Webchat with Professor Siobhan Quenby on recurrent miscarriage on Friday 29 January from 1 - 2pm

[SallyRoseMumsnet]

Hello

We’re pleased to announce a webchat with Professor Siobhan Quenby, Obstetric Consultant at University Hospitals Coventry and Warwickshire NHS Trust and a Professor at the University of Warwick. She’ll be joining us for a live webchat on Friday 29 January from 1 - 2pm.

She runs recurrent miscarriage, implantation and preterm prevention clinics dedicated to the management of and research into recurrent pregnancy loss prevention. She has over twenty years of experience in research into implantation and recurrent miscarriage and has published over 120 original articles and 22 chapters for academic books.

Of course Professor Quenby won’t be able to give detailed clinical advice to individuals on this thread, but she has a wealth of clinical and research experience in recurrent miscarriage and is keen to offer help and advice to MNers with questions about this area, as well as talking with you about the ongoing work of her Coventry clinic.

So please do join us on the day at 1pm or if you can’t make it, please post your questions in advance here. As ever please do also remember our webchat guidelines.

Thanks
MNHQ

What suggestions would you give for explaining rmc to GPS who are "behind" (eg use phrases like chemical pregnancy for 1st trimester losses and/or blame stress or other old wives tales) to encourage them to refer? I know so many whose heartache has been compounded by this!

I have a balanced translocation of chromosomes 9 and 18. I lost five pregnancies before my daughter joined us last year(I was about to start PGD at Guys when I found out I was pregnant with her). I would like to try for another baby in the not so distant future, is there anything that I can do to improve my chances of not having a genetically "wonky" baby, that I will go on to lose? All of my other hormones etc were completely normal so it is just the genetics that are causing the losses.
Not quite rich enough to afford a cycle of PGD!

Hi. Please help.
I had a bad uterine rupture with my 2nd child in 2009 and since then I've had 8 miscarriages. The latest 3 were 2nd trimester losses at 18, 14 and 16 wks respectively following spontaneous rupture of membranes. On the last 2 I was being treated with clexane injections daily and high dose folic acid. The most recent I also had a cervical suture fitted at 12wks. Tissue samples have shown no abnormalities with babies. I was having weekly scans and all seemed to be going well this time around until my waters went at 15+3 and then I was induced due to infection 4 days later. I have extensive adhesions (from uterine rupture) of my Fallopian tubes to abdomen wall and uterus to bowel that cause pulling pains during pregnancy and following the recent loss a surgical placental acretia removal has caused ongoing pain for which I'm being treated with oxycodone. I'm due to have a laperoscopy in Feb to investigate the cause (thought to be the adhesions). My question is
In your professional experience could extensive adhesions be the cause of 2nd trimester losses and what can be done?
Getting desperate for answers😢
With hopeful thanks
Ellie

Sorry not a question. Just a great big thank you for all your help through my pregnancy. Without your help and intervention, my now 14 month old little girl may not have been here

In your experience, can women who have miscarried suffer from postnatal depression?

Hello. I had a miscarriage of one twin in 2014. I have my survivor. Obviously I know how much of a blessing she is, we are so lucky. My question is, we want to try for another baby, but I don't know if I can emotionally cope with another loss.. What is the likelihood of it happening again? Many thanks.

I have 2 children but also three consecutive miscarriages. All the Nhs tests came back clear but I was diagnosed with PCOS. Is this the likely cause of the miscarriages? How does it affect pregnancy and is there any treatment?

As someone who has paid the £360 to visit the Coventry Implantation clinic where you currently carry out miscarriage research, I would like to know the implications of you being involved in the new Tommys miscarriage research centre. Does this mean people will be able to have NK tests done for free funded by Tommy's? Will you still be working at the Coventry clinic? Are there any new things you have up your sleeve that you want to investigate/new treatments that Tommys centre might offer to people, or will it be just an extension of the good work that is being done already by you and Prof Brosens re NK testing/using progesterone and clexane to a larger number of women to gain more evidence that your protocol helps? Just wondering if there is any point anyone who has already been to your clinic trying to get seen again once the Tommys research starts, and if so how do people get referred to it?

I suffered a miscarriage at the beginning of the year. The baby had died at 9 weeks + 3 days, the day before our reassurance scan. My husband and I had conceived through IVF using donor sperm. For this pregnancy I was prescribed clexane, aspirin and cyclogest, I also had two infusions of IVIG.

In June 2015 I had a very early miscarriage, IVF again. I think it may have been a chemical pregnancy?

Over the course of two rounds of IVF I have produced 21 eggs in total. Four have been transferred with the others being poor quality and not making it to be frozen. Would this suggest that I have poor egg quality?

My other question is should we be considering a change in donor with our pregnancy history?

Thank you

I am hoping to visit the Coventry clinic soon as I know so many women who have overcome rmc and had successful pregnancies due to the protocol used there. Please could you explain the theory you have regarding why so many women have successfully carried a first child (more commonly, it seems, a boy) and then seem to experience rmc when trying for another? How does the environment of the uterus change due to pregnancy that makes nk cells to rise, and is there any way this could be reversed? Thankyou.

I have two quick questions (currently following your protocol for low uNk cells following three first trimester losses):

Shouldn't all rmc'ers try the pred, progesterone and heparin combo (irrespective of uNk cells levels) because of the proven success rate of this protocol?

Will the results of the PROMISE trial have an impact on your protocol in future? Do you still believe progesterone helps rmc'ers?

Thanks :)

Hi I'm 43 but in last year I've had 3 consecutive 1st tri m/c. I already have 3 boys, youngest born in 2013. He was a twin but m/c at 6/7 wks. I've had 3 c sections.
All my m/c test normal & was told I must have old eggs. Since last c sec I have nerve pain down one leg almost constantly and severe pain on sneezing. Had hysteroscopy to check for adhesions but clear. Not sure they looked outside of uterine cavity though??
Are m/c due my ageing eggs? Should I just give up on idea of another baby? Would baby be likely to have abnormalities

Hi, I visited your Coventry clinic last year and despite normal uNK levels, I now have a 10 month old after progesterone from cd21 and clexane from 6-12 weeks (thank you)

What do you think of the promise trial results and do you think the progesterone being from CD 21 is what made cases like me successful, rather than only from positive testing.

Hi, I suffered 3 missed miscarriages before being blessed with my most amazing daughter. I got pregnant a forth time before any testing was able to be carried out and before we were able to come to Coventry. My specialist followed the Coventry protocol though and prescribed me progesterone and prednisolone and also heparin. We now want to try for a sibling for our daughter but don't think we can face a further three losses, emotionally or physically. What would be your recommendation in regard to the drugs if I were to fall pregnant again? If they worked last time, would I be able to use them to have a successful pregnancy again or does each pregnancy 'reset' your body and so you have to start the whole process again? Can I just say a big thank you on behalf of all the women I know who you have helped. You really have made a difference.

I am another Coventry pom pom waver, my son was born in March last year after visiting your clinic. I had previously experienced five consecutive early MCs. The support from Prof B and your team was amazing, and I really hope your research will have the national influence it deserves. Here on the RMC thread, your treatment and protocols have been a hot topic for a while, but without this knowledge I doubt I'd have found you on my own. How is your work affecting things at a national level? Will there be positive changes following our "trailblazing" do you think?

Hi
I have been lucky to have 2 children but also 5 mc, I've had nhs tests and all clear .. I've heard about the Coventry programme through the rmc thread and would like to know if it would help me at all... I have a bleeding disorder von willebrands as does my husband, would there be a link ? I was prescribed aspirin after mc 3 and progesterone and then had my son but despite using the same protocol following my son I've had a further 2mc . But with aspirin thinning the blood and my blood already not clotting well am I doing the right thing?

Hi Professor Quenby,

I came to see you mid April last year, I tested 7.41% for uNK cells.

I also want to send you many thanks for the positive vibes that you and all who work at your clinic exude.

I started on the Coventry protocol immediately after I visited in April.

When I stopped the progesterone on day 29, I had a negative pregnancy test, I then had a 7 day, very very watery, bright red bleed.
2 days later I had a positive pregnancy test.

Scans revealed no sign of a pregnancy and after 10 days of monitoring, I miscarried.

My GP has notified me that heparin is blacklisted in Buckinghamshire, and GP's are unable to prescribe it.

Unfortunately, due to health problems immediately after that miscarriage and an operation last year my husband and I were unable to try again for a child.

I am now 40 years old, have had 4 early miscarriages in the last two years and desperate to try again, but feel at a loss as to where to turn to next.

My questions are:
If I were to make the decision not to take heparin, would this seriously affect my chances of a healthy and successful pregnancy?

If the drug protocol was to fail again, what other treatments are available for us who suffer recurrent miscarriage, especially at age 40?

Would IVF help a woman suffering from recurrent miscarriage in anyway?

Many thanks and kind regards

Hopefully I won't need your advice as I'm currently in the very early stages of pregnancy following our 4th round of IVF. My one previous pregnancy (from IVF) resulted in a mc at 5 weeks. I'm in Sweden not the UK so I wondered if you had any advice on how to persuade my doctors about such revolutionary ideas as an endometrial scratch, let alone any other treatment, if this doesn't work.

And if I can't persuade them will the Tommy's clinic be open to non-uk residents?

I saw prof brosens at the clinic in april last year and am now 32 wks after following the protocol for high uNK of steroids, progesterone and heparin. Firstly, thank you so much for providing this testing / treatment. I really hope you are planning a full scale double blind trial for this protocol soon so it can become a standard treatment under the NICE guidelines, which would hopefully make the medication easier to obtain!

Secondly, since finishing the steroids, I've become aware that i seem to have flare ups of some immune symptoms maybe once a month - an increase in allergic rhinitis, eczema like patch on my chin, and an itchy hive type rash on my legs and tummy. I've had all these symptoms regularly before, the latter two only since the birth of my daughter, but only just noticed that they all come at once. Could this bear any relation to the cause of my recurrent miscarriage?

I know that the NK cells are not attacking the embryo, but could whatever is causing these immune events also be causing the high NK and the disruption of the endometrium?
Several of the women in our recurrent miscarriage group report similar immune symptoms or other things like extreme reactions to insect bites or food intolerance and I wondered if there could be a link. Have you ever collected type of data?

Hi Professor Quenby.

I visited your clinic in spring last year after 3 miscarriages after NHS tests found nothing wrong. I was prescribed progesterone subs clexane and my 4th pregnancy was a success and I now have a beautiful daughter. Thank you for your help, I am incredibly grateful and like others on here champion the clinic.

My question is, if I decided to try for a 2nd child, would you advise using the same protocol again? - so progesterone from 7 days post ovulation and clexane.

If yes, what do you advise if your GP feels that having had a previous successful pregnancy, the protocol is not necessary?

Ooooh I didn't realise this webchat was happening today.

My partner has a very high DNA Fragmentation Index of 59% which may or may not be the cause of 3 losses. To what extent does DNA frag increase miscarriage risk as far as science is aware?

I attend the Coventry clinic last week and currently awaiting my unk cells results. Whilst my rmc consultant is supportive, I know others consultants aren't so and have been known to describe the Coventry clinic as another snake oil. Why do you think this and what more can be done to over come this?

test

My partner and I suffered 2 miscarriages. First miscarriage at 12 weeks and another one at 6 weeks pregnancy. The first one ending with D&C operation. We didn't wait with second pregnancy and get pregnant after first period. Also I have a problem with sperm low volume and high level of abnormal sperm 92%. I need to mention that we have a healthy nearly 2 years old daughter. I'm 38 and my partner 39 and we live in Leicester. Could you answer a few questions:

1, What is the chances that getting pregnant so quickly caused the 2nd miscarriage as it was straight after the D&C operation. Should we have waited at least 2 cycles?

2, I thought abnormal sperm meant we would struggle to get pregnant in the first place? Is it this causing the miscarriages ? Why did the doctor say we would go down the IVF route?

3, Are uNK cells test are a part of the IVF route anyway?

4, What Is different about the tests you offer in Coventry clinic as opposed to the NHS tests?

5, How long do the tests take?/ How long before we get the results ?

6, What would happen once the tests come back ?

8, It is worth having the tests at this point or try once again?

Do you think that it will ever become standard protocol to prescribe your treatment plan without testing for high NK cells in women with recurrent loss?