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,

Hi @Kaliou I’m so sorry for your losses. I’ve had 4 recurrent miscarriages too all around 6-8 weeks.
Like you every test we have had has come back as normal. My 5th pregnancy however has stuck. This time my consultant prescribed me clexane injections 4x400mg of cyclogest to take a day and aspirin from 6 weeks which seems to have worked. I’m now 34 weeks.
“ His thought is that maybe my endometrium is enflamed or getting inflamed when pregnant and steroids could help.” my consultant thought exactly the same except she prescribed me antibiotics to take on day 1 of my cycle for two weeks. It’s actually an on going trial in Warwick hospital. The antibiotics are available to buy online although I am sure if you mentioned it to your consultant they may prescribe you them. I’m positive they are what helped my baby stick x

warwick.ac.uk/newsandevents/pressreleases/trial_of_new/

Sorry @Kaliou I’ve just seen you’ve already taken doxycycline. All my bloods came back as normal and they still prescribed me clexane injections as the blood can sometimes be thicker when pregnant

@PurplePansy05 thanks for the link to tommys! Interesting. Also for the cervix length checked did not know ..

@Daffodil21 I have been told that steroids can cause fracture of the hips (of the mum at the time of taking it) although it is rare.

@Daffodil21@PurplePansy05 hopefully 🙏🏼 Thanks so much for the support

@NovRainbow5 congratulations! Thank you for sharing your story. Can I ask who prescribed you with clexane? a local hospital or a recurrent miscarriage clinic?

Your RMC should be prescribing you everything, unless you are getting private prescriptions. You won't be dealing with your local hospital, it will be bettween RMC/private and your GP at this stage. Then GP and community midwife between 12 anf 17 weeks and then Obstetric Assessment Unit at your local hospital from 17 weeks.

@Kaliou my private consultant prescribed them. I had all my tests and medication etc done through a clinic as there was an 18 month waiting list in my nhs hospital x

Get tested for coeliac disease if you haven’t already. I had 4 mcs and then 3 babies on the prednisolone+progesterone treatment. Later found out I had coeliac and if I’d given up gluten I probably wouldn’t have needed the steroids. Treatment was all private, nHS tests found nothing wrong. All my mcs were early - 2 spontaneous at 6 weeks, 2 missed but stopped developing at around the same time (pre heartbeat). Once I saw a heartbeat I was fine.

@NovRainbow5 @PurplePansy05 thank you!!

@HarrietM87 interesting. I might ring my GP to ask. Would it not be checked already in all the blood tests done for recurrent miscarriages though?

@Kaliou I had 4 losses in 12 months after a successful pregnancy 3 years before. I went to see dr Shehata at the CRP clinic. He specialises in NK cells but doesn't do the invasive testing / biopsy - he does it through blood tests. In my case he found that I have a normal number of Nk cells but when he put those cells into a simulated pregnancy state, they were overactive and that's what caused the losses. I am 16 weeks now having been under his treatment plan. He uses hydroxychloroquine or prednisolone to treat it depending on your individual circumstances. I'm obviously not a success story yet but can only say this pregnancy has gone on far further than any of my losses. I'm sorry you're going through this, it is really really crap, but I hope you have success next time 🤞

@HarrietM87congratulations on having 3 babies!! And thanks for sharing your success story!

Coeliac disease is not part of the standard RMC tests @Kaliou. xx

Oops typo - only have 2 babies but would love another 🤣. I was treated by Mr Shehata too. Coeliac is not a standard test but it does cause miscarriage. With my profile (I have hypothyroidism) I feel that it was pretty negligent not to test for it tbh, on the part of both the NHS and Mr Shehata. The NK stuff is just a theory. The steroids treat symptoms but not the underlying cause.
Given that a huge proportion of coeliac sufferers have “silent coeliac” (ie no symptoms) in my view it’s very likely that this is a big and overlooked cause of recurrent miscarriage.

@Kaliou do you follow “the worst girl gang ever” on Facebook? There’s a group on there where you can ask about what treatments etc people of had and they’re very informative too x

@treesall thanks for sharing! I keep my fingers crossed for you. I don’t think Coventry tests NK cells during pregnancy. Interesting to see that it change I will take the question to the clinic at Coventry.
@PurplePansy05 thanks I thought it would have been picked up but in that case I will defo ask my GP to go get me tested

Just to warn you that there is another side to this . I was put on the prednisolone for unexplained miscarriages by a well known private London specialist and I ended up with secondary adrenal insufficiency and loosing my health for the rest of my life . I would have never done it if I’d been fully aware of the risks . We had a second child in the end via ivf and surrogacy in the US. Before you do anything do the research also into the risks of secondary adrenal insufficiency after steroids use

@Nordicmom What dose of Pred were you on and for how long if you don't mind me asking?

I always understood adrenal insufficiency is rare and temporary in a sense it goes away once cortisol levels return to normal? And I would expect in the context of recurrent miscarriage it is very unlikely to occur as cortisol would likely have been too high to begin with? Did you have any undiagnosed or underlying health issues before Pred therapy?

@HarrietM87 2 is already great 😅 Thanks for the information
@NovRainbow5 I don’t follow it no I will take a look. The problem though with facebook is that everyone can see what groups you follow and not many people know about my miscarriages and I don’t really want them to know.
@Nordicmom thanks for the heads up and sorry to hear that. I’d be interested to know the dosage you were on and the length. How did you get diagnosed?

@Kaliou hey lovely did you ever have success with predionsole at the end ? X x

Yes indeed :) my daughter is now 20 months old 🥰
where are you at now?

I had another miscarriage in December and went again through a test at the clinic with Professor Brosens. The test they now do is much more advanced and I have been diagnosed with low nk cells and immune tolerant as well as an unbalanced of immune system. I will take sitagliptin and then steroids