IVF following recurrent miscarriage

[Flower212]

Hi, just a question regarding IVF, I’ve researched the criteria for NHS referrals at my local unit just out of interest, and recurrent miscarriage is one of the criteria. I’ve had recurrent miscarriage and no living children but I’ve had a long break from ttc due to breaking up with my previous partner, and now with a new partner and we are planning ttc later this year.

I’ve always conceived naturally very quick previously, is there a reason that recurrent miscarriage in itself is part of the criteria, as in does ivf actually reduce the risk of miscarriage? I’ve read mixed things about this online. I’m under no illusion that IVF would be a walk in the park, but if there is any chance it could reduce further mc risk I’d want to look into it. I’ve had all the recurrent miscarriage tests through Tommys which are more extensive than the standard NHS ones and these didn’t come up with much. Would this also mean that when ttc with my new partner I wouldn’t need to wait a year before my GP would refer me to the fertility clinic?

IVF can bypass a number of issues but if your issue is recurrent loss then you are already getting through a number of these hurdles. What it can do is ensure a high quality embryo is implanted, if you PGT-A test your embryos then it also can select the euploid embryos, rather than ones that are aneuploid. Did you have any of the products tested after the losses in the past? I'm not sure whether the NHS would do PGT-A though. If you're with a new partner then I expect the clock of how long you have been trying for would need to be restarted and you'd have to wait longer.

@Gardenlady543 I had the product tested on the 3rd one which was a chromosome problem but but following karyotyping it just occurred randomly and there were no genetic problems, so I wouldn’t be entitled to PGA testing on the NHS I don’t think.

I do meet two of the criteria listed on the my local NHS fertility clinic’s website which is recurrent loss, and also when I was 19 I was diagnosed with endometriosis which is another part of the criteria stated for the female partner, so I’m not sure if this would mean I could be referred to the fertility clinic sooner than waiting for the recommended 12 months of ttc.

@Flower212 sorry to hear about your recurrent losses.

Having been there myself, I can tell you that if you're able to conceive naturally, there's only a handful of possible benefits to doing IVF to prevent MC and they all relate strictly to some form of embryo pre-selection where the issue is abnormalities with the embryo (it doesn't really help in case of other issues that might be causing this for you)

• PGT-A, screening embryos before transfer to rule out abnormal ones. The NHS does not do this, it's only available privately.
• PGT-M, screening of embryo for specific genetic conditions, if known or suspected you and your partner carry a genetic condition, which does not seem to be your case. The NHS does this, only if there is a reason
• Selecting only the best grade embryos to transfer, although the correlation is much smaller than one would assume, there seem to be some between embryo grading and chromosome issues
• Pre-selecting sperm via ICSI in case of known high sperm DNA fragmentation although again, the correlation between optimal appearance and low fragmentation is quite poor. There are more advanced methods to sift out sperms with high fragmentation such as IMSI and Zymot Sperm Chip however I don't believe any of those are available on the NHS.

PGT-A would be the most significant by far if you can afford this privately, but not an option on the NHS. That is sadly the only way to get around random abnormalities like the one instance you had tested. That still doesn't mean it's fool-proof. I spent a lot of money to do this privately to only obtain one single normal embryo after screening which resulted in a chemical pregnancy following FET. The reality is that even PGT-A isn't completely fool proof as it misses 4% of abnormalities, but also doesn't help with other possible problems such as immune issues.

If you had 3 losses you should have been referred to a recurrent Miscarriage consultant within the NHS, have you already seen someone ? They can help looking into other possible issues and testing as random chromosolmal abnormalities are only one of many other possible causes that can be treated in other ways. I've been seeing a reproductive immunologist since my IVF loss and his opinion is that the probability of having so many losses all just due to abnormalities is actually quite low (only 2 of my 5 natural losses were tested and found to have random abnormalities, the others are unknown) and there would most certainly be other things at play worth looking into it, especially if I can get pregnant easily, before diving into more costly iVF.

I hope you can find clarity and support in what your next steps should be. Feel free to ask any question as this is a predicament I found myself in and a path I travelled. x

@clhiu thank you for this. I had all the recurrent miscarriage tests through Tommys which is a bit more extensive than NHS (but not quite as extensive as private reproductive immunology as I also researched this but I can’t really afford the cost sadly) and it didn’t find much other than my underactive thyroid which I am already aware of (which is a whole thing in itself in relation to fertility/pregnancy, luckily I am under a consultant endocrinologist on nhs).

I guess one of the things is we don’t know anything about my partner’s fertility yet as he’s a new partner since I had my losses, he is happy to have the standard male fertility tests available when we are at the start of ttc as these don’t seem as costly (through medichecks or a similar company) and take supplements (which I have read are good for any issues with possible DNA fragmentation etc). He’s supportive but also thinks I’m over-worrying about it, I don’t know if the level of anxiety around ttc is different for women anyway, and I try to remember I’ve had the experience of going through the losses and he hasn’t, which we have spoke about and he tries to understand.

I’m also wondering if given my history would my partner still have to go private for male fertility tests if we got referred to a fertility clinic through nhs, even though as yet we don’t know anything about his fertility?

Hey @Flower212 I would wonder if getting your partners sperm tested might be helpful? There's a test available called the comet and it's very thorough (and expensive) but might be good to rule out any male factors.

I had a missed miscarriage and 2 chemical pregnancies over TTC for 3 years and eventually did IVF with pgta testing, I got 2 euploid embryos and the first one we implanted resulted in my little boy. I think it's worth saying that all of my tests came back normal - ovarian reserve, all the blood tests etc, I did test for Nk cells which were found to be a little high so my protocol included a steroid and intralipid. I think that pgta testing can improve successful outcomes but if you have other things going on they are also contributing factors. Do you feel like your endometriosis is managed well? X

@browneyedgirl626 thanks for this, is the comet test available online or does it need to be one of the ones done in clinic? I wasn’t found to have any chromosome issues from the karyotyping done after my 3rd miscarriage so I don’t think I could get PGA testing on the NHS, but I could see the benefits of having this, i just worry about cost and I also think my partner would want to try other routes first (which I understand).

My endometriosis hasn’t caused me any problems in terms of pain/periods since I was diagnosed (I appreciate I’m lucky with that) but I’ve also not had any further laparoscopies since then. When I did conceive previously it was quick. I am still under gynaecology through nhs so I don’t know if it’s also worth raising this? I’m on the waiting list for a follow up appointment but it’s been over 2 years since I have seen them following my losses.

@Flower212 the consultant I saw privately said that recurrent miscarriages could happen because of the following-

1. Chromosome abnormalities
2. Environment in the uterus - includes polyps, heart shaped uterus etc. maybe endometriosis falls under this one?
3. Immunological reasons - there's a theory that body can attack embryo with an immune response, Nk cells tests for this though it's not an accepted theory on the NHS so you could only get it privately and even then it's not a widely agreed upon theory

It would be worth speaking to a consultant as it's so hard to apply other people's experiences to your own when we all have our unique medical history. But I just wanted to say that if you are getting pregnant quickly that is a good sign, I know it doesn't feel like it though as recurrent miscarriage is so hard, my heart goes out to you. Xx

@clhiu We had a similar outcome, 3 egg collections with only 1 euploid embryo that ended in miscarriage. God what a heartbreak it was! 😭

Did you have any luck after?

@contentsmayb I'm really sorry to hear that, it's absolutely soul-destroying when you get told you're only problem is one of egg quality and you put yourself through all that just to ensure you put a normal embryo back in rather than leaving it to chance and then it still miscarry, I can really sympathise 🙁Did you ever get to find out what caused that loss? Mine was a chemical so no POC was tested, I was just given 3 possible reasons for it:

• A stronger auto-immune response that what my NKC test suggested I should have and stronger than what Intralipids were able to mitigate (which I had prescribed for my FET)
• One of the 3-4% chromosomal abnormalities that cannot be picked up by PGT-A testing
• A very depressing new theory according to which some women's endometriums have a preference for 'abnormal embryos' and reject the normal ones. I had 4 losses in total before IVF, 1 chemical, 1 early MC at 6 weeks and 2 MMC. The two MMC were tested and confirmed abnormal, but the other two were not. if that was true, I could definitely never have a baby, even with a donor's eggs

We got 5 blasts out of the one single collection I could afford, 3 aneuploidy, one euploid and 1 low grade inconclusive (technically still on ice, but I don't think there's much point transferring it)

No real luck since I'm afraid. Following the failure of a tested embryo I decided to look into auto-immune issues in more depth and went back to try naturally under the protocol of a reproductive immunologist, failed to get pregnant at all for 3 months in a row so dropped the costly treatment which I could no longer afford. First month trying without anything, I fell pregnant again for the 6th time in my life, but it was a chemical, that was 3 months ago. The following month I thought I'd get pregnant easily as you're supposed to be more fertile after a chemical, but just BFN and last month we missed my fertile window as I was away from DH so we didn't even try. I just ovulated and hoping for a BFP this month, but I know my chances are super slim as I'm turning 44 next month.

Did you get back to trying after IVF? What's next for you?

@clhiu Oh goodness, what a journey for you!! So sorry, you poor thing.

We got a good number of blasts as well...Had 8 blasts from 3 cycles. We have 2 low-mosaics frozen, so will try those, I suppose. If that doesn't work, might do another cycle or do a donor egg :(

As for the miscarriage, since it was the first one, they didn't feel the need to investigate the reason, as it's not a recurrent problem. If it happens again, we might try to do more tests (like NK, as you mentioned, and others...). Planning to transfer one low-mosaic this month....

I am 40, so odds are not great either.

Sounds like you have all been through an awful lot. I had my NK cells tested through Tommys clinic, which they did after taking a womb biopsy. It didn’t come up with anything, but in the back of my mind I’m worried the test isn’t as in depth as what would be done private even though the Tommys clinic is a good reputable place. But I can’t afford private 😞