Two transfers, one chemical and one 10 week miscarriage

[Sofie1994]

Hello, hope you're all doing well 😊

I was hoping for some advice. I'm 30 and my partner is 39. We've recently did ICSI. The first transfer of a 5BB was a chemical. The second one (4BB) just ended in a 10 week loss after a perfect 8 week scan. Heartbroken of course.

We have:

• endometriosis
• adenomyosis
• low AMH 3-4pmnol
• low sperm morphology 1%
• partners age may contribute

We are lucky enough to have 4 embryos left from a round we did three years (I've always known about my fertility issues and we preemptively froze embryos when we were younger). I'm wondering whether to go forward with another FET, or investigate whether there are any underlying causes of the miscarriages that could be helped. As I haven't had three miscarriages I can't be referred to the recurrent miscarriage clinic, so any investigation we would have to pay for on top of our FET as we used all our NHS funding (one cycle and one transfer).

I'm just not sure what to do. I don't want to waste my embryos but it is possible we've just been unlucky with the two miscarriages.

Any advice is appreciated, thank you, and I hope my post is not insensitive as I realize I'm lucky in some ways to have embryos and implantation so far.

It doesnt sound like you have an implantation issue, id say, have your embryos tested if thats a possibility. Early loss is usually down to something being wrong with the embryo. Also have you had your partners sperm tested at all? Poor sperm and low sperm can cause chromosomal abnormalities in the embryo there for ending up in a MC. Im so sorry for your losses but your doing everything right for yourself. Do something nice to treat yourself and definitely talk with your clinic further about other things they can do or supplements you and your partner can both take.

Thank you for your reply ☺️ I did consider getting the remaining embryos tested because the cost is a factor holding me back I think, but to go through this heartbreak again is something I want to avoid so I will look into it. I'm also wondering if he has high DNA fragmentation - but this was never tested before these embryos were made. Thank you

I’m really sorry for your losses. Did they alter your transfer protocol to account for your endo? Although I agree with miracle mum that it sounds like the issue more likely lay with a chromosomal abnormality in the embryo than your uterine environment. I completely understand the fear around transferring your remaining embryos without seeking more investigation and have a similar dilemma myself.

However truly you may not need this, carrying until 10 weeks seems like a really good indication? - can you request a follow up with your clinic to get their opinion on this?

There is a small risk with thawing and refreezing embryos for testing. It’s so hard.

Worst case scenario, if you need another cycle in the future, your partner can optimise his sperm with things like anti oxidants - did he do that this time? My partner is 44 with 1% morphology and we got a good fertilisation/blast rate following him supplementing with ubiquinol, NAC, ALA, carnitine, vitamin D & wellman.

You’re still young, you have options.

Hello! Thank you so much for your reply ☺️ and I'm sorry you're facing a similar dilemma it's really hard.

No it was an NHS clinic and they had standard protocols they wouldn't deviate from, so there was nothing to combat the endo/adenomyosis despite me asking. I read about how adenomyosis can cause progesterone resistance in the uterus and often more progesterone is needed but they wouldn't give me any more than standard. I have asked for a follow up to see what they think went wrong although my other embryos are at a private clinic and I'm hoping they will listen to my concerns more.

I'm really glad to hear you and your partner managed a good fertilization rate, it's reassuring to hear that things we can do actually have some impact as a lot of this is outside our control. My partner stopped drinking, ate better and took Wellman. One concern we had was that he's on setraline and the consultant told us this can decrease sperm quality but by the time we knew that, it was too late to reduce the dose etc and to be honest the setraline is important for managing his anxiety.

Thank you for your thoughts it's appreciated and I hope you get some answers on your jour
ney.

That’s troubling that they didn’t alter your protocol to account for your endo. It’s possible to use Lupron suppression for 2 or 3 months to reduce inflammation and improve the chance of implantation. I hope your private clinic treats you better.

Hi, sorry to hear about your difficult journey. My first two transfers were similar to yours - I had a missed m/c at 10 weeks after a normal 7 week scan and then a chemical the next round. I lied at my GP and said I had had a m/c years before so got a referral to the RMU - perhaps not the most ethical way forward but I know some areas will refer after 2 but mine wouldn't and it feels even crueller when it is IVF that you have to wait for 3 and use up your funding/spend loads of money before anyone cares enough to explore why. Anyway, if not an option perhaps ask your GP for some blood tests. One of my clinics wanted me to pay for loads of tests following our losses and the GP agreed to do the ones they were able to (some were too specialist). I don't think the RMU actually tested for much in addition to these beyond doing an internal scan.The ones the GP did were:

Full Blood Count
Coagulation Profile
Factor V Leiden Common Mutation
MTHFR Common Variants
Anticardiolipin Antibodies

They found a MTHFR Mutation from these. The RMU said the NHS doesnt consider this a relevant factor unless you have a second trimester loss but one of our private clinics did and prescribed clexane and baby aspirin as a result. This was the round that worked (after some other unsuccessful rounds in between the m/cs and this) but it was also a different protocol and clinic and we had the embryos pgta tested. My partner also had an embolism. So it's difficult to say what made the difference or whether it was a combination of it all or just pure luck but I remained on clexane and baby aspirin throughout the pregnancy just in case that was a factor.

I do think testing the embryos is worth it personally - it is costly and doesn't guarantee success but I found it helpful to know I wasn't wasting my time on transfers that were always doomed to fail.

Good luck with it all.