Recurrent miscarriages- investigations and treatments

[Kaliou]

Hi all,

I have had 4 miscarriages in a row since January 2020 trying for baby N1.
I have been referred to recurrent miscarriage clinic after 3. Done all the test possible. Blood tests, etc. Everything came back normal. Husband’s too on private. Genetics analysis on 2 babies came back normal.

I have recently seen a private recurrent miscarriage specialist in London who had done more blood tests (all normal too) and is now suggesting a hysteroscopy Even though I had the womb checked many times and especially twice during investigations (3D), this well known professor suggests to do a thorough examination in case there is an unspotted issue with the shape of the uterus.
Has anyone done it?
The professor suggests to try again and not take any medicine for next pregnancy.

Also, I have self referred myself to a clinic in Coventry to check natural killers cells. 1st biopsy came back normal, I did the 2nd one recently but high chance that this will also be normal.
The professor at that clinic thinks, since all my miscarriages are missed ones and happening around 6-7 weeks, that I will benefit on taking prednisolone (steroids) along with progesterone and maybe aspirin. Last 2 pregnancies I did take progesterone and aspirin, and I know there is little evidence they these can help but I more interested here in any experience around steroids.
His thought is that maybe my endometrium is enflamed or getting inflamed when pregnant and steroids could help.
Has anyone been using steroids for recurrent miscarriages?

Do you have an opinion on these 2 different views?

trying again (5th time) with no medication help
use steroids on next pregnancy

Also do you think thee is any benefit on doing an hysteroscopy?

Littles research in this area means that even the top specialist in recurrent miscarriages disagree in the unproven causes and treatments which make things more challenging.

Thank you for your help,

I've not had the procedure done but was referred to Prof Quenby at UHCW after my third and was recommended the procedure to check for endometritis but fell pregnant again before I could have it done. In my last one they prescribed me progesterone but I ended up having a CP with that anyway, then my blood tests came back which showed everything was where it should be.

I have an appointment with them next week for a scan and blood tests to see how this pregnancy is doing but decided this time to just give it a go without any progesterone as it didn't seem to make a difference last time. I was also told not to bother with aspirin as my blood wasn't sticky and they've not said anything about steroids but I'll ask them about that when I see them.

I think it's so difficult to be told no one really knows why you're miscarrying, especially since all of mine have been different types of miscarriage. I think there's no harm in doing the hysteroscopy just in case. In terms of endometritis, they recommend a certain type of antibiotic. If you contact Prof Quenby's team and ask about the endometritis trial, you might fall under their research criteria to have the procedure done

I’ve no helpful advice but just wanted to send some good luck that whatever you do works for you. My friend is going through almost exactly the same thing and it’s just awful 😢

Thank you for your reply.
I have seen Professor Quenby but I don’t have the criteria needed for her trail. I have taken doxycycline for the last pregnancy ended in miscarriage.

Professor Brosens is the one doing the biopsy’s and recommending the steroids because of MMC.

It looks like you have different types of miscarriages while I have always the same pattern of miscarriage. It sounds like the professors do take this information into consideration.

Regardless good luck with your new pregnancy I ll keep my fingers crossed for you. Do keep me updated if you get any information re steroids, etc.

Thank you so much Sarah! Good luck to your friend too!

@Kaliou ahh I see, I'd definitely look into whatever is being suggested then. It's worth a try I'd say since yours seem to be around the same time. It seems like they're all around the time when the placenta is formed which would be why they're suggesting steroids id think?
I'll definitely ask at my scan though as my MMC showed the baby stopped growing at 5 weeks which makes me worry that it's something to do with the placenta.

I didn't have the testing done but I took prednisolone and progesterone for my fourth pregnancy, after 3 early losses. For me personally I think the steroids were what I needed, and I now have my 2 month old baby boy.

I'm sorry this is happening to you, it really is shit

@robyna they did not talk about the placenta but more about the fact that the endometrium may get inflamed and so is not ready to keep the pregnancy growing.
Worth asking about the placenta though… definitely.

Have you previously done some other investigations to rule out the main issues?

@Daffodil21 thanks a lot - reading this is giving me lots of hope. Did you have any side effects with steroids?

@Kaliou I had blood tests done and that's literally all. I was going to do the trial but didn't in the end. All my blood tests came back normal so I think they were just going to go off whatever the trial showed next but I ended up getting pregnant again. If my scan does end up showing I've miscarried again then I'll push for the NK cells tests but not sure whether I'll be able to get them on the NHS

I expected to see you here, Daff @Daffodil21.

OP, so sorry. Recurrent miscarrier here too, I had a similar story, lots of investigations on me, DH and third baby we lost and no identified issues. I self-referred to Coventry and was just before the biopsies when I fell pregnant with DS - currently just over 8 weeks old, happily snoozing on my chest.

I ended up taking baby aspirin and progesterone in my fourth pregnancy. Prednisolone if prescribed is prescribed in very low doses so shouldn't harm you. Coventry is a great clinic and if that's what they suggest, I'd give it a go personally. I'd also get your uterus investigated- I've seen so many stories where things like these were missed on standard scans or patient wasn't even told. I myself have tilted uterus and only found out randomly at a private scan after 2 losses - the obstetrician was gobsmacked no one told me before (they must have seen it). In my case it didn't have any negative implications, but I'm just pointing out they don't always tell you all they can see for some reason.

It's a tough call re trying again from where I'm sat because my fourth pregnancy succeeded without Prednisolone and I too suspected either NK cells issue or clotting issues but appearing only in pregnancy when no one tests you for APS. But I think in your circumstances I'd give Pred a go as it's unlikely to harm. Discuss baby aspirin too. Best of luck xx

@Kaliou yes. I had rapid weight gain and had gained about a stone but the time I had my 8 week booking appointment. I have stretch marks on my thighs from then rather than later pregnancy and I developed a very obvious moon face. I was also absolutely ravenous with hunger all the time. It was like I couldn't eat enough, which obviously didn't help with the weight gain! The moon face and general puffiness did go down when I came off the steroids though. It wasn't pleasant at the time but obviously it was all worth it. I'd do the same again if we had another but I wouldn't enjoy it!!!

@robyna I don’t think that it is possible to get the NK cells tested on NHSin my understanding. It looks like the cheapest and best options is at the implantation clinic run by Professor Quenby and Professor Brosens under uhcw. Price is £540.
I have had so far a really good experience being under their care.

Sorry I should say your womb as well as uterus - a thorough scan xx

And you are correct, NHS does not offer NK cells testing xx

Hello @PurplePansy05 (and @sarah13xx too!) I almost didn't click the post because I'm happy all that is behind me, but I couldn't help myself. It really is so shit to go through as you know.

@Kaliou I hope we have both given you hope. It really does just break you

Indeed, I feel relieved now to have it all behind me, it was an awful, awful time. But I had people on here being great help to me and I'm sharing the wisdom now. OP, you'll get through it - hope we've given you some hope. It's bloody tough right now, but won't always feel like this xx

@PurplePansy05 thank you for your message and congratulations! This is great and really helping to hear that.

Thank you for your advice. I have almost made up my mind to go with the steroids this time.
I thought of doing the hysteroscopy too but it will be under private and it is quite expensive (I think 1-2k) Insurance does not take it. It will also push the next time we can try again to get pregnant again. My husband is not convinced it does make too much of a logical sense to look into it after talking to some other specialists (+he is a doctor so have better understanding than me on medical’s).
However, if it happens again or I have a later miscarriage because I have not checked this and I do have an issue I will regret it …
I need to keep doing some research but there is no much about it..

@Daffodil21 thanks for sharing this. I guess indeed it is definitely worth it. Although the idea of gaining weight etc is not great I am more worried in case there is issues on breaking hips and especially on the baby with cleft lip and palate. However specialist told me that it has not been proven that it can affect babies. Testing on mice though did.

Bloody hell, I've just looked it up and you're right, it's over 2k now for the hysteroscopy. Could you go to a private consultant and get a referral to have it done on the NHS? Appreciate this might mean few months wait though. I think if that's the case, I'd be trying without it on Pred and possibly progesterone and baby aspirin until your hysteroscopy appointment. Do you have any previous scans to show private consultant, to at least identify if you have a septate uterus? If this is eliminated, it should give you some peace of mind were you to fall pregnant soon xx

And a private consultant will likely scan you anyway so at least the most obvious issues will be eliminated. Regarding the impact of Pred on the baby, I've not come across anything negative. Tommy's should have more information. I think you need to put things into perspective though - any increase in risk could be minimal and the overall risk would remain extremely low anyway. Whereas it might be the case your pregnancy won't even progress without it, IYSWIM. I know it's a lot of guesswork, but you've clearly researched things well already and you need to think rationally about balancing the risks. xx

@Kaliou what do you mean about broken hips..? I've not heard that one. They mentioned the possibility for a cleft pallet but said it was a very very small risk. At the time I just thought I'd rather the baby had a cleft pallet but be alive, as it is something that can be fixed. He is fine though and he doesn't have one

Have a look here about the alternatives to hysteroscopy too:
www.tommys.org/pregnancy-information/pregnancy-complications/uterine-abnormality-problems-womb

I would also suggest having your cervix length measured early on in your next pregnancy if you have concerns about late miscarriage. A stitch can be put in early if there is this sort of an issue, but it's very rare. I had what seemed like a fluid leak early in the second trimester and had my cervix measured at a private scan which was very reassuring xx

@PurplePansy05 definitely I have asked to be referred to this hospital to try do it under the NHS. 1st appointment is in January. The solution you suggest is actually the one we were thinking to do. Try now under the steroids progesterone and aspirin. If unfortunately it does not work we can look at doing the hysteroscopy.
Yes I had lots of scan including one which was a 3D one. They looked at the womb and I do not have a septate uterus. The professor told me that it is still possible that I may have a small issue she can fix and have not been detected before. The team in conventry does not think it should be looked into it.
Thank you for your help!

Oh if that's the case then I'd go ahead just as you said @Kaliou. Keeping everything crossed for you xx

I second @PurplePansy05 's recommendation to get your cervix length checked during later pregnancy. I pushed for this on the NHS but would have gone private otherwise. I really have no idea why this isn't checked as standard

Hope it works out for you it really is horrible, but as @PurplePansy05 says, you will get through it and one day this will all just be a horrible memory x