Embryos measuring behind - causes?

[Fabsco]

Dear all,

This is my third pregnancy and most likely my third miscarriage in the space of two years. My first ever pregnancy was a natural pregnancy in Oct 2020; unfortunately I miscarried at 5 weeks. I had heavy bleeding for a week but my cycle normalised quite soon after.

My second pregnancy was an IVF pregnancy in June 2021 with a 5AA blastocyst. I had no bleeding or spotting and strong pregnancy symptoms from weeks 4-6. I was shocked to hear that they couldn’t see much more than a gestational sac and yolk sac at 6 weeks. There was a fetal pole with a flicker of a heartbeat at 7 weeks, but unfortunately the heartbeat wasn’t there at 8 weeks. I waited for two weeks to see if I was going to miscarry naturally, but as I had to bleeding, ended up doing medical management and miscarried at 10 weeks.

I am now 6 weeks pregnant from another cycle of IVF with a 4AA blastocyst and going through the same situation once again, i.e. no fetal pole or heartbeat on the scan. My hcg levels don’t seem to be doubling aa they should either (I didn’t do any blood tests with my previous two pregnancies, so don’t know what my levels were). I was asked to return to EPU for a scan next week but unfortunately I’m ready for bad news, given what happened last year. I am on Clexane, Aspirin, Prednisolone, Progesterone injections and pessaries and yet find myself in the same limbo as last year, when I wasn’t on any medication.

Have any of you ladies been through the same, i.e. multiple miscarriages at 6-8 weeks with slow developing embryos? Have the doctors given you an explanation as to these being caused by chromosomal abnormalities or immune issues? I am 40 years old and know that my age is probably the cause of chromosomal abnormalities in the embryo, but it is now the second high grade embryo that doesn’t develop quite as it should. We still have two frozen embryos left, but they are of a lower quality (5AB and 5BB) and more likely to be abnormal.

Thank you for any help/experience that you can share.❤️

Hi op I’m sorry for your losses.
Have you had the blood investigations ? Anti phospholipid etc
I had 4 mcs and similar to you. I don’t think my prednisone was high enough ( 10mg) next ivf pregnancy we through the sink at it - 25mg prednisone, clexane, lots of progesterone, intralipids , something called LIT, ivig , baby aspirin. I got my rainbow last year. I can never know for certain why it worked but I do think it was immune related

Threw!

@Loveintherain Thank you so much for your answer, and I’m sorry to hear about your losses. I did a thrombophilia and immune panel six weeks after my last miscarriage and repeated them three months after. I was tested positive for lupus anticoagulant and antinuclear antibodies six weeks after my miscarriage, but tested negative for lupus anticoagulant three months after. The clinic them put me on low doses of everything (20mg of Clexane, 75mg of aspirin, 10mg of prednisolone), so I also wondered if higher doses would have saved the pregnancy. I am also on progesterone support.

Have you genetically tested your embryos? Thank you so much once again for your reply; it means a lot to me. I will definitely ask the clinic for higher doses of the medication.

Hey no worries, I know how horrible this is. I hope, like me, this painful time doesn’t hurt one day and is just a bad memory .
I don’t know if the losses were normal due to sampling issues the two times we tried.
I went to see dr Gorgy and he upped all the meds that I was on with my other clinic. I really felt that was the issue because I do have an immune condition which has flared up part way through the pregnancy and went away after more immune treatment and is now back with a vengeance after birth!
Perhaps a consultation with him would be useful? Best of luck op, keep going

I'm so sorry this is happening @Fabsco ❤️ I have had 6 miscarriages now.

I had antiphospholipid / lupus / thyroid tests after my second loss and all was OK, so no treatment. I had 3 MMCs where the babies stopped growing in week 6 (never saw a heartbeat) and one chemical. We tested my 4th loss and he was chromosomally normal so we went to see a private reproductive immunologist. He diagnosed overactive nk cells (he also said the nk cells were the cause of our subfertility, we've been ttc 4.5 years now). I was put on hydroxychloroquine, intralipids, aspirin and cyclogest but stopped being able to conceive again. He added in prednisolone (25mg) and still struggled. We did ivf last summer but I had a chemical pregnancy of a 5AA embryo. I did the Endometrio tests to rule out inflammation and infection but all was clear.
We did our FET last October with a 3AA embryo, adding in lubion alongside all the immune meds and all was going well, saw a heartbeat and then they stopped growing at 6+2. We had that baby tested too and she was healthy again.

I'm under Tommy's and they have prescribed sitagliptin to try to build the endometrial stem cells (I did a biopsy last year and it came back very low which we told at the time was likely a fluke). I'll be on this drug for 3 months then we'd like to try our last embryo transfer with the immune protocol.

My specialist says that recurrent losses are rarely due to recurrent chromosomal issues and around 60-80% of recurrent losses are down to immune issues.

Sending love xx