Okay here are my notes! Sorry that it's quite long but I am a 'knowledge is power' kind of gal!
Dr Zinn – 11/9/20
Benefits of having a D&C procedure over natural miscarriage.
Karyotyping – counts up the chromosomes to see if the count if normal. Doesn’t guarantee that there isn’t a genetic problem at a deeper level. If the count comes back as abnormal, then we can say that this was pre-destined to be a miscarriage and we couldn’t have done anything to influence the success of this particular pregnancy. There’s an age-related risk and it’s a numbers game. Going to do a D&C to try and get this tissue for the testing. Chance that if the sex chromosomes of this embryo are female, if the count is normal, we won’t be able to be 100% sure that it’s the pregnancy chromosomes and not mine. If male, obviously we’ll be able to tell that it’s not me. It might also be an issue in mine and OH’s DNA called a balanced translocation.
www.verywellfamily.com/balanced-translocation-and-recurrent-miscarriage-2371840#what-balanced-translocation-means
D&C will ‘clean out’ the possible debris in my uterine lining which could negatively affect pregnancy next time. Some studies suggest that women who have had a ‘cleaning’ of the uterus have a higher success rates in next pregnancies because the cleaning may reduce the chance of the immune environment being negative.
Another procedure, which is similar, is the endometrial scratch, theory behind it is that it improves stem cell production by stimulating new cells in the endometrium and enhancing the body’s natural ability for healing. Boosts endometrial quality. No way to say if it makes the difference in a successful pregnancy but it does no harm. Can do that test in the luteal phase.
Histological dating. Possible to take a sample of the endometrium in the luteal phase to check on the best ‘window’ of hospitability for implantation. Can be different for different women. The purpose of this (it’s similar to the ERA test) is to find out the best time for the embryo transfer to try and optimise implantation. As I’m not having an issue with the implantation part, we probably won’t do this.
Immune stuff: the embryo can overcome the immune system, but the immune system can also ‘eat’ the embryo. The receptivity can be almost ‘too much’ or not enough. The Clexane I have been taking will reduce the inflammatory response in either case so we'll include it next round.
There is information that we can get from PGS testing our embryos. Upside: you can reduce the frustration and ‘time-wasting’ of future transfers and possible miscarriages. The downside is the manipulation of the embryo, which might not survive the process and the fact that it’s costly. You can also get normal embryos but that’s still not a guarantee that I won’t miscarry.
There are women whose bodies and immune system (and endometrium) are less discriminatory (it’s called unfussy uterus) and accept implantations more readily than others. So, you end up potentially having more miscarriages than other women, because normally the embryos would be rejected and not implant at all. There’s a test that you can do (pioneered by Dr Lesley Regan) to check out thrombophilic defects which looks at the pattern of blood clots. Still in its formative phase. The result would still be to use Clexane in any case. Could also add low-dose aspirin next round to cover off any ‘sticky blood’ issues.
www.researchgate.net/publication/11311348_Thrombophilia_and_pregnancy_loss
Read her book: www.amazon.co.uk/dp/B07232ZCYJ/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1&tag=mumsnetforu03-21
No obvious issues from my scans of any anatomical or uterine issues with things like endometritis or polyps. Will be able to see more with the D&C in any case.
Natural Killer cells? Expensive test and would be treated with Clexane anyway. Possible additional use of steroids on next protocol. Will depend on the D&C results. Soft data does exist for some people as to its benefits.