# Post MMC: wondered if you all had any advice!



## lulumead (May 29, 2008)

Hello all,

Hope no-one minds me starting this thread, wasn't really sure where else to post but I know that lots of you have an incredible amount of knowledge in this field and I wondered if you all had any advice for me, or things I should think about asking when I go to my consultation on Friday.

background: ticker says it all but basically I have clear tubes, uterus all fine, good AMH (17ish), good FSH & LH levels (around the 4/5 mark when checked earlier this year), I respond well to drugs, have produced embryos when I have done IVF but nothing that could be frozen. Have always done short protocol IVF which resulted in one biochemical, 2nd attempt I had awful UTI and had to take antibiotics for 1st time in my life! and third attempt I was under loads of stress so in someways no surprised it worked. I got pregnant this time by medicated IUI with one follicle...it was the second month of doing IUI back to back, and followed a natural IUI in the month before. I took baby aspirin and 400mg of Cyclogest until week 11 which is my clinic's standard procedure. It looks like the missed miscarriage happened at 8.5 weeks and was detected at scan at 12 weeks.
I've had basic immunes done on thryoid, and i think.... ANA (Antinuclear Antibody), Anti-DNA/Histone Antibodies, APA (Antiphospholipid Antibodies)...all were fine.

So the thoughts that are going round my head are:

1) is it simply back luck!
2) is it an indication that I have egg quality issues...especially as none of the IVF embryos implanted or were good enough to freeze
3) should I stick with IUI - my feeling is yes as it worked and IVF didn't
4) what about immunes? my clinic is very skeptical says that more research is needed and that you really need to biopsy womb lining to work out what the issues are and if I had blood tests done, something will be found - it generally is! so I really don't know what to think - I do really trust my clinic but....
5) for those who have done immune testing, has it always resulted in positive outcome? if it was a guarantee I would definitely go for it...
6) does anyone know of good immunes research that I can read?
7) do I do an immune protocol without testing....or take prednisolone...I don't even know what that is!
 what else should I be checking? progesterone levels?? think this might be the only thing I haven't checked...

Generally any ideas of what I should ask them...or think about??

Am wondering about phone consult with Dr Sher...what do I need to get together to do this...i assume I'll need all my notes from GP and clinic??

Thanks....my head is in a bit of a spin as to what to do next. I am pleased I did get pregnant but its made me even more determined to carry on.

Also I'm thinking about embryo adoption, if eggs are scrambled - I can't remember who has done this....I get confused with donor eggs! if anyone is happy to PM me and chat, it would be very much appreciated.

Thanks all - your advice will probably be more useful than a million different consultations!!

Lxxx


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## morrigan (Dec 8, 2009)

I can't really any of your questions but u am in the middle of ploughing through the dr beers book on is your body baby friendly- seems really good might cover some of your questions.

I'm sure some of those more knowledgable on subject will be along soon.

Wish you luck with your next step xx


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## suitcase of dreams (Oct 7, 2007)

Lulu,

So so hard all this isn't it hun? There are just no easy answers but I'll give it a go   

1) It could just be bad luck - I know several people who have had early/missed miscarriages and gone on to have healthy babies - all natural rather than IVF but nonetheless....and even one friend who had 2 early miscarriages and now has 2 healthy boys. So yes, it could be bad luck
2) Or it could be an indication of egg quality issues...trouble is there is no way of knowing. Even PGD or CGH (where they test the embryos before they put them back) doesn't really tell you whether you have egg quality issues in general, it just tells you how that particular set of embyros looks from a chromosomal perspective. And it's expensive too....
3) Certainly seems like IUI is better for you. I know I have read somewhere that the older you get, the easier it is to conceive naturally vs IVF..and IUI is as close to natural as you can get. But this does mean you may need to keep going for quite a few months to find the 'right egg' - which requires lots of patience and emotional stamina...
4) Immunes - the De Beers book is good but quite complex/long winded. Try reading the Immune FAQ which you can find on the Immunes board here on FF first - will give you a really good overview and then you can decide whether you want dig deeper. Not true that something will always be found - there are women on the Immunes threads whose test results come back fine and they don't have immune issues (almost harder for them as they have nothing to blame their infertility on if you see what I mean...)  Many UK clinics are sceptical of immunes but I do think the US success rates speak for themselves and even an anecdotal look at Dr Gorgy's thread would suggest that immunes can make the difference where everything else has failed...
5) sadly no guarantees even with immune tx. Took me 3 DE cycles with full immunes to get pregnant so it wasn't first time lucky/a guarantee by any means. Would I have got and stayed pregnant this time without immunes? I don't know - maybe/maybe not - if only there were some more concrete answers   
6) De Beers is prob best but as said above, rather a tough read. Try the immune FAQ first. In terms of research, not enough done yet to give any conclusive results I don't think
7) prednisolone is a steroid, it's cheap and has minimal side effects if taken for a reasonably short period of time (ie from day 5 of stimms to week 12 of pg) - if your clinic were happy to prescribe it, it might help. Go for 25mg though as smaller doses mean you might as well not take it. You could also take baby/75mg aspirin throughout - you can buy this over the counter. And consider clexane 20mg - that's the other one which seems to be prescribed for basic immune issues

you could check progesterone levels and see if you need gestone rather than pessaries but tbh if it worked this time, it doesn't look like you have progesterone issues...

re Dr Sher - you don't need your GP/clinic records as long as you have a good idea of your tx history. When you book a consult he sends out a form to fill in and you need to be able to give all dates of treatment, protocol, no of eggs retrieved, no fertilised etc etc. So as long as you have all this to hand, you won't actually need a copy of your clinic notes. No harm in having the consult, it's free and it may give you some ideas you haven't already considered. Although I have to say I personally didn't find it all that helpful for me, but I know others have.

Embryo adoption is basically FET with donated embryos - difficult to get in the UK as most clinics don't seem to offer it, but very common in Czech Republic. It's much cheaper (€1000 vs €3900) than fresh donor egg cycle and waiting times are shorter. Both donors would be completely anonymous and you may get limited choice in the characteristics you can specify to get matched. At Reprofit at least, they create these embryos from the eggs retrieved from the 'back up' egg donors - for each fresh cycle they have a back up in case of problems with the primary donor. Most back ups aren't needed but of course they have produced eggs, so these are retrieved and fertilised with sperm from their sperm bank. Success rates are apparently lower than for fresh cycle but that said, lots of people seem to have success - Cem and Mrs Keats (formerly Lady Lottie) are two of them   
I went for fresh DE cycle because I thought success rates higher but then ironically got pregnant from the FET after that cycle and there does seem to be some anecdotal evidence that women with immune issues respond better to FET than fresh cycles for some reason....

Am always happy to chat more over PM if you have other questions. I wish there was a definitive answer, that's what I was always looking for. After my mmc I did two more IVF cycles with own eggs because I felt if it had worked once, it would work again. Eventually it just got too much for me - the stress of the stimming, the EC and then the 2WW and the crippling disappointment when it failed, and so moving to DE was basically about upping my chances of success. That said, it still took 3 attempts and nearly a year of DE and even now I have no idea why it worked this time having failed before - I didn't do anything differently at all....

  hope you work out next steps soon, take care
Suitcase
x


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## Bethany915 (Aug 1, 2010)

Hi Lulu

Lots for you to think about here!  I suspect that your m/c was a combination of bad luck and having a few more "poorer quality eggs" in there compared to a younger woman - but I might be able to give you some hope!  Not sure if I've mentioned before but I had a miscarriage at the age of 39, then only took 3 more attempts before conceiving LO.  The m/c was at 11 weeks, however I suspect that things had in fact gone wrong several weeks earlier (but I didn't realise at the time). Both the m/c'ed pregnancy and LO's conception were AI/natural (we don't know which for sure as we were using both   ).

Anyway, my understanding at the time was that although anyone can have a miscarriage at any age, as you get older there is a higher proportion of your eggs which will be poor quality / have chromosomal problems etc.  So statistically I believe that at 40, the miscarriage rate is about 40%.  But, even so, you are likely to still have a good number of decent quality eggs so, as Suity says, it's just a question of getting a good one.  And I would say you would be right to stick with IUI, especially since that worked for you before.

Re the embryo adoption question, it's good to have as a Plan B (as you know, I am formulating it as my Plan B too   ) - but in your position I think I would be inclined to try a few more cycles with my own eggs first.  Just my opinion, but since you did get pregnant and you have always got to the embryo stage with IVF, it sounds like there is some life in your eggs yet!

I don't know anything at all about immunes so can't help on that one, but sounds like a consult with Dr Sher might be worth doing.

A final thought - have you tried an email consult with CHR in New York? - apparently free until end of this year (I am planning to do one myself).  They seem to specialise in "older women" and/or anyone concerned with egg quality.

Good luck for your consult on Friday   - let us know how you get on!

B xx


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## lulumead (May 29, 2008)

Hello Bethany & Suity


Thanks for your thoughts, very helpful.


Annoyingly I got stuck in traffic and missed my appointment so asked for a phone consult, which then got missed and finally I emailed my questions...didn't really get very good answers, but I think this might have been because she didn't have my notes with her - so I got stock responses grrrrrrrrr..


Am not really sure what to do now...my instinct is to stick to IUI. Bizarrely I have found out about 3 people I know of who had miscarriages within the same 2 weeks as me!! Although they all already have one, so not sure if that makes a difference.


Bethany: I looked on the CHR website but I couldn't see anyway to get free advice?  Do you have a link?


I'm thinking of talking to Penny @ Serum too as she seems to be getting good press...anyone been there?


xx


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## Bethany915 (Aug 1, 2010)

Hi Lulu

That's frustrating about your consultation. But looking at your sig, I think your instinct is probably right. IUI was what gave you your BFP so probably worth trying that again for a few cycles? Did you have progesterone support before? If not, would it be worth adding that?

Just out of interest, I see you went to Create and did the mild IVF - any particular reason you went there (e.g. do you have low AMH)? If I "graduate" onto IVF, my current clinic would not treat me and tbh I don't think it's worth trying drugs so it would be a case of natural or nothing. How much is IVF at Create?

Here is the link for the CHR consult:

http://www.centerforhumanreprod.com/infertility.php

I had saved this link a while ago - and strangely I can't see it now from their homepage - so maybe they have "hidden" it! But it definitely said free to end of December 2010, so worth a go.

Good luck with deciding your next steps

B xx

/links


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## Betty-Boo (Oct 14, 2007)

Lulu didn't want to read and not post      for everything you are going thro and have been thro ... Ref freezing - I had fresh cycle of DE and they didn't make it to freezing - just one of those things if you ask me ... all a bit hit and miss when it comes to freezing I think - especially at reprofit.  Sometimes, as hard as it is to understand, these things just happen.  No reason or fault and can't explain why.  It's like those who have had so many failed cycles and then - bang - it works ... why??  If we all could answer that one we'd make millions.  I wish I had a fairy wand sometimes to help take away your pain.  With an AMH and FSH like yours I'd still continue with your eggs.  I can't help with the immune stuff - only the clotting issues.

Big big hugs honey, am here if you need to scream x x


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## lulumead (May 29, 2008)

thanks mini, big    coming right back at ya   


bethany: thanks so much for that link, will investigate.


One thing my consultant said was that I could try prednisolone but I wondered if that seems worth it for IUI when you don't even know if you have made an embryo in the 1st place. Any thoughts?  Similarly she said i could do injectable progesterone but I'm not sure that's really a problem if my body didn't even reject the foetus?
xx


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