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

Hello Prof Quenby. Thanks for coming on. I'm 33, had 2 mcs last year, now ttc again. Would you recommend aspirin as a matter of course? GP unwilling to do any tests

Sorry for the delay.

Hello everyone. We've had a lot of questions so lets get started.

@sarahjkl82

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!

There are some excellent studies which show with womenwith balanced translocation and miscarriage have a good chance of having a 'normal' baby in the future. The data suggests that uterus is so good at supporting normal pregnancies but allowing abnormal ones to miscarry that doctors tests and interventions are of little benefit. The best thing is to try again and be confident that your uterus will work well.

Hello Professor,

I have a couple of friends who have suffered miscarriage after miscarriage.

I wondered whether you have any advice on how to support them - what language to use; anything to avoid saying? I feel forever on the cusp of saying the wrong thing, but don't want to stay silent either?

Many thanks

@Ellie24oc

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

This is complicated case, adhesions do not cause miscarriages but I recommend a referral to a speicalist such as myself to discuss options to prevent second trimester miscarriages. In particular, I would discuss trans-abdominal suture with an expert.

@kellys86

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

Thank you for your kind word and congratulations.

@SeriousStuff

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

Yes, women who suffer a miscarriage can suffer from severe depression similar to post traumatic syndrome. It is important this is recognised and appropriate counselling is give.

@Alabama23

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.

Having another twin pregnancy is rare and miscarriage is more common in twin pregnancy so hopefully you would concieve again with one pregnancy and the likelihood of it happening again would be rare.

@Loopyaboutmy2boys

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?

The Tommy's research is funding some new treatment trials to try and prevent miscarriage. These are free but do not involve the NK test. One is a trial of just scratching the lining of the womb to see if this alone prevents miscarriage and the other is a trial of a diabetic drug which may improve the lining of the womb as a sign effect. Both this trials have not be done anywhere else in the world before so we are excited to have the opportunity to have some results.

@MaudGonneMad

Hello Prof Quenby. Thanks for coming on. I'm 33, had 2 mcs last year, now ttc again. Would you recommend aspirin as a matter of course? GP unwilling to do any tests

The trials have shown that aspirin does not prevent miscarriage. As part of Tommy's research we intend to make some tests and research available for women who have had two miscarriages. Please get your GP to refer you to myself as you will help the research and improve this situation for other women.

@Louloulou999

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?

The aim of our research is to get better tests to determine which women need treatment. It is important to realise that 70% of women with recurrent miscarriage will end up with a baby with no medication. This means, the way forward is to improve the NK test to ensure it is accurately predicts who will miscarry and who needs treatment to prevent this.

Hi

I have a daughter who is 2 and then have had 3 miscarriages within 7 months . They were all early , 2 at 7 weeks and 1 at 5 . I'm now waiting to have a period so that I can have Nhs blood tests , my scan came back normal . Do you think it's important to let my body rest for a bit before trying again and how do I go about registering with Coventry if my Nhs tests come back that there is no problem ? Thank you

Re the Tommys research, I had the scratch at Coventry in November, and thanks to the wonderful Prof B diagnosing my PCOS when he was called in to see my scan because it was such a mess inside me, I am now taking metformin. Is that the drug you mean? Or might it be worth me contacting you re the Tommy's trials if I don't get pregnant soon? (This is our first cycle ttc as I had to abstain in December to get my smear test done so am due to use a pregnancy test early next week)

@girliesaints

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?

At University Hospital, Coventry we are pioneering new tests and new treatments based on the lining of the womb. This means, whilst we have more knowledge of the lining of the womb than anyone else we do not have the complete answer. We are extremely grateful to all patients who attend as they all are helping to add to our knowledge and as a result we are world class in this field.

I ended up needing metformin in my two successful pregnancies as I got gestational diabetes. I wonder if there was something underlying for my 5 miscarriages but all tests came back normal for diabetes when not pregnant

@EmmyL2013

Hi

I have a daughter who is 2 and then have had 3 miscarriages within 7 months . They were all early , 2 at 7 weeks and 1 at 5 . I'm now waiting to have a period so that I can have Nhs blood tests , my scan came back normal . Do you think it's important to let my body rest for a bit before trying again and how do I go about registering with Coventry if my Nhs tests come back that there is no problem ? Thank you

Physically there is no benefit from waiting but psychologically it is often a good idea to give yourself time to recover from your miscarriage. This recovery time is the ideal, is the ideal time to been at the University Hospitals, Coventry miscarriage clinic to have tests and learn out our research projects so you can join in them if you want. Contact [email protected]

I had gestational diabetes too and noticed that a host of minor health niggles that had pre existed my pregnancy (blephartitis, thrush) cleared up when I was on a low GI diet. I have never been prescribed metformin as my fasting glucose levels have always been good (even when I had gdm and high post meal spikes)

Hi Professor

Thanks for doing this webchat. I was wondering what you think of miscarriage care and how women are treated by those responsible for their care? What can realistically be improved to help women following a miscarriage?

@patienceisvirtuous

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 :)

It is important to realise a research unit who is constantly improving our protocol, we do not feel we have the perfect protocol yet and with the Tommy's funding we expect this to improve sigificantly.

@Kowza

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?

All these questions are those that the Tommy's is funding research into. Birmingham Women's is leading on sperm tests on recurrent miscarriage and here at University Hospital, Coventry we are leading one tests and treatments of the lining of the womb. You are welcome to have our current tests, the results come back in four weeks and by doing this we use any leftover piece of womb lining to improve tests and treatments in the future. These are questions we hope to be able to answer in the next few years by coming to see us you would be part of the solution.

Hi Prof Quenby
What is the chances that getting pregnant after one period caused the 2nd miscarriage as it was straight after the D&C operation. Should we have waited at least 2 cycles?
Could abnormal sperm (92%) causing the miscarriages ?

@Imps9

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?

Tommy's is going to fund a project that will enable us to answer this question as I agree it is very important. Birmingham Women's Hospital is leading this part of the research.

Hi Prof Quenby.

I am 32 and have had 5mcs since may 2014. I am yet to have a successful pregnancy. 3 of my mcs have been mmc where foetal development stopped at around 6 weeks. The other 2 were full natural mcs at 5weeks. For one of these (mc4) I was on the Response trial. For mc5 I was on progesterone and clexane.

Is it likely that the mmc and the natural mcs were a result of 2 different problems?

My paternal grandmother had at least 7 miscarriages in the 1930/40s before conceiving and carrying my father. What are your thoughts on a possible genetic /inherited link here?

Following discussions with other ladies who have experienced recurrent miscarriage we noticed that a disproportionate number of us are 1.teachers 2.cat owners 3. Suffer quite severe reactions to mosquito bites! Do you have any thoughts on whether these things can potentially heighten the immune system therefore possibly impacting in pregnancies?

I am planning on coming to Coventry in a few weeks time for the unk cell tests and am really hoping you can help us find some answers.

After the uNK test performed by Prof Brosens, my recommended protocol is progesterone only. We're currently on 3rd cycle of ttc.

I feel anxious only relying on the progesterone - especially after the results of the promise trial. Would it do any harm to have heparin and pred too, as well as the progesterone? I feel I want to throw everything at the next pregnancy if I am lucky enough to have one.

Would Coventry be supportive of prescribing the 'full protocol' despite my results not indicating I need it?

@TinyTear

I ended up needing metformin in my two successful pregnancies as I got gestational diabetes. I wonder if there was something underlying for my 5 miscarriages but all tests came back normal for diabetes when not pregnant

At present, the reseach trials do not show that metformin prevents miscarriage however, it is logical that it may prevent miscarriage is some women. This is an area that needs further research and we hope by having a National Miscarriage Centre we will have sufficient expertise to tackle this problem.