So much information!!

[roadtoarainbow]

Hi everyone,
We have been TTC a second baby for a little over a year now with an early MC and four CPs in that time. I’m 33, my AMH is 13.7. Me and my husband have both had hormone runs which came back fine, I’ve had a full blood run, blood clotting panel, thyroid check and pelvic ultrasound which were all ok and his semen analysis is also ok. Our first was conceived easily in 2021 and we never experienced losses until this past year.

I truly appreciate that many of you have been trying for a longer period of time and I also appreciate that IVF isn’t an easy, quick or guaranteed fix but for numerous reasons in our lives we are strongly considering the IVF route.

The thing is, every doctor we’ve spoken to and everywhere I look online there’s different advice!

We’ve had two doctors happy to go straight to IVF, one highly recommended a hysteroscopy but said it wasn’t essential. He also recommended PGT-A on the embryos but said it’s up to us.

One doctor has advised uterine microbiome testing and DNA fragmentation first.

And another has advised maybe doing a karyotype test, and possibly looking into NK cells.

All of this is private and obviously costs!
So my question is really has anyone had the suggested tests? How likely is it we might find an issue that we could resolve? Do we try a IVF round and see? I know it’s very individual of course but any help navigating this information would be appreciated.
TIA

Hi @roadtoarainbow sorry you find yourself in this position, its very tough

I'm now doing IVF and have done pgta testing, also had 2 hysteroscopies so can hopefully offer some advice based on my experience!

I had a surgical TFMR for a chromosomal abnormality in 2023, I'd gotten pregnant quickly. A couple of months after the loss we started TTC again and in January 24 I went to my GP for advice at having not gotten pregnant again - hadn't been 6 months but I lied! Did all the hormone tests, sperm test, ultrasound, all allegedly fine. I got advice to go to a more expert scanner (in fact I was advised to get a hycosy where they use saline to look at the uterine cavity but didn't do that first and wish I had). That scan suggested I had adhesions/scar tissue which can form after uterine surgery, either a termination or c section and some people can get them for other reasons, and they can cause a problem conceiving. I went in to have 2 hysteroscopies which confirmed I had adhesions and then removed them.

The next month after I had a chemical pregnancy and that's when we went to IVF as I was at this point 37 and it had been 18 months since we started TTC the first pregnancy. Because of my history and age, we wanted to do pgta to reduce the risk of another chromosomal issue and Miscarriage, and also we'd like to have 2 kids and time is getting on! We got very lucky with the number of euploid embryos from 2 rounds of egg collection, haven't transferred yet but it gives me a lot more hope when we do.

Have also done NK Cell testing which is expensive but showed I do have elevated killer cells which is being managed with steroids. My doctor suggested that because i have elevated thyroid antibodies, and had high TSH, usually they wouldnt test for that unless there's been recurrent miscarriage or implantation failure. Also did sperm DNA frag pre IVF - we've really thrown the kitchen sink at testing and spent a bomb. It's hard to know what to do! I've not done microbiome biopsy, I have done a vaginal swab test though and taking probiotics as am low in good bacteria. I've also tested for blood clotting and whether I synthesis folate properly.

Ita really hard to know what to prioritise. I've probably gone way overboard! Some doctors think the NK and microbiome stuff is way overblown but it seems to have been thr thing for some people.

The main things seem to drill down to embryo health and uterine environment so esp if you've had a previous c section a hysteroscopy could at least rule out an issue there. At 33 you're more likely to get a higher rate of euploid embryos than nor but pgta testing if you're thinking ivf could be a good idea to see

That's loads of info and my life story haha hope that helps!

Hi @Orangewillow,
Thank you so much for sharing your story. It’s helpful just to know what others have done and found useful.

I’ve been told there’s no need for a HyCoSy or HSG because I’m managing to get pregnant just not sustaining it. My daughter was a vaginal birth and my miscarriage was managed with an MVA. I do wonder whether the MVA has affected something but it’s so difficult weighing up what is worth spending time and money on!

@roadtoarainbow yeah it's so hard to know when all these things are expensive! We've been private for everything and the hycosy scans are about £500 but the hysteroscopies I had were a lot more as they were surgical.

Have you tried an NHS fertility clinic, I know they don't do IVF if you already have a child (which I think is nuts!) But you might be able to get investigations done - my gp referred me last summer and they offered me a hycosy pretty swiftly. Have you been referred to a recurrent miscarriage clinic also? Tommy's are good for advice on that front

@Orangewillow Yes so I was referred on the NHS to gynae for recurrent miscarriage back in July and haven’t even been seen. I was also referred to Tommy’s in September/October and haven’t heard back from them either! So we’ve all but given up on the NHS unfortunately!

@roadtoarainbow sorry to hear that, NHS waits do seem to be very long for the most part. While we got a fertility clinic referral quickly and then were seen shortly after, I gave up on pursuing IVF that way as they said they thought you had to be trying for 3 years but would let me know, never heard back and that was in august/September.

If you're thinking private IVF then I guess just seeing what clinic you like the sound of the best and going with them is probably a good route, in fertility it seems like there's so many different approaches and opinions but if you feel you trust a clinic and consultant to get started with then you'll be on a good track! Emma the Embryologist on instagram has loads of helpful info, including what to ask clinics before deciding who to go with. I'm at The Lister in London and so far really rate them