IVF after recurrent loss

[Stillhopeful12]

Hi, looking for any advice people may be able to give.

We're just about to start our first cycle of NHS IVF. We have previously had 3 miscarriages, naturally conceived. We were due our first appt with the recurrent miscarriage clinic (after waiting many months) only for it to be cancelled last minute and no cover while the consultant is off on long term sick. We had all the usual RM tests done beforehand which have come back clear.

Is there anything additional to the 'standard' IVF protocol I should be pushing for which might support with recurrent loss (bearing in mind it's NHS)? Our IVF clinic is being very vague about anything extra they can offer and seem reluctant to take our history in to account with treatment planning.

Any suggestions or advice hugely appreciated.

Thank you

[IVFat40]

Hello hun, I'm so sorry for all you've been through, I can't imagine how heartbreaking your losses must have been. To be on the safe side I would ask them to test your Progesterone around the time of embryo transfer and make sure they're giving you plenty of this. If your losses were early I'd also look in to getting your uterine natural killer cells tested and consider taking steroids to address this if high (you may need to organise the testing separately yourself though - Tommy's have a wonderful clinic/research project run at Coventry hospital with Warwick University that you can self refer to). You may already be aware of this but if you haven't already it might be worth getting your vitamin D levels checked as well. Wishing all the good luck you so deserve.

[Stillhopeful12 in reply to IVFat40]

Thank you so much for your really kind message. I took progesterone for the last pregnancy and got by far the furthest so I think there must be something in that and getting them to check it is a great idea. They've said I'll be on suppositories again but said sometimes they use injections instead, from what I've read there doesn't seem to be much benefit of one over the other I think?! Yes NK cells are definitely on my radar, we've said we'll give it one/two transfers and then go down that route. I wonder if NHS ever prescribe steroids without any of the testing beforehand. It's so hard to know what to do when there's so many options to investigate (and all crazy money!) Thanks again

[IVFat40 in reply to Stillhopeful12]

It sounds like you're already really well informed hun.My understanding, but I could be wrong, is that they sometimes give Progesterone injections in addition for women who struggle to maintain high enough levels.

The main Dr's at the clinic I mentioned are Dr Brosens and Dr Quenby if you were interested, at the risk of sounding too fan girl like Dr Brosens is basically the main reason I was able to have a baby and I've also heard brilliant things about Dr Quenby, my experience was that because they're running research projects/are within the NHS help from them was extremely reasonably priced in IVF terms, I'm biased of course but I wish I'd looked in to them sooner.

[Stillhopeful12]

I am so pleased it worked out well for you. I will definitely be looking in to this, and I think you're right, sooner rather than later. So many people seem to have had such good success when this is addressed.

[DreamingOfTwo79]

Hello, I am so sorry that you've experienced so much loss! How old are you? Have you had any of your babies' remains tested for chromosomal abnormalities? I conceived my son naturally when I was 39 and it was a completely uncomplicated pregnancy and delivery. Since we started trying for a sibling we've sadly lost four babies late in the first trimester. I only know for the last two that it was down to chromosomal abnormalities, I will never know why my first two since having my son did not progress. We went down the IVF route as this gave us the option to PGT-A test our embryos and we were so fortunate to get two euploid embryos after two rounds of back to back embryo banking (we were 43 and 57 at the time). When we started IVF, my clinic did an Ovarian Reserve Test and measured my AMH, my partner did a semen analysis and DNA fragmentation test. I also had the thrombophilia panel done (checks for blood clotting disorders) and an extensive thyroid panel (where TSH antibodies were detected which have been treated with steroids during transfer). My consultant initially suspected chronic endometritis as a potential cause for my first two losses so we did the EMMA/ALICE tests to rule this out and check I had enough lactobacillus cultures in my uterus. I also had a hysteroscopy to check for polyps, fibroids, adhesions and scar tissues in my uterus. Lastly, we did the NKC bloods and biopsy, after which I was prescribed three intralipids infusions around transfer time to balance my slightly raised NK cells. I also opted into doing a mock cycle where we checked the receptivity of my uterine lining (ERA) as I tend to have short cycles and early ovulation and luckily, this was spot on. I wanted to cover all the bases before attempting another pregnancy and we only had these two euploid embryos so wanted to be sure I had done as much as I could to maximise my chances of success. I am so happy to say that following our first FET (modified natural) I am now eleven weeks pregnant and both scans I've had show everything is progressing perfectly so far. I am feeling highly anxious in this pregnancy but trying to take it day by day.

My stims protocol details are in my profile if you're interested. I'm wishing you so much luck for your next steps and hope that your dreams will come true. X

[Stillhopeful12 in reply to DreamingOfTwo79]

Congratulations, what wonderful news after such a difficult time. It sounds like you really put everything in to this. We're both 32, unfortunately haven't had any of ours tested, I wish we had, especially for the last one as it was late in the 1st tri ,but the hospital were not helpful at all and I just didn't push for it. What made your consultant suspect endometritis? I have recently had a hysteroscopy and biopsy which was all normal, so hoping that would've shown anything. Were you ever offered blood thinning injections even though all thrombophillia testing was normal? It's something my clinic have said they sometimes use but not sure about it. In my last pregnancy I had a subchorionic haematoma and I wonder if this played some part in losing it, so concerned whether blood thinners would be potentially harmful in future.

Wishing you the absolute best with this little one, pregnancy after loss is so cruel.

[DreamingOfTwo79 in reply to Stillhopeful12]

Thank you so much for your lovely wishes x

As for chronic endometritis, apparently this is more common in women who've given birth before and she was mainly going by my lack of symptoms for an impending miscarriage in both cases, I never had any prolonged bleeding/spotting or cramping leading up to the losses. With my second pregnancy I also had a sizeable hematoma but I am hearing different opinions from medical professionals, some seem to think it could contribute, probably depending on location, but others are adamant it's unrelated. It's so difficult to find closure sometimes when we don't know why things ended so sadly.

Yes, I have been put on 20mg Inhixa injections during transfer and for the first ten weeks of pregnancy as a precaution (mainly because of my age, though, I am 44). I am also taking 150mg Aspirin. The thrombophilia panel did not show any signs of blood clotting disorders in my case but I was glad to have had it checked. In case you end up with another SCH in your next pregnancy they would typically advise to stop the Inhixa until the SCH has resolved but you might be advised to continue with a reduced dose of Aspirin. This is currently happening to a friend of mine and as with so many cases, the medical opinions differ and in the end it was up to her own choice which of course only adds to the stress you're feeling anyway when you experience a lot of strong bleeding in early pregnancy.

Keep up the faith, lovely, I know it's so hard to keep going sometimes. Much love x

[Stillhopeful12 in reply to DreamingOfTwo79]

Thank you, that is honestly so helpful! You're so right about so much being left to us and the pressure and guilt this can cause. It's great we've got places and people such as this to discuss it and air thoughts. All the best to you x