Questions to ask at cycle review after two failed pregnancies

[Harlem25]

Hi, we have our cycle review next week with our fertility clinic. Because we’ve now had two failed pregnancies we’re due to speak to a consultant rather than a nurse. I’m after some advice on the questions I should be asking? A bit of background, I have PCOS and borderline underactive thyroid which is currently under control. Our first ivf cycle resulted in a missed miscarriage at 6 weeks then recently I’ve had a miscarriage/pregnancy of unknown location which I’m still a bit confused about. We still have 5 frozen embryos left but I really don’t want to go through another loss again. Are there tests I should be asking to have? Sorry for the long post. Any advice gratefully received. X

[Imperfect89]

Hey, I was offered an endometrial scratch after two losses & also a double transfer. The consultant said to me that they can only see the outside of the embryo & do not know what’s happening internally but they expect 50% of embryos to be chromosomally normal and that miscarriages tend to happen when they’re not. My advice would be to write down anything that pops in your head up until your appointment no matter how big or small. We are all faced with the big question why but don’t get the answers we hope for. Stay strong & keep going xxxxxx

[Harlem25 in reply to Imperfect89]

Thanks Freyabelle. Can I ask, what is a endometrial scratch? And did it work for you?

[Imperfect89 in reply to Harlem25]

I didn’t have it because I didn’t actually have two losses, I had a baby & a loss, the consultant didn’t have my paper work correct or something. I think it’s where they scratch away abit of the lining in hope of a better chance. Xxx

[hannahkc in reply to Imperfect89]

Hi Chel, sorry to hear of your losses, it's tough to face into another round of treatment after all that and a good idea to get as much info from the doc as you can. Be prepared a lot of it is just down to luck. But egg quality is a big factor - it sounds like this isn't an issue for you though. Then implantation success/failure depends on many things.

I have had endometrial scratch. This is where the womb lining is scraped to a) collect cells to test for NK cells (immune response cells which are rare but can harm/reject the embryo) and b) the scratch process also agitates the womb lining which had been found to benefit *some* but not all women by generating good hormones.

A nurse/doctor does the procedure, similar to a cervical screen but a few seconds are quite painful!

Your doctor should advise if this is a suitable procedure for you or not.

Good luck with what you decide next xxx

[Chel91]

Hi, are you taking Metformin for PCOS? It's been shown to reduce miscarriage for those with PCOS, so definitely worth asking for if not, or maybe a dose increase? Also low-dose aspirin might be helpful, not just as a blood thinner, but it does target some of the specific PCOS issues, such as increased inflammation. Perhaps enquire about getting a hysteroscopy if you haven't had one recently to double check the uterus?

Also, I've recently been reading about Letrozole induced FETs (rather than using HRT), looks pretty promising for increasing implantation and reducing early pregnancy loss, especially for those with PCOS. I'm in a similar position to you, so been trying to find everything that might help xx

[Harlem25 in reply to Chel91]

Thanks Chel91. This is really helpful. No I’m not on Metformin, I was told they had stopped prescribing for PCOS but like you have read that it can help, I’ll definitely ask. I’ve never had a hysteroscopy so will look in to that too as well as the letrozole. X

[Chel91 in reply to Harlem25]

Oh I see, just so you know I take Metformin for my PCOS, I switched fertility clinics this year and both still put me on Metformin. My new clinic upped my dose to 1500mg a day. My periods are nearly regular for first time in 20 years, so I would definitely say it's working for me so far. Also I forgot to say that my new dr also recommended Myo-inositol supplement for PCOS, I take 2000mg a day (you can buy it over the counter) if you don't already. Best of luck hun xx

[Harlem25 in reply to Chel91]

Thanks Chel91. I’ll definitely ask about metaformin then. I’m taking myo-inositol already so will continue taking it.

[Snow345]

I would definitely ask for a NK cells test where they do a biopsy of your uterus on day 21. They can also do blood tests to check your immunity. I had 3 failed ivfs before they did this but they do say that high levels on Nk cells can cause recurring miscarriag or implantation failure. If that is the case, they can treat you slightly differently on your next ivf cycle with steroids and intralipids. I've also got PCOS and take metformin as they've said that can help with pregnancy but so far nothing. I'm not sure if the scratch will help you as you do actually get pregnant, my doctor didn't want to give it to me as she said there's not enough medical evidence to say it helps. I can't imagine how hard it is to actually get pregnant and then lose it. Prayers and thoughts are with you xx

[Montgomery2]

Hi I've had 3 failed transfers. They did an ERA, Emma/Alice test. Everything was normal. I need to ask if they tested for NK cells in that because I'm not sure. I've had a timed transfer the last 2 and this time I've had blood thinners clexane. Basically they've said that we've thrown everything but the kitchen sink at my round this time. So fingers crossed 🤞 might be worth looking into for you x

[alockie]

I am sorry to know your story. I would recommend digging into the reasons why mcs happened. Genetics is one of the common reasons in many cases (you need to do karyotyping, and/or consider combining IVF with PGS NGS), eggs quality (IVF DE or RPR), and others. Knowing the reasons will help you tailor your treatment in the future.