Recurrent miscarriage- is the next step IVF??

[Summerrose24]

Hi, I hope I'm posting in the right place. I had 4 miscarriages in the space of 12 months last year. Im now 39 and spoke to a private consultant recently, they recommended IVF with PGTA testing, based on the assumption that the issue is chromosomal each time (as no evidence anything else is wrong).
I have gotten pregnant very easily each time, so its hard for me to make the leap to IVF (financial but also medical trauma reasons), but I'm aware there maybe some truth to the theory.
Has anyone had success naturally after 4+ miscarriages?
Grateful for any help or experience.

Sorry to hear of your losses.

I had a similar conversation with my consultant, and asked what else we could check. He suggested we check my clotting profile with a thrombophila screen and immunity with a TH1:TH2 ratio. It was £600 in total, but my results have revealed I have both elevated Glyco proteins and high cytokine
ratio. Likely Antiphospholipid syndrome.It sounds like an embryo wouldn’t stand a chance!

For my next cycle we have added LMWH Fragmin, Asprin, steroid prednisolone and intralipid infusion on top of the usual FET medication.

Frustrating to have waited almost 4 years to get to this point with the number of times basic tests have been repeated and always returned fine. The clinic wanted me to use two more embryos and ‘see what happens’ before running these tests but that didn’t sit right with me. I am very fortunate I was able to afford the tests, and recommend you push for them as your profile sounds similar to mine so maybe they will be free via GP. Unexplained until now.

Sorry for your losses OP. Chromosomal could be the reason for your losses, or some, but I would agree to get some further tests done first for blood clotting, immune issues (not all clinics believe in these but for some women with multiple losses they've been a game changer), a full thyroid panel if you've not already had one and poss a saline ultrasound scam to check out the uterine environment, especially if you've had any surgery following miscarriages to check uterine environment ok. You could also consider an at home vaginal microbiome test, Daye is £100, to check if there's any imbalances that could be throwing things off. If you do end up doing IVF, I do think (from personal experience of having done all of this!) then you know you're in the best possible position to be putting (hopefully pgta tested) embryos back without wondering if there's anything else going on, and you may not need IVF if it turns out there was something else going on. Good luck!

I'm so sorry for your losses. It is definitely worth getting the common causes for miscarriage checked first before IVF as IVF itself doesn't prevent miscarriage and there's mixed opinions out there on PGT-A currently. When I went to the recurrent miscarriage clinic they started with bloods for clotting disorders, thyroid, autoimmune issues. They also did an internal ultrasound to check the structure of my uterus. After this, because we had tissue checked from our third loss (which turned out to be due to trisomy 15) me and my partner had karotyping done which showed I have translocations (although they weren't the cause of my losses). I was already pregnant for a 4th time when I got the results, which unfortunately was another loss (again, a random chromosome issues, triploidy, not caused by my translocations).

We did get pregnant a 5th time and baby was healthy, unfortunately lost her at 22 weeks because they had to induce me due an infection that was potentially life threatening to me and she was too small to survive. BUT she was chromosomally normal.

We are TTC again naturally whilst we wait to start IVF. We are going down the IVF route as we get PGT-SR to check for my translocations, which massively reduces the miscarriage risk for us, because there is a diagnosed issue. Before I got the diagnosis I wouldn't have done IVF for recurrent miscarriage I don't think, and definitely not as a first port of call before all the other tests were done.

Have you had any of the losses tested? I recently had a private consultation & they also suggested IVF as they were saying most miscarriages are chromosomal, until I told them my third loss was genetically normal. So there’s more things that can be tested before IVF, such as nk cells & chronic inflammation of the womb

Thank you so much for all the replies, and im so sorry for all that youve been through, its so helpful to hear shared stories. I have had some standard tests (blood clotting factors, thyroid etc), but havent had a pelvic ultrasound or immune testing. My 2nd loss was tested and was a trisomy, unfortunately couldn't test any of the other losses. So if I had information that any of these were chromosomally normal I think we'd be having a different conversation. Does anyone know if hycosy v hysteroscopy v pelvic ultrasound is most beneficial to look for issues? Ive gotten mixed answers.
Thanks again and I hope next year brings better news for everyone.

Hey OP, I have had several ultrasounds, hysteroscopies and hycosies! I started with a pelvic ultrasound with a very good consultant, she told me she thought I had adhesions (following a surgical TFMR) and I had a hysteroscopy following that which is the gold standard to diagnose and treat adhesions and scarring, which I did have. I had 2 in quick succession, then a hycosy/saline ultrasound scan to check all was now fine in uterine cavity and to check if my tubes were open.

A pelvic ultrasound can check for a lot, but they often miss scarring, a saline scan sees more and a hysteroscopy is the best for checking our everything but is expensive if private, and I'm guessing NHS wouldn't do one without there being a reason for it - when I was referred to an NHS fertility clinic though they were keen to do a saline scan/hycosy quite quickly though, though I ended up doing this privately due to timings. For me, the hysteroscopy was the best as it actually sorted out my issues!

@Summerrose24 the issue is very likely to be aneuploidy. It's worth checking for other issues in parallel but yes I do think IVF and PGTA may be your surest route. My sister got pregnant every time she tried aged 39. She had 4 losses and then a successful pregnancy just as she was signing up for IVF screening but that was chance and it really depends how much you can cope with your body effectively doing the testing the hard way. About 40% of your embryos are still chromosomally normal at 39 but that's an average stat and sometimes someone can have a run of bad luck.

Thanks so much that's really helpful! A private clinic has recommended the hycosy so i suppose starting with that might be no harm and I can see what it reveals, if anything. Thanks for taking the time to reply, I hope your ttc journey is going ok too!

Thanks Sirensong, I definitely see your point and I think the question for us now is just whether we want to go through that, but also to make sure nothing physical is causing it, so any ivf would be a success. Im very happy for your sister too, but know those odds were a long shot!

@Summerrose24 wouldn't say it's necessarily a long shot. I think the law of averages means you'll hit a euploid naturally at some point. So it's just whether more losses on the road would be bearable vs isolating normal embryos pre transfer. Something specific could of course be thrown up by your other investigations but your aneuploid result for one loss (and fact most losses in general are embryonic) points things that direction.

A bit different as I was already undergoing ivf and then had recurrent miscarriages following treatment (untested embryos). Had all the blood tests and everything normal. The consultant from the recurrent miscarriage clinic said ivf with pgta would be the next recommendation and that had already been recommended by my fertility consultant too.

Even with normal embryos you won’t always have success but testing could potentially get you to a viable pregnancy faster through discounting abnormal embryos from the start. Rather than spending weeks or months on a pregnancy that was never going to be viable.

Agree with earlier poster though that pgta isn’t foolproof. It won’t necessarily lead to a live birth but it does reduce chance of miscarriage as you’re only putting healthy ones back in. Miscarriage is still a possibility but the chance of a loss due to chromosomal abnormalities is greatly reduced.

There’s no way to tell how likely you are to make normal embryos naturally if you don’t want to pursue ivf. Another few rolls of the dice and you might get lucky with the right one and have a healthy baby without any intervention. I think you need to weigh that up with the possibility of further loss(es) and the toll that might take. It’s a gamble either way and I think there’s lots of luck involved in the whole thing.