, but it wasn't working out. It may have been me over-analysing symptoms, but in some cycles I felt that something conception-related is going on in my body (enlarged breasts, pulling in lower abdomen, being out of breath etc), but it eventually it would not work out and AH would arrive. For peace of mind, I did a full fertility MOT and again, everything came out as normal - at that point I was under the impression that I had gone through all necessary tests, and it was just a matter of time until it worked out for us. My DH also had his results confirm he had "very good swimmers", so we were all calm and ready for it.

Got a BFP again in early April (a little more than a week ago), but started bleeding in the evening of the same day I did the test, and having gotten used to the pattern, I unfortunately knew it was another MC - or a chemical pregnancy I think they would classify this one as.

So, the question is, after two miscarriages, WHAT SHOULD ONE DO NEXT?

What are the tests, checks and treatments you ladies have had to go through?

What are the best London clinics to do further tests at?

Is it worth continuing to try naturally, or are 2 MCs showing a concerning pattern that urgently needs to be checked so as to avoid another MC?

Should I try to get a referral from the NHS for a recurrent miscarriages clinic or is this going to be several months wait until I am seen by a specialist?
Fortunately, I can afford private treatment (and would not spare money for healthcare if it is necessary), but what sort of costs are we talking about? Assuming one can afford it, is it the right answer to go private and not waste any more time?

I have read that some of the checks and treatments may mean that we cannot TTC for a while, so that is also worrying, but I'd really like to make sure I know the cause of this and prevent this in the future to the extent possible. It's really taking its toll on us..I think it is fair to say that as much as we are trying to be positive, we are also quite stressed and it’s starting to impact our physical and mental wellbeing, which is not what we need at the moment..

Thank you all for your help in advance!

Xxx

About 10% of women will have two mc in a row. So it's not at all unusual, unfortunately. But only about 3% will have a third in a row, so that's the good news. This is why the nhs don't refer you for testing until after 3.

There are a HUGE number of blood tests to run for recurrent mc and this is done exclusively by a specialist.

I'm sorry you've been through this.

It nearly killed me when I had two in a row. My little ivf miracle arrived a month ago. I started ttc three years ago and had chemicals in July '16 and March '17.

I had two very early miscarriages both between 6-7 weeks in a row - went to see my GP who said she couldn’t refer unless I had three.

I had already had my tubes checked due to pelvic pain a few years back but We paid for private tests - bloods for hormones, clotting, folic acid deficiency, karyotyping etc and semen analysis. All came back fine and the doctor said to me when everything is fine it really is just a matter of bad luck and to keep trying.

I fell again and the pregnancy progressed to 10 weeks, we even saw the heartbeat, but then I miscarried again. This one was sent for genetic testing and I have since seen a consultant at my NHS hospital.

I think they chances of it happening again to you are very slim.

My suggestion would be to try again. Start taking 75mg of aspirin daily from ovulation - chances are there is nothing wrong with you and it is just bad luck. I felt very strange after spending 2k on tests only to find out it was just ‘bad luck’. My consultant tells everyone to take the aspirin so it won’t do you any harm but might help is you have slightly sticky blood.

Good luck!

Hi ladies - thank you very much for your responses and your encouraging words!

@physicskate - congratulations on your little miracle! I'm so happy for you! I hope you are both doing well!
May I ask if you were eventually recommended trying IVF after doing various tests post your chemicals? Presumably they had at least found a reason why it was not working out naturally. Either way - so glad it worked out for you!

@Holly19 - I am so sorry you have been through all this, and doing tests after tests does not help..I hope you get on the right track very soon and will have a little miracle of your own. On taking aspiring - I thought it is recommended after a BFP, but if it can be taken from ovulation, I am on it from tomorrow! Would you know if it is meant to be taken daily (as opposed to just during/post ovulation)?

We were unexplained infertility. As we'd been ttc for over two years and I'd had no success with clomid (which did nothing but shorten my cycles and make them more regular, oh and cause me to grow a fibroid), ivf was the next step for us.

Ivf had nothing to do with my chemical pregnancies. They were just bad luck, which is still hard to stomach.

I think there is mixed messages about the aspirin but my consultant said from ovulation and to be fair I held on to that pregnancy for a lot longer so worth a try I would say. Good luck!!

Emeke okaro at the Portland is great but tbh the RMC on the nhs was better.

Did you get checked for factor V Leiden ? Since realising I have it myself I've discover3d how relatively "common" it is (this is a blood clotting disorder) so sorry to hear about your MCs.

If I were you I would see Dr okaro but also ttc in the meantime in case there is nothing wrong x

Unfortunately the NHS will only investigate once youve have had 3 mc in a row - I didn't feel like the recurrent miscarriage clinic told me anything I didn't already know - ran a few standard thyroid and blood clotting blood tests and pack you off with a good luck and call when you next get a BFP
X

Thank you for the recommendation on Dr Okaro. So far ive only had a fertility MOT done (which included AMH, LH, FSH and a couple of other things) - all came out normal, but it seems like there are many other things to check!

In at least 30% of infertile couples, there is never any reason found. And you aren't infertile - you are still more likely to become pregnant than not. You've conceived twice in 8 months.

I mean this from a place of absolute kindness because I once felt similarly: there is nothing you can 'do' to make yourself get pregnant other than Dtd regularly. There aren't tests that will make you get pregnant faster. Statistics are massively on your side.

It might be that your unluckiness continues, and that's a huge shame. But it seems like you might be medicalising something that doesn't need medicalising just yet. I'd highly suggest parking the fertility tests for at least a few more months because all they might tell you is if you need ivf or not (and it doesn't look like you do as you are able to conceive). Tests are the way to madness. I was convinced I needed an hsg and hysteroscopy. I didn't. And each of those would have set me back hundreds/thousands better spent because not having them had no impact on conceiving.

Do what you need to do for your own sanity, but I think you need to be much kinder to yourself instead of seeking explanations when there probably aren't any...

I have had 3 CP and am currently going through a MMC that got to 6 weeks (saw heartbeat) but by 8 weeks had gone. After my CP I got the RMC tests done, that's thyroid antibodies, blood issues etc. Those came back clear but I was given 75mg aspirin daily and told to take pogesterone and blood thinners from BFP. Which I did and got further than ever before but still no dice. The dr said that just because it didn't work this time doesn't mean it isn't the right protocol for me. So I'd take the aspirin and higher dose folic acid (from GP) and just keep going if I were you. If it does happen again then I'd push for the tests.

hello, have they tested you for anti phospholoid antibodies? I have not miscarried but have an autoimmune condition, so got all the tests before beginning to ttc, and was diagnosed with anti ro and told to take aspirin in early pregnancy, and that I would need far more scans. I think Anti Phospholoid are the ones known to cause MC though? (Although the ones I have can cause SB as they attack later but only in a small percentage of cases)

Worth getting tested.

Do you have any other health conditions? Good luck xx

Sorry, I didn't mean to scare you btw, and there are steps they can take to reduce the antibodies chance of affecting your baby, so it is good to knowx

Hi Ladies,

I am in a similar boat. In the last 6 months since being off contraception, I have been pregnant twice, first time the embryo did not grow at all and I found that out at 12 weeks. The second time, I started to MC 4 days after I got a BFP.

I have been pregnant 4 other times, only one being successful. No complication whatsoever with my daughter. STRANGE? I clearly am capable of carrying a child yet I've lost so many.... due to what? I don't drink or smoke, I eat well?

I went to the docs after the last loss and they referred me to a Gynecologist. I had the option of 3 hospitals, all had a waiting list of 60-80 days. I'm still waiting. Not sure what they will suggest but my husband and I have put off trying again until we have answers(??). I'm not sure I could handle the anxiety associated with another pregnancy/potential loss. Unless they would see me immediately for tests if I were to fall again?

I hope you all get answers/solutions. XXX

I am just starting the recurrent miscarriage route. I had 2 MMCs and 1 CP last year. Last MMC was in Nov. cycles have been a little unusual since so I went to GP last week, saw the nurse. I wasn't sure they'd count the CP but immediately she said "let's refer you". I have private healthcare but it doesn't cover fertility but does cover gynecology so she said to go both routes simultaneously and I can things done quicker privately but not delay NHS in case it starts getting pricey for me. So within a week and a half - on NHS I've had standard blood tests and still waiting for results and privately (Dr Iskaros at the Portland (he also did my D&C and I saw his after 2nd MMC also)) went for Initial consultation and he said we were more going to mess around and he did n ultrasound there and then to check ovulation and lining and I have my 21 day blood test next week and then we move on to next check round of checks week after!

My advice would therefore be to go both routes. If you can't get assistance on NHS because only two I would make sure you see your GP anyway and log the details of your miscarriage and any odd cycle concerns - you might get a gynecology referral.

Best of luck.

Thanks all for sharing your experiences. I think it makes total sense to get a gynecology referral as a start - to have someone who I can even just share our TTC story with, someone who knows what happened in the past and will follow whats going in on the future. So far ive been only to one of the top two women’s clinics in London - they have been helpful in running fertility MOT for me but I probably need a specialist referral at this point.
Last month since the CP has been a mess - DH had shingles shortly thereafter and now I’ve caught chickenpox..also I had impetigo 2 months before that after the first MC. Just weird to have so many viral infections, which primarily affect young kids or elderly people, in such a short period of time, when we have both been healthy all our lives. It may be stress, it may be weakened immune system, it may be the result of/the case of the MCs, it may be a stretch of bad luck - but it feels like it may need to be investigated at this point.

Fingers crossed for good news for all of us in the coming months!