New to IVF - any advice

[Sunflower004]

Hello, I'm new here

I am due to be referred for IVF and wondered if you had any advice for me, or should I be asking any particular questions? Feeling a bit anxious, I'm on my fourth year of trying for our first after 4 miscarriages through natural pregnancies and feel totally exhausted by it all.

I am also wondering whether I should start taking ubiquinol but I'm not sure what dosage.

[soccerkt6]

Hi lovely, welcome! I am so sorry to hear about your struggles and miscarriages, four is a lot for anyone to go through. 💔

Given your history, I would say that you should definitely undergo some thorough investigations before embarking on IVF. IVF is great at two things - creating embryos and then popping them back in the uterus for them to implant. However, it seems your body is already getting to the point of implantation all on its own. So either the embryos are abnormal for some reason or something is happening after the embryos implant that's causing you to miscarry, and that's what you want to get to the bottom of. There are several common reasons for recurrent miscarriages, so I've outlined the tests below that you may want to consider:

1) Has your GP offered you a recurrent miscarriage blood panel? You're eligible for it after three miscarriages and it tests for clotting and thrombophilia issues as well as a few other things. If you haven't had this done yet, I would definitely start by requesting it from your GP.

2) Karyotyping test. You might also be able to request this from your GP. Karyotyping is a blood test that looks at your chromosomes to see if you have any chromosomal abnormalities that could be causing genetic problems with your embryos. You and your partner should both have it done.

3) Sperm DNA fragmentation test. Your GP may have already ordered a semen analysis for your partner (which measures sperm count, movement, etc), but there is another, more detailed, test called the DNA fragmentation test which looks at the DNA in sperm to see if it has any breakages. High sperm DNA frag is a known cause of recurrent miscarriages so it should be ruled out early on. This is a speciality test that you should be able to have done through your local IVF clinic.

4) Immunology tests like checking for high natural killer (NK) cells. If your immune system is overactive, it can view embryos as foreign invaders and fight them off, leading to miscarriage.

There are more tests beside these, but these seem to be the most common issues and what I would check for first, if I were you.

Best of luck. This journey can feel interminably long, frustrating and exhausting, but you are in excellent company here and the ladies on this forum are incredibly understanding and kind xxx

[Sunflower004 in reply to soccerkt6]

Hello, thank you so much for your reply, I have had tests with the NHS for recurrent miscarriage and karotyping all of which came back fine. I've also had my uterine NK cells tested, all fine again but I haven't had any nk cell blood tests done. Hoping it's all been bad luck and IVF might help if they can pick a good embryo. It does feel like a long journey, thanks for your help. My hospital won't test for thrombophilia because I don't have a family history of blood clots xx

[soccerkt6 in reply to Sunflower004]

Ah, I'm so glad to hear that you've had some investigations done already, though it's always frustrating to hear that 'everything is fine' when something clearly isn't! When you had your karyotyping test, did your partner also have it done?

I would def push for the DNA frag test before you start your cycle because if your partner's results come back high it will affect which sperm selection technique they use for your cycle (conventional IVF is normally used when the man's sperm sample looks normal, ICSI is used if count or motility is low, PICSI/IMSI/MACS/ZyMot are used for high DNA frag). From my own experience, I had three miscarriages which came down completely to my husband's high DNA frag results. Every test for me came back completely normal and it was only once we fixed his DNA frag that things started improving for us.

Since you've already had a decent bit of testing, the other two things I would suggest are testing your uterine microbiome to make sure that you don't have any infections, and having a 3D saline scan of your uterus to make sure you don't have anything like a septate uterus/ polyps/ fibroids which can cause micarriages. The microbiome testing can either be done via an endometrial biopsy like the EMMA and ALICE tests, or via an at-home test like the Fertilysis Female Microbiome test - fertilysis.com/tests/female.... Fwiw, Fertilysis also does thrombophilia testing which might be helpful if your hospital won't do it. The saline scan can be done by most IVF clinics.

Sorry for the long messages! Hopefully it's helpful in some way xx

[Sunflower004 in reply to soccerkt6]

Please don’t be sorry for the long messages, I appreciate your help .

My husband also had the karyotyping done and his was ok too, I know one of my losses was most likely due to chromosome issues as we had testing done but I’m unsure on the others.

I’ve recently had a hysteroscopy and my uterus shape looked ok and they removed some mild scar tissue most likely caused from previous MVAs.

That is interesting about the DNA fragmentation, I would have no idea how to treat that if there was an issue. I think I was told having a healthy lifestyle would be the only way to improve it.

I’ve never heard of the uterine microbiome.

Thanks for your help xx

[soccerkt6 in reply to Sunflower004]

Male infertility is almost always very treatable but it seems really poorly understood by most fertility doctors. The first NHS fertility consultant that we saw early on in our journey said that there was nothing to be done for male infertility besides lifestyle changes, so we didn’t investigate my husband further because we figured it was a bit pointless. (In hindsight, I can't believe we didn't question this because it seems like a bonkers comment!) However, when we found out a year later about his DNA frag we started investigating more and found Dr Jonathan Ramsay, who is one of only a handful of urologists in the UK who specialise in male infertility. As it turns out, there are a few common causes of male infertility - like varicoceles, infection in the urinary tract, hormone imbalances, etc - and they can almost all be treated very easily. But getting the DNA frag test done is the first step, and if it comes back high then I'd recommend seeing someone like Dr Ramsay who can help you diagnose and treat the underlying issue causing the DNA frag.

Good luck! xxx

[Eloquentia]

Hello. Very best of luck with the IVF! Have you read 'It all starts with the egg'? Some really good advice on food supplements and lifestyle changes. For stimulations, I took Ubiquinol 400 mg (I think), vitamin D spray, Zinc and Vitamin C, as well as probiotics. My clinic later recommended Proxeed for both me and my partner. In terms of questions, I would be asking for a progesterone blood test two days before and on the day of the transfer. I think increasing my dose of progesterone made the difference for me. Good luck!

[Sunflower004]

Thank you for your reply