# Missed Miscarriage - Is It Age or Should We Try Again?



## Sarah Sue (Mar 8, 2010)

Hi everyone,
As you can see from my history, after 2 failed ICSI attempts, I finally got a BFP on my third cycle. I was over the moon but sadly after six weeks, I was informed that my baby was not growing. I am now due to have an ERPC on Monday, which has left me feeling devastated. My question is, as my husband is 57 and I am 40, are we ever likely to get a healthy pregnancy from IVF and should we try again or is this miscarriage an indication that we should just give up and explore other options? Any thoughts or opinions greatly appreciated! S x


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## isobel snow drop (Feb 2, 2009)

Hi and firstly Im so sorry that you're going through this heart break   

I was thinking the same as you (Im 37) but my consultant assured me Im not too old yet    Ask your clinic to do some routine bloods hun as it could be something simple that could be  sorted easily. Mine came back negative and we had another m/c so now we are currently waiting on chromosome testing but I think they will come back fine too so we are at a loss as to what is causing our "bad luck"

You're going through so many emotions at the minute so please take care of yourself and let your heart heal before you stress about another tx. 

xxxxxx


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## Sarah Sue (Mar 8, 2010)

Hi Isobel,
Thanks for coming back to me so quickly. So sorry to hear about your m/c too. I've booked a meeting with my fertility clinic in December to discuss our options but I don't think they are able to do chromosome testing. May just have to take another risk and see what happens. 

Btw, You are definitely not too old at 37   .
S xxxxxx


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## isobel snow drop (Feb 2, 2009)

Hi Sue,

Check what tests you can get done free with your clinic  when you have your follow up, you may be surprised at what they can do for you. In the mean time take very good care of yourself xxxx

ps- feel 87 today not 37


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## nvb (May 31, 2008)

Hi Sue...so sorry to read of your MMC and can totally empathise with what you're going through having just gone through the same. (We cycled with DE and got our BFP but at our 2nd scan at 8+4 the heartbeat had stopped)
At our age a lot of our eggs are chromosomally abnormal and IVF kind of 'forces' a pregnancy so the risk of MC/MMC is a lot higher. 
As our cycle was with DE we were totally gutted....but we are using TESE sperm and so that may be to blame.
We are having one last cycle with my OE but having testing done prior to fertilisation to weed out any chromosomally abnormal eggs.
There is also a test called Array CGH which may interest you. This tests the embryo at day 5 and so far, clinical studies have shown it gives a high live birth rate for ladies over 40. We were initially going to go for that but the problem is over 40 you may not have enough embies at day 5 to test.
I'm sorry that you too are going through this....to have a MMC after IVF seems doubly cruel as we have gone through so much just to get that BFP. Thinking of you xxx


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## Sarah Sue (Mar 8, 2010)

Thanks for your suggestions. I have made an initial inquiry to CARE in Nottingham who offer Array CGH. I'm a bit concerned though that I'm running out of time as I'll be 41 by the time I get round to another cycle. I'm also going to start looking into adoption as well.
I'll keep you posted about how I get on.
Sarah xx


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## ♥JJ1♥ (Feb 11, 2006)

I am so sorry to hear of your loss I had my mmc when I was 37 on my first cycle, I suppose we loose sight that miscarrages are also common in younger women.  I went for mc investigations privately straight away and was diagnosed with raised NK cells.  
I have had various steps along the way and now going for surrogacy but using my own eggs. I contemplated CGH and went for 2 consultations and wanted CGH but in fact I am not a good candidate for CGH as I never produce enough eggs and have never got to blasts so am not a good candidate for them. I am going try.

Wishing you luck with CARE you are in gd hands
L x


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## SamJ (Mar 25, 2008)

Hi Sarah Sue

So sorry you have had to go through this.

Im 42 and found that nobody is that interested in helping us get to the bottom of why we are mc.  Its mainly the usual ' its your age' and does make me feel that i should be giving up the ghost with my own eggs.  Which we did, then went down the donor egg route but that didnt work and then found ourselves pg naturally three weeks after, but mc at 8+3, emailed my consultant with  some questions but not heard anything yet.  

Good luck with Nottingham let me know how you get on.

Looking into the private tests for nk cells with Care Manchester that JJ1 mentioned - shame we have to pay to get anyone to listen.

nvb - i dont understand how you can get to such an important development such as the heartbeat, for then it not to go on and develop any further, is it because its around the time when all major organs are forming?? If our eggs are chromosonally abnormal would that not lead to the development of the heartbeat or is it after that it causes problems. I know statistically when you see a heartbeat the chances are around 95% to see the pg through.  Ive been told that after second mc i was 'unlucky' after seeing the heartbeat on both m/c,wonder what my consultant would say having been through a 3rd mc and again seeing the heartbeat. 


Sam


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## daisyg (Jan 7, 2004)

Dear All,

Just offering my story because I believe you really have to fight to have miscarriage tests, especially over 40 as age is so often blamed.

Obviously, the huge majority of m/c are caused by chromosomally abnormal eggs. Even an abnormal embryo can develop a heartbeat (e.g. Down's and Turner syndrome embryos), so that is not necessarily a sure fire guide.

However, if you are repeatedly failing or miscarrying ESPECIALLY with DE, then it is logical that other tests should be carried out.

Here are most important areas:-

*Uterus* - Check no fibroids/polyps etc. Do you achieve a good lining and triple stripe? (v. important)
*Thyroid* - Your TSH needs to be between 1 and 2 for fertility. Also check T3, T4 and antithyroid antibodies.
*Clotting* *screen* (including Antiphohpholipid Syndrome, Factor V Leiden, prothrombin gene mutation and MTHFR). 
*Autoimmune* - Thyroid (above), antinuclear antibodies, lupus anticoagulant, RA factor etc.
*Infection* for you and DH - Ureaplasma, mycoplasma, Group b strep., chlamydia etc.
*DH* *sperm* - dna fragmentation etc.
*Karyotype* for you and DH to check for any genetic issues
*Immune* *issues* e.g. NK Cells/Tnfa etc. - needs a specialist RI to do these. Either through some clinics or independent specialist - N.B. These are much more unusual issues than the above, which are more common causes of failure.
*Embryo* *Testing - *If you can afford, then CGH testing or PGS/PGD could be considered. BUT you need to make enough embryos to make this worthwhile.

Many of the above tests (excl. immunes and CGH) can be done via your GP.

If you have Homozygous MTHFR you need to be taking 5mg folic acid, 50mg B6 and 1mg B12 daily for at least 2 months before you cycle. I would recommend this regime to anyone over 40 cycling TBH. 
For MTHFR you also need to be on 40mg clexane from start of cycle.

For those taking clexane/prednisolone, it is also important that it is started at the beginning of the cycle for maximum effectiveness.

I started with OE ivf at age 44. Got pg but miscarried. Changed clinics; - pg but miscarried. Went to US, transferred 6 OE embryos. Pg but miscarried at age 44.5. Moved to DE, but miscarried. M/c with next DE cycle.

It was only because I fought for referral to St. Mary's Recurrent Miscarriage, in conjuntion with consultations with Dr. Beer/Dr.Gorgy and Dr. Ndukwe that I was diagnosed with several major issues (MTHFR ****, Factor V Leiden, and autoimmune issues).

I finally found success after a donor embryo transfer in Spain using IVIg, prednisolone, clexane, extra vits and gestone.

I would recommend the basic testing above and a referral to a sympathetic clinic/consultant who will support extra testing.

Lister
ARGC
Care Notts
Mr. Gorgy
St. Mary's Recurrent m/c (do not support immunes, but prescribed my clexane and steroids and all my antenatal care and birth there under their wonderful support).

Sorry this is so long, but time and time again I see women written off for being too old who then go on to fail with DE. Yes, it is very likely that the major problem with own eggs (and often with DE) is chromosomal abnormality due to age, BUT there may be other issues in
tandem with this that must be addressed.

Finally, some clinics will prescribe clexane/and or steroids even if no cause found and this is something to be considered. Most important is that you find someone to support and monitor you with these drugs as they are strong meds.

Best of luck to all of you,
Daisy
xx


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## SamJ (Mar 25, 2008)

Hi daisyg, sarah sue,nvb

hope you are all ok

Thank you daisyg for your post, like you say its a shame you have to fight tooth and nail for the tests.  Was advised by Care that we would only need a few of the immune tests if we were going down the donor route, but will take that up with them when we see them next.The only ones i havnt had done are the Immune and infection.
Dont think i would ever see the words 'sympathetic clinic/consultant together   

Arranging an appt for early next year - so hopefully will be able to find some answers.

Thanks again for such an informative and helpful post .

sam


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## nvb (May 31, 2008)

Hi girls...

I tried to get my GP to do the Level 1 tests but was refused. I went back to my clinic and paid for the Thrombophilia test which has come back normal. I am having clexane with my next cycle. I don't think a MMC/MC with DE is too uncommon as even though we use younger eggs, there is still an element of risk associated with it. We are also using TESE sperm so can't rule out that being the cause of our problems. Our Consultant told us that they scan at just over 6 weeks and then again at just over 8 weeks as this is the critical time for the fetus and this is when they see most MMC's/MC's happening.


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## lilysilver (Feb 1, 2011)

DaisyG, I just wondered - what were your autoimmune issues?  I just found out that I have "moderate to strong" anti-nuclear antibodies. Were you prescribed prednisolone?  Although CARE do use it for such a thing, my CARE consultant told me at the outset (before my results) that he doesn't bother with it.  I know there is no evidence it helps, many clinics do prescribe it; and ANAs are associated with RPL and infertility.  I didn't go any further with CARE in the end. It took me three months to find out my test results... Anyway, just wondered if the autoimmune issues were addressed in your case.

Thanks,

Lil


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