Advice for next steps post recurrent miscarriages

[Whiterabbbit]

Hi everyone, I’d appreciate some advice on what steps to take next. I know it’s a bit long, so thank you for bearing with me.
Here’s a bit of background:

• Last year, I had 2 chemical pregnancies (natural) and 1 miscarriage (IVF).
• IVF: AFC 12. I originally planned to PGTA test all embryos due to my history of early miscarriages. I managed to get 6 embryos, but only one 5-day 3BB embryo, which I decided to transfer fresh. The clinic discarded a 3CC embryo from day 6.
• The fresh transfer ended in a miscarriage at 9 weeks, followed by a D&C at 10 weeks. This left me physically and mentally devastated.
• Tissue testing revealed triploidy (abnormal chromosomes), which, in hindsight, confirms I should have stuck to my original plan and tested all embryos. This would have prevented the miscarriage and the trauma that followed.
• Additionally, I recently had abnormal APTT results (something related to blood clotting), but I haven’t had the chance to look into it properly as NHS hasn’t had time to discuss it with me.

I’m hesitant to try naturally again due to the trauma and want to test any embryos I have going forward, even though I know testing doesn’t eliminate the risk of miscarriage entirely. At least it helps rule out some issues.

My first question: If you’ve experienced recurrent miscarriages, how did you manage to keep trying naturally, or did you go straight back to IVF in the hope of testing embryos?
In my case, considering my age (40), AFC (12), AMH (12.6pmol), and history of getting only one embryo, I feel like I should bank as many embryos as possible to test them. This would likely require multiple IVF cycles, which is daunting financially since I no longer have NHS funding.
I’ve also looked into Dr. Shehata’s theories on NK cells potentially attacking the body and causing recurrent miscarriages, rather than solely blaming egg quality or age. He focuses on immune protocols, and while some people swear by it, others are skeptical. After reading numerous stories (both positive and negative), I’m wondering if I should explore this approach. While my miscarriage results point to egg quality, it could also be my body attacking cells based on my previous chemical pregnancies (which I couldn’t test for).

My second question: Given my age and situation, should I focus on IVF to bank embryos and test them, or consider Dr. Shehata’s immune protocol? I know I need to make a decision soon.
I asked my GP to refer me to Dr. Shehata’s NHS clinic, but the appointment isn’t until mid-June. On the other hand, I could get a private appointment in two weeks, though it’s more expensive. I’d save £3-4k on blood tests if I go the NHS route. From what his team has told me, if the tests indicate a need for immune protocol treatment, they’d start it 2 months before egg transfer.

My third question: Has anyone used Dr. Shehata? If so, did you go private or NHS? Could you share what blood tests are needed, and whether he would accept my recent test results or let me use my GP for them? I’m trying to save as much money as I can, as the costs of the blood tests alone are quite high, without even considering the multiple cycles of IVF that we will need to cover on top.

Thank you so much for reading, and any advice would be greatly appreciated!

@Whiterabbbit hey hope you're doing ok. Quick question for context, how come you went to IVF last year when you got pregnant twice naturally, before having any tests related to recurrent miscarriage?

I'm sorry for your losses, it's always so hard. As an aside, the most common cause of triploidy is actually the pure bad luck of 2 sperm fertilising one egg, and beyond this, sperm are also responsible for a lot of chromosomal issues so please don't blame your eggs. Your eggs may be absolutely fine! Xx

@Moosey898 hello! Our clinic suggested IVF so that we could test them before transfer so that they could try to mitigate another miscarriage. We did try naturally for 6 more months after the 2nd loss but never got pregnant so the IVF was being lined up in the background!

Unfortunately because we only ended up with 1 x embryo I didn’t want to risk freezing / thawing and transferred fresh! (which in hindsight we obviously should have done as it would have shown it had abnormal chromosomes)

Speaking as someone who has a balanced translocation, discovered by chance after a loss at 9 weeks after 4 chemicals. Have you been offered karyotyping? If you or your partner have something like a balanced translocation then it’s a very simple explanation without going into the murky world of NK cells etc. I was where you are around 6 years ago and it’s so confusing and frustrating.

@Kungfoopanda we are still waiting on our results. It’s been 5 weeks…🫠
May I ask what your journey was with the balanced translocation diagnosis?

Can you take baby aspirin if its an immune issue?

@peanutForever It may not be enough and I guess I won’t know until I try / risk it. I did take aspirin this time round but aware I miscarried due to abnormal chromosomes on the last one.

It depends if you are emotionally ready for the chance that you could miscarry again?

there is no guarantee even with ivf (as your previous experience) i guess i would weigh out your options with finances etc

personally i would be inclined to try naturally (if youve fallen pregnant before) but maybe take advice from elsewhere before you go down the whole ivf route as that seems like a long/emotional journey in itself. Or someone similar to the dr you are saying- perhaps an online clinic abroad? Something you can get a quicker appt with ?

@Whiterabbbit Aah gotcha. Like another poster, I've also been diagnosed with chromosome abnormalities after 4 losses at 11,10,8,10 weeks (all discovered on scans, after a first scan showed a heartbeat each time).

The good news about triploidy is that it tends to be more random than anything (I know it's never good news, but it's the best of the bad news if that makes sense?). Translocations tend to be between 2 chromosomes.

I've got a bit of a complex situation in that I have 2 different cell lines (unusual) both of which have issues (very unusual!). I've got a balanced translocation on one (basically where parts break off and rejoin at the wrong number chromosome) and a robertsonian translocation on the other (2 entire chromosomes stuck together). I wouldn't have known any of this without the karotyping, so I'm really glad I had it done.

I'd suggest going down the route of testing for blood disorders, thyroid issues etc. first, followed by karotyping, before trying to go into NK cells etc.

And it's always worth remembering, sometimes it really is down to just bad luck. 2 of my 4 weren't due to my chromosome issues, they were just bad luck.

Side note - we don't have any kids yet. We're continuing to try naturally currently before getting our referral from the genetics counselor because we're eligible for PGT on the NHS (thankfully as there's no way we could afford it otherwise!).

i had a very similar experience to you last year. I’m sorry for your losses.

You need to do a reccurent miscarriage panel, you’ll want to have the clotting disorder blood test 12/13 weeks after your previous one to confirm its accuracy.

600mg of CoQ10 per day + vitamin D.

read it starts with an egg.

it’s worth seeing an expert if you can afford it so you can fast track the tests.

in your position, given age I’d guess it’s bad luck but I’d want to rule other things out before trying again.

@Whiterabbbit how are you getting on?? I was also diagnosed with High activated NK cells when testing in a pregnancy state. I had 1 MMC and 2 chemicals before being diagnosed with this. I then was put onto prednisolone and progesterone along with infusions. I am now 15 weeks pregnant xxxx

@Whiterabbbit I was with Professa Shehata and i went privately to him ... the whole thing has probably cost a lot of money but its been worth it x

I’m sorry to hear of your losses.

My experience went: miscarriage, chemical (IVF), miscarriage (IVF), TFMR, miscarriage (triploidy), healthy baby.

I went through a similar thought process. However, I have a much lower AMH than you (1.1) so IVF was a challenge for me.

It’s worth checking the sperm side of things. My husband had poor morphology and, specifically, lots of sperm with enlarged or two heads. This could explain our triploidy.

He had surgery on a varicocele and I conceived our living son 4 months later. I suspect this made the difference for us.

However, I also took low dose steroids in the first trimester, blood thinners throughout the pregnancy and progesterone for 16 weeks. These were prescribed by recurrent miscarriage specialist Mr Rami Atalla. I initially came across him by chance as my Bupa paid for recurrent miscarriage blood tests and referred me to him but it seems that he has a strong reputation in the area of recurrent miscarriage so I’d recommend looking him up.