Early pregnancy after IVF & recurrent miscarriage

[Hobbes39]

Hi - I guess I'm looking for anyone on the same boat....
We have had our 4th fresh round of IVF, this will be our last as I'm 42 soon.
So I have unexplained secondary infertility - we have a naturally conceived DS age 5 and then spent the last 3.5 almost 4 years trying for a sibling.
I had a PUL about 8 months after we started trying then various investigations (all came back fine) and so we started IVF. 4 rounds later, as well as 3 FETs, I've had a chemical, and 2 MMC. It's been pretty heartbreaking.
I am now 5 weeks pregnant from our last round, which is brilliant, but I'm terrified it's all going to go wrong again.

Signs are good - my HCG at 11dp3dt was a good number (391) and while I had a small bleed the night before my beta, all has been well since AFAIK.

I'm due a scan to check all is well in 2 weeks. We have never had a positive 7 week scan - it's always looked dubious/ bad. This last week has felt like an eternity. I am completely unable to concentrate on anything & I'm scared that this last chance will slip away too.
Anyone else is a similar situation and want to keep me company? Thanks x

That should have said WANTED to shout at them, not waved!

Oh and I meant to add @Jenbot78 - I have had spells of having quite a bit of EWCM - I think it's cos our estrogen is higher in pregnancy, (estrogen rising causes EWCM) so it's totally normal - don't worry! X

Hey good to see you over here chocolate and thanks everyone for making me feel like less of a bitter and twisted nutcase! It is so good to talk to people who understand. After the announcement I started thinking about how it would feel just to have a shag and get preggers and whether I would have such a high level of anxiety in early pregnancy?

Just sitting on sofa waiting for DH to prepare me burger and chips. I was such a healthy eater before this pregnancy, my diet has literally done a total 360 and I can’t face any veg at all! Hope I can get back to something healthy in second trimester (all being well of course...)

Just a quick update as I've been stressing for the last 36 hours ...

Embryo was measuring on track and had a heartbeat, but the sonographer also mentioned in passing that there was a 'small bruise' where implantation had happened i.e. a subchorionic haematoma. Of course, I have gone home and worried myself stupid. And being an academic, I have specifically worried myself silly using the peer reviewed literature.

I have had no bleeding YET (and actually have not bled in any of my pregnancies - even the miscarriages - until well after I've known I'm miscarrying) but still trying to do modified bed rest around a full time job and kids (ha!).

I have another scan on Monday (different hospital) ... so I will see what they spot in terms of the haematoma size etc. and try to get a sense of what the risks are. I know that it roughly doubles my risk of miscarriage (great!) but not much more than that.

Sorry for the complete lack of personals. I know that these are more common with IVF pregnancies but that somehow doesn't make it any better!

@BottomleyPottsSpots2 Sorry to hear this. There is always something else isn't there? Hope you can find ways to keep your mind occupied until your next scan. Not easy if you are on bed rest.

Bottomleypotts sorry to hear this. I have it too. I had a big bleed and have spotting daily. It is very common according to the midwife I saw in the EPU. More so with ivf pregnancies. I don’t know where you got the info that it doubles your chance of miscarriage because I was told there is not much more risk than without one. It is stressful for sure but I have read that most resolve themselves and women go on to have a healthy pregnancy. Very occasionally it can cause problems but this is much later on in pregnancy.

I’m here if you need an SCH buddy! It is scary but like I say most pregnancies turn out just fine apparently. I’m going with this anyway...

Thanks @Jenbot78, I'm sorry that we have this in common but glad at the same time that we do.

I found my information from a systematic review and meta-analysis of several SCH studies. The review written by a guy with the amazing name Methodius Tuuli in 2011. This is the abstract (I got the doubling from the odds ratio reported).

Seven studies including 1,735 women with subchorionic hematoma and 70,703 controls met inclusion criteria. Subchorionic hematoma was associated with an increased risk of spontaneous abortion (from 8.9% to 17.6%; pooled OR 2.18, 95% confidence interval [CI] 1.29–3.68) and stillbirth (from 0.9% to 1.9%, pooled OR 2.09, 95% CI 1.20–3.67). The number needed to harm was 11 for spontaneous abortion and 103 for stillbirth, meaning one extra spontaneous abortion is estimated to occur for every 11 women with subchorionic hematoma diagnosed and one extra stillbirth occurs for every 103 women with subchorionic hematoma diagnosed. Women with subchorionic hematoma were also at increased risk of abruption (from 0.7% to 3.6%, pooled OR 5.71, 95% CI 3.91–8.33), preterm delivery (from 10.1% to 13.6%, pooled OR 1.40, 95% CI 1.18–1.68), and preterm premature rupture of membranes (from 2.3% to 3.8%, pooled OR 1.64, 95% CI 1.22–2.21), but not small for gestational age (OR 1.69, 95% CI 0.89–3.19) or pre-eclampsia (OR 1.47, 95% CI 0.37–5.89). The numbers needed to harm were 34, 28, and 69 for abruption, preterm delivery, and preterm premature rupture of membranes, respectively.

Having said that, the literature used in the analysis has quite a few limitations and the studies with the better quality designs (prospective cohort) do seem to have the more modest effect sizes. And basically the abstract does absolutely agree with you that the vast majority of pregnancies turn out just fine anyway so you are 100% correct to go with this, and I will definitely try to too!!

Gosh botttomley that does look scary when you read it written down. I’m glad you have good research knowledge and have picked up the limitations, maybe we can be reassured by that!

Did the review mention this study: www.mdedge.com/obgyn/article/78173/obstetrics/miscarriage-risk-not-increased-subchorionic-hematoma

I like this one best 😂

The anecdotal evidence seems reasonably reassuring; many women on many different sites talking about successful pregnancy outcomes with SCH. I did start a thread over on the pregnancy board, there are a few stories there.

I’m quite confused about my SCH. I was told it was relatively small at 2cm x 2cm but that was quite a large percentage of the gestational sac at 8 weeks.

I was told that acupuncture could help. Other than that not going too mad with exercise and lifting I’m not sure what else...

I'll have a look at your thread on Pregnancy @Jenbot78, thank you!

I've been looking at the literature since the review was published, and found this which is encouraging:

www.ncbi.nlm.nih.gov/pubmed/27045331

Another really good point I read on a different board is that it is often very hard to distinguish between a pregnancy that is ending for other reasons (e.g. genetic error) and bleeding 'round the sac for that reason vs a health baby compromised by the bleeding itself. In fact, with my 4th miscarriage, I knew things were failing when my beta hcg stalled. We then saw bleeding on the ultrasound - which would have been referred to as a SCH I think - but I already knew that it was not going to end well. So I suppose that without testing for other causes of losses with SCH, it's hard to tell whether it's actually causal. I hope that all that made sense!

As for things that could help, I am doing 'reduced activity' which has involved lecturing sitting down, doing a lot less housework, keeping feet up where possible. I have also stopped commuting to work by train (using car, for now).

I have started taking alpha lipoic acid (300mg twice per day) based on a couple of middling quality studies that suggest that it might help, but decent evidence that it doesn't do any harm. I am also starting magnesium because it's useful for reducing uterine contractions and that sounds like something that would just freak me out more.

I had a really odd scan appointment yesterday though. The SCH was visible last week on a transabdominal US, but I had a transvaginal US yesterday and asked the sonographer to look for it - she couldn't find it transvaginally at all. So I assume it is only visible from once angle? I'm hoping this means that it's not huge (as surely it would be visible no matter how it's viewed) but generally just mystified.

When is your next scan?

How is everyone else doing?

Hey, how's everyone doing? Not heard from anyone for a while. Bottomley I think it sounds like your SCH is small if they can't find it up the vag but then I'm no expert! AFM, next scan not for another two and a half weeks when I will be 12 + 5. JUst want the time to pass, the waiting is agonising! Been doing the round of playgroups today with DD and finding all the second time mum chats quite hard, seems everyone is pregnant with their second. Feeling anxious about something going wrong for us and having to endure everyone else having their babies. I know it all sounds very irrational but I guess this is just what happens when you've been through what we all have!

So I'm 10 + 1 today and just willing the time to go fast to 12 week scan. Nausea still here but slightly better than it was in that I seem to be able to tolerate a bigger variety of food, tiredness still here! I'm experiencing cramps and twinges and every time I do I'm freaking out even though I know it's normal. Also increased watery discharge (sorry for TMI) which keeps making me think I'm bleeding again so I end up anxiously running to the loo every five minutes!

Oh the joys!

Would love to hear how everyone else is getting on.

I could have written your post jenbot! Still queasy but able to eat more at the moment. I've got a few cramps here and there which is freaking me out but then nothing so i think maybe things are stretching out in there. I'm 9+6 today and willing away the time to 12w when i can finally stop injecting clexane every night. It hurts and leaves bruises and sometimes bleeds! Urgh. But obviously not complaining, just wanting that bit to be over.

I'm currently getting excited to get excited, which sounds funny but can't really emotionally invest in it until 12 weeks. Then we can tell dd and my niece and nephew and rest of family which will be really nice!

Hi @Jenbot78 & @Catren - I know exactly how you feel! Time feels so slow when you are desperately waiting for the point at which you can actually breath out and relax just a little...
I had my harmony scan & bloods on Wednesday and was lovely to see my little wriggly beans on the scan! I'm still in disbelief that there are 2 and I still feel nervous about getting attached to that idea. They were measuring 11+6 so a good size and looked so cute snuggled in together!
I am however nervously awaiting the blood test results which I'll prob get towards the end of next week. I think I'm just so used to things going wrong, i don't want to get too excited about it all yet. We have decided we will tell our DS about the babies if the bloods come back clear and I'm getting excited about telling him, but scared too. We weren't going to tell him until more like 16w or as long as we could tbh, but the problem is we really want him to know before anyone else, and I'm already showing cos there are 2 in there and I'm struggling with hiding it already!
So I'm just counting down the days til the most nerve-wracking phonecall of my life when they call with the results! Hope you guys are doing ok and can distract yourselves too! X

Hi all - NIPT came back all low risk! I'm so relieved - I'm actually beginning to relieve this is real now!

Phew hobbes!! What a relief, how very very exciting 😊 have you started showing yet with twins? I have and I've only got a singleton in there - bit awkward at 10w..!

Omg sorry you said you'd already started to show! Mn fail 🤦‍♀️

Hi @Hobbes39,

I’m glad to hear you say you’re starting to show as I’m feeling very self conscious about the fact I’m showing already. I’m 11+6 today with twins as well and it’s reassuring to hear it’s not just me. Still waiting to get the date for my 12 week scan (seven though the US department called me yesterday to tell me information they need me to provide at my scan appointment - then didn’t tell me when the appointment is; so I still have to watch the letterbox for it to come through the post!!)

@Rememberallball - I just found a pic of me at 19w pregnant with my DS - I look pretty much the same now at only approx 13w 😱 I'm going to be the size of a house...

hobbes i was looking at old pregnancy photos from my dd and found the same! Photos of me at 12w - flat tummy not a jot.. 😂

@Hobbes39, I don’t have anything to compare with (never got to this stage before) but my belly is definitely feeling firm and solid rather than the ‘jelly belly’ I had when I was just fat!! I will get a photo later on as I can’t belive I’m only 12 weeks!!

Hi all, how is everyone this sunny Sunday? I’m doing OK. Nausea starting to subside although just when I think it’s gone it rears it’s ugly head again. I think it’s mostly hunger related; unless I eat every two hours it seems to return! Tiredness is really something at the moment too! DD is nearly two and getting really into saying “no” to everything! Is hard work when I feel so rough...

I’m 11+3 days today, another week and a bit till my scan. Slowly coming off the FET drugs. Actually clinic said I could stop at 10 weeks but I felt so anxious about doing that as with IVF it was 12 weeks. Anyone else nervous about stopping drugs? The only thing I definitely won’t miss is the Clexane! Hate those damn injections...

Still really nervous about the scan. It’s like every time I start to get excited about having a baby I stop myself...

Hope everyone else is doing OK

Hey jenbot nice to hear your update! I'm 11w today and my nausea is getting a bit better, also not as tired. But the fading symptoms scare me a bit! Im really nervous about stopping the progesterone and clexane. I was told to finish on 11+6 and while i shall also never miss the clexane it feels crazy to just go cold turkey!

My scan is on 2nd April and I am pretty nervous about that - I just want everything to be ok. My dd is almost 4 and not being too tricky thankfully, I really hope she'll be helpful at she loves a good job to do. Swept the patio yesterday just because she felt like it! Can't guarantee the quality of her work but i love the enthusiasm 😂

Hi @Catren & @Jenbot78 - I know exactly where you are coming from about being nervous stopping the drugs... I was when I stopped mine (much earlier, as I was told to stop at BFP) I kept going for longer than they said to, and tailed off gradually as it was a crutch for me totally..! I do believe what the say tho - that actually you don't need it post BFP as basically your progesterone drops if it's unviable, by the other way round. But it's HARD!
I'm a week or 2 ahead of you guys it seems - and I had the panic feeling when my sickness symptoms improved hugely - but all was fine.
We've started telling people - told our wee boy and was a bit for a bit there as he actually burst into tears and started sobbing saying he hated babies 😱. But after a long chat and some reassurance that he's still or baby too, and him having a chat with my belly(!) he's actually super excited and has been drawing pictures for the babies and all sorts - it's been v sweet! He wants them here NOW tho..! 😂🙈 x

@Hobbes39, so glad that your little boy is now super-excited. It can be an initial shock but it sounds like he will be an amazing big brother.

@jenbot78, I'm worried about coming off the drugs too. Going to try to stretch out what I've got and wean really slowly ... what weaning regimen are you following?

@catren, good to hear that the sickness is decreasing although I understand what you're saying about the paranoia of symptoms. At least it's the 'appropriate' time for them to fade a bit.

As for me, 10 weeks today and had the midwife booking appointment today which makes me feel like I've instantly jinxed the pregnancy. 12ish week scan scheduled for the 5th of April ...

Hi @Hobbes39, I finished all my hormone drugs last week when I reached 12 weeks - but the last week I was only using the vaginal progesterone gel once a day not twice and carried on the injected progesterone at alevery 3 days. Now I’m just on the clexane, aspirin (both of which I now have to take until the birth, unless the consultant changes that when I see him) and then my increased steroid and my vitamin D and folic acid which I take anyway!!

Had my scan today and both babies are developing well and one is even measuring a couple of days ahead of the ivf dates. Just got to wait for consultant appointment now!!

Congratulations on the scan @Rememberallball ! Are you staying on your steroids for the duration? x