Steroids for Transfer - has it worked?

[Sunflower360]

Hi

Not sure if there is anyone out there who's been in a similar situation.

I had some miscarriage screening done in readiness for our next egg collection, following a chemical pregnancy in August. I have been told I have high Anti-Thyroid Peroxidase antibodies that can increase miscarriage, so I will be on steroids from the egg collection in readiness for a transfer. Does anyone have an experience of this or a similar situation for an auto immune condition that needed steroids or something similar? Are there are other remedies if this wasn't to work?

@Sunflower360 Hey! I don't have any info on this however I do have TPO antibodies (hashimotos disease) they are around 85 atm so not massively high. Do you know what your result was? Did you also get your TSH tested?

When I had initial bloods done it showed my thyroid was elevated at 5.5 (it's best under 2.5 for fertility and reduces miscarriage risk) I'm on levothyroxine and then that's when I found out my antibodies.

I'm due to have my first transfer next week as I had a freeze all and my clinic won't prescribe steroids as they say there isn't the evidence that it works but I have read stories from women with TPO antibodies and steroids have worked.

Have you had an ivf cycle before?

@NatW2021 thanks for the response. I have had TPO tested it was 270...so it was high, benchmark is 34. Weirdly my TSH levels are fine and under 2.5 so did not see this one coming, glad I found out before a transfer.

You may find the following link of use regarding steroids and high TPO to achieve pregnancy...

www.ncbi.nlm.nih.gov/pmc/articles/PMC8526225/

Have your clinic suggested anything else instead of steroids?

@Sunflower360 Thanks, it's such a mind field and I have no hope that my transfer will work. I feel like everything is against the odds and it will be a miracle if it actually works.

I'm exhausted 😩

@NatW2021 have you had your TSH retested in readines for the transfer? Hope it all goes ok

@Sunflower360 yes it's come back down to 1.6, I had it checked just after EC and it was 3.6 but I had I read that ivf meds can cause it to rise.

I found out about my thyroid nearly 2 years ago we have been ttc to for 2 1/2 years nearly and have unexplained infertility.

Trying not to be negative but so hard after so much disappointment.

I have 2 frozen embryos x

@NatW2021 thanks for getting back to me. I've read mixed things on steroids and thyroid antibodies, it's such a tough journey with each of these obstacles. Have you had any other investigation tests done to rule things out?

Hope your transfer goes ok too next week, did you get the embryo tested? We've not done PGTA.

I took prednis on my last transfer which was successful. Other things were also added into this cycle but in answer to your question, it may have made all the difference

Thanks @CR7 did you have immunology issues? What dose did you have?

@Sunflower360 I was on 10mg a day up to 12 weeks of pregnancy. I have quoted from my Consultant letter why. Obviously every case is different but this is what was right for me

We also discussed immune testing. Unfortunately, there is very poor evidence for immunology testing and there is no evidence for certain tests which is Natural Killer Cell testing anymore. There is however, a role for immunology and while I do not think that we are currently able to truly identify who would benefit from immune therapies it may be beneficial to add in some empirical drugs to try and dampen down any inflammatory or immune response. There is other evidence to say that clotting or blood flow problems within the uterus itself can be a cause and therefore giving some inhixa in order to thin the blood and improve blood flow, may improve implantation. There is good evidence for this in the literature.
Therefore, we agreed today that we would add in Inhixa or low weight molecular Heparin in your next cycle with some steroids and also increase Oestrogen to the maximum dose.

Thanks @CR7 that is really appreciated, suppose it is worth a shot! I'll be taking that same dose from stimulation through transfer and will stop either at negative pregnancy test or when the scan takes place

Yes I was to take it to test day and then on ton12 weeks if I had a positive result. I had to wean off it

@CR7 thanks. Is there any other procedures/tests/treatment you had advised for immunology?

I don't think it was to do with immunology for me but I had -

Three retrievals
Three transfers
PGTA
One mock transfer with Hysteroscopy and Endemetrio testing
Steroids
Inhixa
Progesterone test on the final transfer so I was given lubion

I had 2 chemical pregnancies. Did a few basic tests but nothing was flagges however I was prescribed prednisolone on the basis that it wouldn't do any harm and that transfer worked out (I also had lubion as well as pessaries though which was different to my previous cycles).

Thanks @CR7 Thanks @Iliketwirls , did you have have any immunology tests at all?

@Sunflower360 only lupus anticoagulant but it was negative

Thanks @Iliketwirls did you have thyroid issues at all?

@Sunflower360 it was somewhere between 2.5 and 3 so they put me on low dose levothyroxine to bring it down a bit

@Sunflower360 Hey, how you getting on? My first transfer failed which tbh I was expecting, the clinic have agreed steroids for next transfer in January.

@NatW2021 sorry to hear your transfer failed. I had to have a freeze all after my last collection 2 weeks ago as they saw a polyp, so I'm having a Hysteroscopy and biopsy in January to remove it and will then hopefully transfer the cycle after that. Thankfully they saw it as I was due to have a fresh transfer which can lead to implantation issues and miscarriage. How many frosties do you have?

Thanks @Iliketwirls I'm going to test my thyroid levels in the new year and see if Levothyroxine is needed, it was under 2 in November but I want to keep a eye on it to give the transfer the best shot

@Sunflower360 - oh no what a faff IVF is never straight forward is it, but good they found it. How did you get on with stims and how many frozen. We got 2 so only one more left, dreading the thought of having to do it all again. It was a little disappointing as we got 19 eggs/17 mature/10 fertilised/5 fertilised abnormally/2 didnt fertilise at all.

I have my DH on impryl now in the event another round is needed and dr has possibly suggested Icsi If we have to go again x

@NatW2021 it is an emotional rollercoaster. This time I was on mild and got a good result, although I don't know if any are euploid as we've not tested. We got 7 eggs / all fertilised / 5 frozen blastocysts (4 x day 5 and 1 x day 6)

We had ICSI @NatW2021 not sure if you've had that? In our first ever cycle we got no fertilisation of 2 eggs but with ICSI and diet/supplements for months thankfully the fertilisation improved