# IVF Aged 42 Following Recurrent Miscarriage



## Sally Kate (Jun 13, 2007)

Hi Everyone

I've followed discussions here for ages, but never posted before, so here goes:

I've just started my first IVF cycle in a last ditch bid to have a second child.  My 42nd birthday is looming.  We've been trying for ages, but I've had four miscarriages in a row over a couple of years.  Some of these seem likely to have been due to a blood clotting disorder - family history of Lupus and Anti Phospholipid Syndrome, and others to chromosomal problems (non-recurring but age-related).

I have been getting really conscious of time running out, so in a bid to accelerate conception I tried IUI, and have now moved on to my first IVF cycle. The question of consent for the number of embryos we transfer has come up, with the clinic suggesting a maximum of two.  Obviously we haven't reached a stage yet where we know whether this will even be an issue (fingers crossed), however, they have told us we will need to secure the Clinic Director's authorisation should we wish to transfer three.    Given my dismal recent obstetric history and the fact that both my partner and I are positively geriatric in reproductive terms, I'd assumed that in the event of being lucky enough to have three decent embryos we would transfer all of them.  I'd really welcome any thoughts?  I'm also struggling to find data on the risk of multiples aged 40+.


Sally Kate


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## Cotswold Girl (Nov 16, 2006)

Sally Kate,

Firstly welcome. I'm sorry to hear that you've suffered so many miscarriages, I can only imagine how devastating that must be. 

Regards transferring more than 2 embryos I think the maximum you can transfer in the UK is 3 and I'd seriously ask your clinic if they could get agreement for that ahead of your cycle. Even if you decide against transferring 3 at a later stage you'll find it one less worry to have got agreement before you start. I'm not sure if the odds of multiple birth are increased because you already have a child but generally speaking I don't think the odds of us older ladies ending up with triplets is that high. It's a very personal choice about how many you decide to transfer and when you get to the point of deciding how many to transfer you can take a steer from the embryologist based on their view of the quality of the embryos they are choosing. 

Good luck, CG xxxx


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## daisyg (Jan 7, 2004)

Sally Kate,

I am very sorry to hear about your sad experiences and recurrent miscarriage. Before continuing with your cycling, have you had thorough recurrent miscarriage testing - you and DH? There are two lists here which contain relevant tests, and I would really recommend you have them before trying again. After four miscarriages you are certainly entitled to investigation.

http://www.fertilityfriends.co.uk/forum/index.php?topic=80433.0

http://www.fertilityfriends.co.uk/forum/index.php?topic=82741.0

With your family history, sadly miscarriage can be more likely. What medication are you taking and are you being effectively monitored for your APS and Lupus? Are you being prescribed clexane, aspirin and steroids as these have been found to be effective in cases like yours.

Regarding how many embryos to replace. I would go for 3. The chances of you giving birth at age 42 to multiples is pretty slim - sadly more chance of not getting pregnant I am afraid (I have had 6 embryos replaced in the US and still only had a singleton pg). Here is some information from the US which suggests that 5 or more embryos are effective for over 40s - standard practice in the US where they have much better over 40 live birth rates.

http://www.ingentaconnect.com/content/klu/jarg/2001/00000018/00000010/00343777?crawler=true

http://www.medscape.com/viewarticle/521860

Finally, are you with a good clinic with very good live birth rates for your age and experience of handling your health issues? This is also very important as you need a world class clinic with a great lab and embryologists.

Wishing you the best of luck

Daisy
x


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## BG (May 23, 2006)

Hi Sally Kate,
I am nearly 43 and sadly waiting to miscarry for the 2nd time.  My 1st IVF was unsuccessful due to having loads of empty follicles, infact they were all empty.  I changed to Menopur and had less follicles but 10 eggs.  3 fertilized and I had no problem at all in them putting all three back in.  We had a BFP but lost our little angel at 6.5 weeks.  I left it for over a year and then tried IUI which again was successful but lost this one at 6.1.  The clinic are looking at my blood to see if I have the same as you.  They recommended a 75mg asprin a day next time I try which will probably be in October.  I would have been thrilled to have had a multiple pregnancy but as you can see each time I have only had to one, so my advise to you is to have as many as you can.  I am really hoping that these tests come back with some good news for us.
Good luck and dont let the age thing worry you!


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## Sally Kate (Jun 13, 2007)

Dear BG

Just to say thanks for your reply and so sorry to hear of your sad losses.  I do hope the tests your clinic are doing provide some further insight into the cause of the miscarriages.

Very best wishes


Sally Kate


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## Sally Kate (Jun 13, 2007)

Daisy


Many thanks for your reply and for the interesting links - v. helpful.  Yes, I've been through a range of tests for recurrent miscarriage -all negative, although given family history and post mortem results from my miscarriage at 20 weeks (evidence of uterine growth retardation, suggestive of maternal circulatory disorder), my Consultant treats me now with clexane and aspirin once pregnancy is confirmed (but not sure if IVF clinic start clexane following transfer? I need to follow up on this...).  Have just about ruled out Chicago tests/subsequent treatment with IVIG - because of limited funds, and nervousness about IVIG having read Lesley Regan's book. Have asked clinic about (low dose) steroids and the Doctor simply said 'very controversial!' - any thoughts?

In terms of the quality of the clinic I am using - I guess I feel pretty poorly equipped to make judgements about this as an individual health care 'consumer'. They do well in terms of **** data, and I have faith in my Consultant (who is v. good on recurrent miscarriage, but perhaps a bit remote from the IVF side of things).  Good but not world class? My sister (with APS, aged almost 40) recently became pregnant in her first cycle with them, which if I'm honest, swung it for me at a gut level (for now at least).  Before starting I also had an interesting consultation to get a second opinion from CARE  - who ruled out aneuploidy screening, and confirmed that my biggest problem was simply age.

Can't quite believe what a protracted battle this has become, but still travelling  hopefully.  

Very best wishes

Sally Kate


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## BG (May 23, 2006)

Sally Kate,
I'm having to ask you for advise now !! I am so sorry to hear about your experiences, 20 weeks is a long time.  I miss the feeling being pregnant after 8 weeks!  We have been told not to bother trying to save our little one for tests as the blood tests should reveal anything.  You mentioned Maternal Circulatory disorder, both ours did not get to 7 weeks and were very small, could this be our problem ? would it show up in blood tests ? and what is the treatment, if any?  I feel so robbed and determined to achieve our goal, any advise would be much appreciated.  I have been told by the sister to start taking an asprin every day once my cycle has come back to norman and also DHEA again, the asprin, I suppose is for APS.  Sorry to ask so many questions but you seem to have some answers.  Thanks
BG


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## daisyg (Jan 7, 2004)

Hi Sally Kate,

Again, I am so sorry about your loss, it is just awful. I would say that most opinion is that clexane should be started WELL before a bfp - the endometrium and your system need to be prepared before implantation as after is too late. Most clinics would start it 2 days before embryo transfer and some would start on day 6 of your cycle. Regarding aspirin for APS - St. Mary's generally say to start it when you get your bfp as it may interfere with implantation in some cases. You may be interested in these links for more information -

http://www.repro-med.net/

http://www.rialab.com/miscarriages_prevented.php

Steroids are not that controversial especially regarding those with APS. Almost all the ivf clinics in the US routinely use steroids to prepare the endometrium for implantation before ET. St Marys in Paddington (Regan's) clinic are now giving steroids to women who have failed with clexane alone. I would say go for it. I was only successful after 4 miscarriages when I added steroids to my protocol so I personally believe they made a difference to me (my autoimmune symptoms disappeared as soon as I took them, and reappeared once I stopped).

Of course you must go with your gut instinct and it is good news about your sister. Do they have good results for women your age though? You may also want to take high dose folic acid and b vits - as we age we absorb these less effectively and as you have not been tested for MTHFR (which contributed to my miscarriages), it could be taken empirically.

I am wishing you the best of luck. It is a harrowing journey for you and I really hope you find success.

Daisy
x


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## Sally Kate (Jun 13, 2007)

Dear BG

So sorry to hear of your experiences - miscarriage is such a devastating experience.  

I'm afraid I don't have answers (my questions are just getting longer and more complicated!) -  but I would recommend Prof Lesley Regan's book, 'Miscarriage' (usually in stock at our local Waterstones).  It is the best lay person's guide to miscarriage that I've come across and covers the major causes of pregnancy loss. The Miscarriage Association also have some good information leaflets that you can download from their website, including one on Anti Phospholipid Syndrome, and one on causes, tests and treatments.

There are a range blood tests that can be done to identify different blood clotting disorders, including APS.  Treatment for APS is usually with clexane and aspirin in subsequent pregnancies - and see Daisy G's post below for info on steroids.

I have had retained tissue analysed in some of my earlier miscarriages - not to shed light on blood clotting issues, but in order to identify chromosomal abnormalities - the biggest cause of miscarriages for women our age (not sure if this sounds odd but I have found it comforting to know that a miscarriage has been due to random bad luck, rather than an undiagnosed condition).


Very best wishes

Sally Kate


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## Sally Kate (Jun 13, 2007)

Daisy

Thanks for your further post - again the info and links were extremely  helpful. Am off now to e-mail my Consultant!

And really glad to hear you cracked it - so easy to start to feel defined by failure/loss after repeated sad experiences.  


Cotswold Girl

Thanks for your post - re: number of embryos to transfer.

Best wishes


Sally Kate


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## Sally Kate (Jun 13, 2007)

Hi Daisy


Just to let you know how I got on: progress with the question of Clexane, but no movement on steroids (if I do this again I will consider a move to Care).  

V. high oestrogen level today, but on balance of risk, including age, advised to go ahead with HCG injection tonight (so there are some advantages of being old!).  Because of clotting risk with hyperstimulation, it looks as though I may end up on aspirin shortly anyway.  But not clear yet whether we'll be able to go ahead with a transfer now (assuming we have embryos) or whether we'll need to freeze.

Thanks again for your help and and advice


Sally Kate


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## daisyg (Jan 7, 2004)

Hi Sally Kate,

Sending best wishes to you and good luck for this cycle.  Hope you don't need to move to CARE.....

Daisy
xx


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## Sally Kate (Jun 13, 2007)

Hi there

Did egg collection today (14 eggs); despite high estriadol levels Doctor not too concerned about risk of OHSS so, fingers crossed, will have something to transfer next week.    This is our first IVF cycle, so no idea what to expect from here on in, or the sorts of judgements we may need to make?  

Bracing myself for call from embryologist tomorrow morning - should I expect a really high wastage rate given age?  Not sure about how the grading works or the question of the timing of the transfer - are there any special considerations when dealing with old eggs (and even older sperm!)?

Would really welcome any insights/advice

Best Wishes


Sally Kate


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## libra (Jun 23, 2006)

Hi,Sally Kate,
so sorry to hear what you've been through.

congratulations on so many eggs.
Just to let you know my age had no effect at all on how many fertilised-I think last cycle was about 18 out of 24,all other cycles were similar or better.
personally I had 3 embryo's transfered on most cycles(apart from on some FET when not that many available)
Most clinics transfer embryo's on day 2 or 3,apart from when they are aiming for blastocysts(day 5)although not all clinics have the facilities to do this.
There are a few postings about grading-so a search should fetch them up for you.

Wishing you loads of luck  
love libra.x


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## Sally Kate (Jun 13, 2007)

Thanks Libra.  And best wishes with whatever you decide to do - must be so frustrating when your have responded so well.


Sally Kate


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## Sally Kate (Jun 13, 2007)

Dear All

Thought I'd just let you know what happened re: no. of embryos to transfer today.  Was lucky enough to still have four embryos this morning -  three looked good bets and one was dividing more slowly (borderline with 5 cells).  

Not sure I've done the right thing, but have transferred two and frozen two.  Realised, when confronted with the choice for real, that my bottom-line  consideration was trying to protect myself from the worst of the crushing disappointment of failure or miscarriage, by having something held in reserve.  I'm guessing in the worst case scenario, a two-stage disappointment will be slightly less hard to bear than going straight back to square one immediately. (I realise, of course, though this exposes the good third embryo as well as the borderline one to the risks of the freezing process).  

Half expected this cycle to reveal that I had completely lousy response/egg quality and the game was up (excepting DE route) - but in fact now realising the reserve I may have the most immediate problem with is that of emotional stamina/nerve.

Thanks everyone for advice and support - it really helps

Sally Kate


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## daisyg (Jan 7, 2004)

Sally Kate,

Wishing you the best of luck.

Daisy
x


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## Sally Kate (Jun 13, 2007)

Daisy

How are you?  Just wanted to let you know about what appears to be a bit of a shift in thinking at Care - I have switched across, but my Consultant here is now also reluctant to prescribe steroids 'empirically'.  Not sure if this is linked to the public controversy in recent weeks (The Observer articles etc) but the position has changed since my initial consultation (no new medical information).

Maybe I shouldn't be, but I am feeling pretty relaxed about this.

Very best wishes

Sally Kate


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