Recurrent miscarriage - do we try ivf?

[Rebych]

Hello, I’ve had two miscarriages in a row (one at 7wks, the other 9 weeks) and I am now seeing a fertility specialist who has recommended egg testing and ivf. She thinks (but doesn’t know for sure) that it could be problems with chromosomes/genetics and therefore by testing them before implantation we could have more success. I’ve always taken pregnancy vitamins but no other medications. I’m 38 (partner is 33) so I’m worried that if we try again naturally and it leads to miscarriage we are running out of time. I’m also not sure I can deal with the heartbreak again. I asked her about aspirin but that is not a method she recommends. Has anyone had any similar experiences? Thanks so much x

Sorry for your losses. No advice I afraid but I'm in a similar situation, been referred for investigations following 2 miscarriages at 9 weeks. I was hoping you could give me insight on the other tests they have done before getting to offering IVF with selection. This is what I am hoping they offer straight away, I don't have an issue getting pregnant (or staying pregnant as they have been MMCs) it's just they don't seem to develop. Did you need the full arsenal of tests first? Hope someone comes along soon with some advice for you xx

I have recurrent losses. I'd recommend getting a recurrent miscarriage panel which looks at blood clotting factors, thyroid, vitamin D. My tests came back OK but I then had my 4th loss so we saw a private specialist who looks at reproductive immunology (nk cells) and I have been diagnosed with an overactive immune system which attacks the babies. His view is that recurrent losses are rarely chromosomal (under 5%) and we had my 4th baby tested and he was chromosomally normal. We also had parental karyotyping and neither of us are genetic carriers for anything that could cause a loss.

I've been on an immune protocol for a year but we were unable to conceive so we started ivf in May. I have low amh so we didn't collect many eggs but we made 3 top quality embryos which shocked everyone due to my history and age. We did not genetically test the embryos (I'm unsure about the need for this in our case and didn't like the thought of the embryos being messed with). I did have an early loss after my first transfer but think this was related to my progesterone levels as I bled before test day. But I did a frozen transfer and am very early pregnant on an amended protocol.

Trying ivf without knowing the reason for your losses is unlikely to help, so I'd recommend doing some additional tests before going down that path. Best wishes x

@PeanuttyButter the nhs won't offer genetic testing of embryos unless you or your partner are identified as a carrier of a particular chromosome. If this is the case you can be offered PGD testing on embryos. But we didn't get parental karyotyping until we'd had 4 losses and that took me pestering the team until they relented as they don't usually test until 5 losses (I was under a Tommy's clinic). I had one funded nhs ivf round and we were offered to self fund genetic testing but declined for the reasons above.

If you're seeing a recurrent miscarriage clinic they will check for basic factors like clotting which is treatable. Sadly only 20% of people come away with a cause. We were sent away with no reason than bad luck. But it's not bad luck for us, there is a cause but the nhs don't test for it. X

@VenusStarr thank you for your reply I really appreciate it, nobody I know has ever been through anything like this so I don't know what the deal is. I also think the information will be useful to others too.

@PeanuttyButter recurrent losses are so isolating ❤️ I have connected with a few women on here and Instagram and that's helped me both emotionally and finding out about tests to request / persue. My GP is pretty clueless but did support referrals for me and me seeing a private specialist. I hope you do get some answers, not knowing why they happen is really scary. Lots of love xx

IVF with PGS testing isn't recommended as standard for recurrent miscarriage and you wont get a referral that way on the NHS - in fact most CCGs reset the clock as it were for fertility referral because a miscarriage (and ectopic) are still classed as getting pregnant so they would make you try again naturally for the 6-12 months with you not getting a BFP in that time before making the referral (this is the rule in the midlands anyway)

I had 5 miscarriages and did move onto IVF as I felt the NHS recurrent miscarriage clinic was too basic and not interested in anything than a few cursory blood tests. PGS testing isn't free on the NHS - it's an extra you have to pay for. I did 5 rounds of private IVF and did pay for PGS on one of the rounds and all my embryos came back abnormal which I guess sort of gave me the answer I was looking for. We ended up changing our IVF protocol to natural modified IVF though which hugely increased my egg quality and I did go on to have twins. My twins weren't PGS tested by the way - it's actually a pretty flawed science

I would probably look at a better preconception vitamin - something like Proceive max for women

@VenusStarr tentative congratulations on your BFP - if i remember right you ended up going to Create where I had my twins? X

Sorry for your losses. I would go with IVF, tbh. Like the specialist said, you can check the embryos beforehand, to minimize the risk of future heartache. Keeping everything crossed for you!

I thought baby aspirin was very standard for women who've had miscarriages? It seems there is a lot that hasn't been tested for/tried and ivf is a difficult road. Things will have moved on since I had my mcs but I never heard of anyone moving to ivf without standard RMC testing.

@Iggi999

I thought baby aspirin was very standard for women who've had miscarriages? It seems there is a lot that hasn't been tested for/tried and ivf is a difficult road. Things will have moved on since I had my mcs but I never heard of anyone moving to ivf without standard RMC testing.

Aspirin and progesterone still aren't widely accepted as standard recurrent miscarriage treatment. In fact my NHS miscarriage clinic said categorically not take aspirin unless there was a confirmed medical need as aspirin is not the same as taking something like clexane which is widely prescribed in IVF but lots of women do self medicate with aspirin at home anyway. They also refused to proscribe progesterone empirically. But also refused to even test progesterone levels 🤷🏻‍♀️
There's no real consensus unfortunately

Hi @tiggerwhocamefortea thank you :) yes same clinic as you. This was my FET as my fresh ended in a chemical. On a tonne of meds and so far so good 🤞

I actually mentioned you to another lady on a thread I'm on (the ERA one in infertility) as she was asking about natural modified ivf and I remember you saying you'd done it.

The nhs offered me no guidance or treatment, said no to aspirin and even progesterone until I'd had 4 losses, despite it being a Tommy's clinic and their own research saying it can help. But I managed to get progesterone with my 4th and still miscarried. My current protocol includes aspirin and clexane amongst other things.

I had two early miscarriages and the gynaecologist who treated me for them offered to do a whole host of blood tests including the key antiphospholipid. They're expensive tests hence often told to wait for three which is so unfair. But ask for blood clotting tests. Fwiw after I was given the all clear for those I felt more confident to try again and I'm now 22+2. Things can still go wrong but I'm taking it a day at a time.

Like Venusstar , my issue was immunes. I was pushed to do pgs and ivf but don’t think it’s always necessary ( this pregnancy is untested but with heavy immune support)
Dr Shehata said recurrent mc is statistically impossible. Like flipping a coin and getting the same result 3 times in a row. So there’s normally something else going on.
I did all the other tests like anti phospholipid and were all fine but good to rule out.

@Loveintherain

Like Venusstar , my issue was immunes. I was pushed to do pgs and ivf but don’t think it’s always necessary ( this pregnancy is untested but with heavy immune support) Dr Shehata said recurrent mc is statistically impossible. Like flipping a coin and getting the same result 3 times in a row. So there’s normally something else going on. I did all the other tests like anti phospholipid and were all fine but good to rule out.

This is strange. I was seen in the recurrent miscarriage clinic after 5 losses. All tests clear. And then a few gears later I had my DD. There wasn't anything obviously wrong so if it is statistically impossible to have recurrent miscarriages without there being an issue then whatever my issue was must have healed itself?

I assumed it was my age and they were all chromosome issues but this is what he said to me. This pregnancy I followed the advice to do immune treatment and it’s doing ok.
Did you do immune tests ? I assume the immune system can have periods of flare and low periods. I’m no expert of course.
I think it’s important to just not assume it’s age or luck

All my other tests were fine too