# Introduction - 39 recurrent miscarriage considering IVF with PGS



## puddles01 (Feb 27, 2019)

Hi everybody,

I'm new to fertility friends so just want to introduce myself and ask for some advice. I am 39 and have had 5 miscarriages (incl 1 ectopic). OH is 39 also. 1 mc was spontaneous unknown, 1 blighted ovum, 1 ectopic and 2 confirmed trisomy's (21 &13).

My last FSH result was 13.1. I am waiting on FSH result for this cycle along with my amh.

We are now considering IVF with PGS. I am based in Ireland but due to costs are considering going abroad.

I am looking for any advise on PGS - is it a good idea based on age and history? We are looking at a couple of clinics in Czech but finding it hard to decide. What should we be looking for?

TIA


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## Dory10 (Aug 6, 2013)

Welcome to FF Puddles  

I'm sorry to read of your losses, life can be very cruel at times.  Were your pregnancies natural or through IVF? Just asking as wondered if they've offered you any immune testing too?

With regards to selecting a clinic, head over to the international section where you,l find lots of people who have cycled or are currently cycling in the different locations.  Czech, Spain and Greece are all popular.

Give me a shout if you'd like any links

Dory
Xx


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## bombsh3ll (Apr 19, 2012)

Hi Puddles01

I'm sorry you have been through so much.

The advice I would give may not be what you are looking for, but may be your best chance at a take home baby:

What PGS does is look closely at the genetic material of embryos you and your husband create through IVF.

It helps (but is not 100% effective) at screening out any embryos with defects that could lead to miscarriage or other problems.

In the best case scenario once any embryos with identifiable defects were removed, you would be left with one or more healthy embryos to transfer.

What PGS doesn't do is _create _ healthy embryos, it only screens out unhealthy ones from the group you start with.

You can conceive naturally, hence IVF may not necessarily add that much value. It is a game of numbers, and say you produced 5 decent embryos from IVF, then PGS eliminated 3 of them, you would have 2 left.

If you conceived naturally 5 successive times in place of the example described above, the two healthy embryos would also be among this group, and would probably have a better chance as the IVF hormones themselves can make the intrauterine environment less hospitable than in natural conception.

IVF is expensive, physically and emotionally traumatic and exposes you to numerous risks from the drugs and procedure. It also has low success rates - each healthy embryo transferred has only about a 16% chance of taking.

PGS is better for people who have a known genetic defect for example cystic fibrosis, or if a consistent genetic defect has been identified in miscarried or stillborn babies.

My advice which would likely most quickly and successfully lead to a healthy pregnancy and is much cheaper, easier and safer than standard IVF would be embryo adoption. This uses surplus healthy embryos from couples who have usually already completed their families through IVF.

39 is also late to be starting IVF using your own eggs, especially given you have already had two trisomies.

Just something to think about that could potentially save you a lot of fruitless grief and expense and give you a shortcut to your happy ending.

If donor conception absolutely isn't for you, then just ignore this.

I wish you well in your journey whatever steps you decide to take.

B xxx


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## puddles01 (Feb 27, 2019)

Thanks for replies ladies.

Dory - all pregnancies were natural. I have had recurrent miscarriage testing completed after the 3rd - thrombophilia screen, lupus etc... not sure of them all but it was told they all came back okay, we both had karyotyping test as well and all okay. Each time we were just told to keep trying.

B - IVF will not help us with regards to getting pregnant, this was never an issue, always happened after 1 or two months. It is the PGS that we think may help as you said to screen out unhealthy embryos. I understand that there is also a change that we may not get any healthy at all. For now I don't want to considering donor. We are late coming to this as after each miscarriage we were told it was just bad luck and to keep trying. That it still the advice that we are getting but have decided to look into options ourselves.

thanks xxx


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## Everythingcrossed42 (Nov 30, 2018)

Hi I’m 42 and got pregnant twice in the last 18months naturally but both ended in miscarriage. We had all of the immune testing and then I had a hysteroscopy which did find a partial septum in my uterus. Also my partner had some sperm dna fragmentation issues. We did a round of own egg ivf, I had 16 quality eggs but only 4 got to blastocyst and all 4 came back from testing as abnormal. It was expensive and emotional but I’m glad We did it as it helped us in our journey and to take the next step and explore donor eggs. We did our testing in the uk so I can’t offer any views on clinics abroad. 
However, there are lots of threads on here with links to research saying that pgs is not always correct, people who have had ‘normal’ embryos transferred have still gone on to have miscarriage or genetic issues and there are cases of people deciding to transfer so called ‘abnormal’ embryos and going on to have successful pregnancies. If you haven’t do a bit of trawling through the threads I found it useful. 
Only you can decide, you never know fingers crossed it could deliver a great outcome, if not it might help you like it did us to take stock and look at other options. Good luck with whatever you decide.


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## Cloudy (Jan 26, 2012)

I’m very sorry for your losses  

I would really recommend a visit to Professors Brosens and Quenby at Coventry: they are doing groundbreaking work in looking in to recurrent losses (uterine biopsies) and are very knowledgeable in this area. They will do a face to face consultation, a couple of biopsy appointments, and a follow-up email and telephone call (and to be fair further calls/emails if you need further advice.

Good luck with whatever you decide xxx


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## bombsh3ll (Apr 19, 2012)

I don't know how much a uterine biopsy costs, and it can certainly be helpful where the causes of RMC are unknown. 

However given that only one of your 5 losses is unknown & the other 4 are from non uterine causes (ectopic & genetic), bear in mind it is likely not your womb that is the problem. (This should be viewed as a positive )

Professors Brosens and Quenby at Coventry may be a great source for a further specialist opinion though, I am just saying that when it comes to paying for expensive tests & treatment if you have limited funds you want to invest them in the directions that are likeliest to yield results.

B x


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## puddles01 (Feb 27, 2019)

Hi ladies

Thanks for all the replies. I had my FSH tested again this cycle and it came back as 7.6 on day 3 compared to 13.1 on day 4 last month. Had AMH tested too  and it has come back at 4.8 which I believe is low.  

I have Skype consults with 2 clinics tomorrow. Never done this before so not sure what questions that I should be asking.


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## Londonwriter (Mar 18, 2015)

I'm currently starting a FET with a PGS clean embryo and am also 39.

The success rates for a clinical pregnancy (i.e. heartbeat seen) for a frozen cycle at CRGH with PGS are 68% per embryo transferred - not 16%. Live birth rates are usually 5-10% lower. The low figures are for national averages, not for the best clinics (in the UK, certainly). The best clinics often using intensive monitoring and heavy stimulation, alongside - sometimes - experimental treatments, such as DHEA and growth hormone. They often do a lot of investigations before beginning an IVF cycle.

There are various questions over PGS. For a start, the latest technology does PGS on 5-day blastocysts. According to the embryologist I spoke with, out of 10 blastocysts in a woman of our age group, you will get one PGS normal embryo in 83% of cycles. Hence, for PGS to be useful, you need a good resting follicle count and to produce lots of blastocysts for testing. So, for example, I had 12 eggs collected, of which 7 were mature, 6 formed (good) blastocysts and - out of those - I got one PGS normal embryo. This means, in effect, that the 68% success rates reflect women whose egg quality was good enough to get to embryo transfer.

The PGS procedure is very new and involves removing a small number of cells from the outer layer of the blastocyst, which goes on to form the placenta. These cells are supposed to be a sample of the chromosome composition of the embryo, but it is not perfectly accurate as normal/abnormal cells can clump together. As the technology is new, there are also questions over how well the outer layers of the embryo reflect the chromosomal makeup of the foetus, and whether the embryo biopsy affects the likelihood of implantation. Also, some embryos are 'mosaic' (i.e. the biopsy comes back with a mixture of normal and abnormal cells) and mosaic embryos can sometimes 'repair' themselves and produce a baby.

I'm not sure what to recommend in your case, but it does sound like you may have an egg quality issue. A PGS cycle may be helpful to clarify just how bad that might be and what your chances look like with your own eggs. I'm doing a PGS cycle because I have had unexplained infertility since I was 33 years old, which may be due to an immune system abnormality, but spontaneously conceived a DS (now two) aged 36. The consultant thought PGS would avoid multiple failed FETs due to age-related chromosomal abnormalities and help to distinguish whether I have a severe implantation or egg quality problem.

Fertility treatment is disruptive, invasive and very expensive, so you probably do need to trade that off against the possibility of further miscarriages. Having had a child conceived naturally, it is a lot pleasanter than fertility treatment, which is immensely medicalised. You will have to have at least one minor surgery (egg collection), which is normally - although not in my case - done under sedation. If your consultant wants to do a hysteroscopy or other gynaecological procedure, that may have to be done under general anaesthetic. You also lose a lot of months of natural conception while you're downregulating/stimming/having investigations and, if you can conceive naturally, you may not want to lose that time. In neither case, is the situation desirable or easy  You just need to decide which is worst 

[NB: My Anterior Follicle Count is 12-15, my AMH is 7.7 and my FSH is 8.7-9.1].


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