Recurrent miscarriage - which test should/could they do now?

[JBrd]

I had an early scan on Sunday, and even though I'm nearly 8 weeks, all they could see was an empty sac, no fetal pole and no heartbeat. Measuring 4 weeks, but there is no doubt about my dates.

This is my 3rd miscarriage in a row, and I am completely heartbroken and crushed. No idea where I will go from here.

They will scan me again next week to see how things are progressing. Since this has now happened 3 times, I think I will qualify for having tests to try and investigate why this keeps happening.

What do/can they test for? I want to go with specific questions, but right now, I don't know what to ask for. I really want to get to the bottom of this, even if it means to get any test under the sun.
I don't seem to have any problems falling pregnant, it's the staying pregnant, which appears to be an issue. Or actually being able to form a viable foetus...
I realise that it might well be my age (I'm 41), but then again, I had DS when I was 39, and lots of my friends had normal pregnancies in their forties. So until they can prove to me that my eggs are failing, I'm not going to put it down to that.

Should DH get any tests done?

Any advice/suggestions are welcome, right now, I'm really clueless.

Jbrd think I recognise you from TTC after MC/preg after MC threads, and v sorry you are going through this again. Come and join the recurrent MC thread - not where anyone wants to end up, but an endless source of support and information.
I'd really encourage you to try to get any products tested this time if the miscarriage is confirmed at your next scan. You need to know if you are losing babies because of a chromosone problem, which might be linked to age, or for another reason. I've had so many people telling me it's my age (38) until I finally got MC4 tested and it was chromosonally perfect.
Other than that, after MC3 I had a midcycle scan to check for PCOS and that I had a decent endometrium, and a whole raft of blood tests (for thryoid, clotting, APS, autoantibodies, FSH/LH, karyotyping). DH needs to donate one tube of blood for karyotyping. I also had anti-mullerian hormone tests, which are not available on the NHS, used to check for PCOS and to give an indication of ovarian reserve, useful if you are in late 30s/early 40s.
All my tests were normal, but I had another miscarriage, so now I'm being seen in Coventry where they are researching abnormal stromal growth during the latter part of your cycle and high NK cells as causes of early miscarriages - this is not available on the NHS.

If you want reading material to gen up, I'd suggest Mary Regan's book "Miscarriage - what every woman needs to know" "Coming to Term" and perhaps "Is your body baby friendly" though I didn't find it an easy read.

Baking Yes, we were on the ttc thread together for a while, I remember you! Sorry that things haven't worked out for you, either, it's just soul-destroying.

Thank you for the info, at least I have some starting points now. I shall be doing quite a bit of research before my next scan on Tuesday. I was too upset right after my scan on Sunday to ask about anything - and my EPU are being extremely cautious anyway, they didn't actually call it miscarriage or pg loss yet, all they would admit to was that I'm measuring only 4 weeks, when I'm almost 8, and that nothing can be seen , but that they wouldn't expect to see anything at that stage anyway!
However, they did that for my previous mcs, I think they are just covering their backs. Even if they do find a heartbeat next week (that has happened to me as well, with my first mc), the measurements just do not match my dates, and I think the outcome is 99% certain.

I'm not even bleeding yet, in fact, I have not physical problems at all. Just hoping that it won't be a long and drawn-out affair...

I'll check out the recurrent miscarriage thread, thanks for the tip!

They just have to be 100% sure that it's not a case of mistaken dates. V frustrating when you are sure of yours. My most recent MC in June was like that - measured 2 weeks behind at 7.5 weeks, then 2.5 weeks behind at 8+ weeks but with a faint HB, then 3 weeks behind at 9+ weeks, then I finally MC. All the way through nobody could give me any hope since I was certain of dates and each time there was less development than there should have been, but with a HB there nobody could do anything to end the limbo. It was awful
I hope you get clarity at your next scan.

Thank you katatonic, it's just so sad that we all have to come together here. I'm currently at the stage where I just want to stamp my foot and shout 'It's not fair'! It really isn't, but sadly, that doesn't help.

How are you doing?

kat That sounds horrendous, I think the waiting around and not knowing is the worst. Are you off work now? Any idea what will happen after your scan next week?

There's a lost to be said about the emotional detachment for protection - after having a meltdown on Sunday, when we had the bad news, I definitely have gone into denial, surprising myself at how 'normal' I am currently functioning. I've decided to keep going to work until things actually kick off for certain, and I find it actually helps me to keep busy.
Just worried that it'll all break down at done point, which I know it will. Hopefully, I'll be at home and safe then...

I was sent away for a rescan after no sign of heartbeat on my first pregnancy. Heard tales of another friend who had everything work out fine after doing the same, but not for me.

I had 2 more mcs and was given tests. I didn't ask exactly what tests were being done, but they drew 4 lots of blood from my DH and 10 from me to test for different things.

I did read an excellent book on the causes of mcs and what tests are carried out and came to the conclusion that I hoped I wasn't diagnosed with any of them.

As it happened, we went to our consultant's appointment and he shrugged his shoulders. There was no known cause found for my MCs - "just one of those things - go away and keep trying" was what we were told.

We did that - and were really lucky. I got pregnant for the 4th time and had a bleed. I expected another mis, but when we went to the scan we were shown my DDs heartbeat, and an empty twin sac that was probably the cause of the bleed (sonographer said that as scans got better and better, they were showing more and more cases like mine, where it could have been twins, but one failed very early on).
My DD was born perfectly healthy and is now 12.

When we planned to have DC2, we were prepared for more mcs, but caught straight away and had my DD2 8 years ago.

I had got to the point of questioning "How many more times do we try?" but then it all worked out really well.

That sounds like more waiting on the horizon for you, kat, what a joy... Surely if they thought it could be an ectopic, they would be a bit more watchful? My EPU is also very hands-off, always trying for natural management. I think they draw the line after 12 weeks, but I honestly hope that something will happen before then, one way or another. Another 4 weeks of this misery?! Please, no.

2kids Thank you for sharing your positive story, it's good to hear that there are good outcomes in spite of everything.

I will certainly have to ask myself if I can face ttc again. As much as I would love a brother/sister for DS (I never wanted an only child, in fact that was one of my conditions for DH when we decided to ttc back then), I'm starting to wonder if it will happen... After 3 mcs, I feel tired, drained and deflated, so much heartache and pain, I don't know for how long I can keep going.

But for now I'm trying to take one day at a time, it's all I can cope with at the moment.

Hi there, I just want to say how sorry I am for your losses and ongoing difficult times. I've had 5 miscarriages altogether. 2 followed by my daughter, then 3 more and now I have a 7 month old boy. I only finally got here by getting a referral to St Marys in London, where I tested positive for 'aps' IGM anticardiolipin antibodies. My local hospital got these tests WRONG!! So if you can please get your GP to refer you to St Marys. Wishing you better times ahead as I know how awful recurrent miscarriage is. X

Hi sorry to hear about your losses. I too was referred to St Mary's after six miscarriages. After the first three we had tests at our local hospital which found a problem with one of DH's chromosomes, but basically said we had a 50/50 chance of a successful pregnancy. After a further three we asked to be referred again as at those odds you'd think one of them would have been ok.

Our local hospital referred us to St Mary's and they did further tests and decided I needed to take 150mg Aspirin as soon as I found out I was pregnant until 36weeks. As a result our next pregnancy ended in the birth of our healthy DD in March last year. I was nearly 40 when I had her.

They told us later at our local hospital that they advise any woman over 35 with recurrent miscarriages to take aspirin while pregnant - under medical supervision of course - why they couldn't have told me that the first time when I was 35 I don't know. Certainly worth asking about.

I wish you the best of luck for the future.

kaster Thank you for sharing your story - I struggle dealing with 3 mcs, I cannot imagine how you can deal with 6!

The aspirin is something that I come across again and again. I've been taking 75mg/day since we started ttc again after my 2nd mc, and although the GP recommended it, too, she said that she can't tell me 'officially' to take it, as it's apparently not in the guidelines.
I will definitely ask about it.

Went to the EPU again today for another scan - they discussed all my options, and I have decided to continue to wait and see if it'll be a natural mc. It's unlikely they will consent to do an ERPC, and I don't want the medical procedure, if I can avoid it. They're going to have another chat with me next week to check how things are going.

Once the mc is complete, they will now start investigations into possible causes.

There is no agreement amongst the experts about aspirin if you are not diagnosed with one of the clotting problems. I had all the tests after MC3, nothing found, was told to take aspirin, progesterone, folic acid, had MC4, now been referred to Prof Q at Coventry who thinks that aspirin can be counterproductive if there is no clotting issue and told me not to take it. I know Raj Rai at St Mary's has told someone else the same thing.
So like everything else surrounding MC it is not clear cut.