# some advice please



## Kelly42 (Jan 28, 2006)

Some advice please!
Have had 2 m/cs after IUI and 1 failed IUI but we HAVE to go and see our consultant before we can go any further.

I just want some advice about what questions to ask:
  as i have had 2 m/cs should the hospital be doing some tests re immunity (had the basic tests-all ok)?
  do you think i should push for 1 more go at IUI?
  because of my age, should i go straight to DE abroad?
  is it worth doing DE if there is no explanation for the m/cs (everything was OK)?

Thanks for your support
Kelly x


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## daisyg (Jan 7, 2004)

Hi Kelly,

I am so sorry that you have had miscarriages. Sadly, your age is an increased miscarriage risk and it is possible that both your miscarriages are due to chromosomal abnormalities due to your age. BUT that may not be the case, and if you are to continue ttc either with your own eggs or DE, it would make sense to have some basic miscarriage testing before you continue.

Firstly, it is immensly encouraging that you are getting pg through IUI. More women of your age and over get pregnant naturally or using injectible cycles with IUI or trigger injection and sex than through ivf.

There is a list of basic miscarriage/implantation failure tests at the top of the immunology and investigations board and you may find that your GP will do many of them (or your consultant if you present the list to him). You say you have had the basics but do they include all the tests mentioned here (inc. things like MTHFR?)

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

The main reasons for miscarriage are:
Chromosomal abnormalities due to age, or sometimes genetic factors which would require a karyotyping test for you and DH
Uterine issues - fibroids, scarring, thin lining etc.
Clotting issues - Antiphosphlipid syndrome (also under autoimmune issues), Factor V Leiden etc.
Autoimmune issues - endo is one of these, arthritis, etc
Hormonal issues - low progesterone during the 2ww for example
Bacterial - Ureaplasma, mycoplasma etc - GP can swab for this
Sperm issues - dna fragmentation, genetic issues etc

It is certainly worth doing these tests. In addition to these basic and more common causes of miscarriage are the so called immune tests or Chicago tests as detailed in London Lou's thread on the Immunology board. These need to done by a specialist and they include tests like Natural Killer Cells, cytokines, TNf-alpha, DQ alpha etc. Please see more info. on the Investigations and Immunology board.

The tests are also relevant if you are doing a donor egg cycle.

You may want (if you can afford it) to move on after you have been tested to doing one final ivf with your own eggs (for closure, although your age is against you) possibly or continue to try a little longer with IUI. But I would recommend you do this after making sure there are no issues causing miscarriage that can be medicated. I notice that you have taken quite a long time between IUIs and sadly time is really of the essence for you. It is really up to you how long you personally want to keep trying, but moving on to DE would up your odds very considerably of course.

If it is down to your age causing problems, then of course donor eggs will address this. If there are sperm issues then DE and DS would also address this. These are both big steps and I am sure you will have much to consider when thinking about moving on.

I know how hard this is and how time and fate seem to conspire against us. In my own case, I did get pg three times at age 44 - 44.5 through ivf but miscarried. I also miscarried donor eggs. Only after the tests listed above did I find some answers and once treated went on to have twins on my next DE cycle.

Sending best wishes,

Daisy
x


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## Kelly42 (Jan 28, 2006)

Thanks for the response Daisy and congrats on your pregnancy  

You have given me a lot of information to work through and we will be armed with the questions at the consultation.

To answer some of your points: I have MS so that might account for something although I have been reassured that it doesn't, but I shall raise it again; it took my body a VERY long time to recover from both my miscarriages, hence the gaps; after the 2nd m/c they looked at the remains and there was nothing wrong - nothing chromsonal.

I know that a 2 out of 3 pregnancy rating with IUI at my age is OK. I have a gut feeling that I should give it another go.
Thanks again for your help and pointers.
I shall let you know how it goes.
Take care
Kelly x


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## daisyg (Jan 7, 2004)

Hi Kelly,

Your MS is, in my opinion, a huge marker for problems with fertility including miscarriage. You have a very significant autoimmune issue which according to well known reproductive immunologists like the late Dr. Beer, will continue to give problems until it is addressed.

http://www3.fertilethoughts.com/forums/archive/index.php/t-372123.html

http://www.msrc.co.uk/index.cfm?fuseaction=show&pageid=736

Clearly there is controversy in this field, but I really think this is something which should be investigated in the context of your miscarriages and IF. You may want to look more at Dr. Beer's website (repro med - google Dr. Alan Beer) and discuss this with your consultant. This may call for you to investigate more autoimmune testing and possibly the level 2 tests (NK cells etc).

The fact that you miscarried a chromosomally normal baby is informative - something other than aneuploidy is going on with your system - it may be that you need to introduce fairlly simple meds. like steroids into your protocol or possibly IVIG.

Sadly, many conservative consultants may poo poo this, but it may be worth scheduling a consult with someone like Dr. Armstrong at the Portland or Dr. ******* etc.

Anyway, I wish you all the very best for your next step.

Daisy
xxx


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