Recurrent Miscarriage and Super-Receptivity?

[Anonymous]

OP I had very similar thoughts and researched the same thing when I was trying for my 3rd. I got pregnant super easy with baby 1 (at age 30) and baby 2 (at age 31) but then had a hard time staying pregnant with baby 3 (age 35). I went off the pill and got pregnant immediately and had 2 miscarriages in two consecutive months. Then got pregnant again 4 months later and had a 6 week miscarriage. Finally was able to get pregnant and hold the pregnancy the following month and went on to successfully have a DC. However in the span of a year I was pregnant 4 times (with one live birth). It was really traumatic for my body to go through that. I am now on birth control and am very nervous about going through another miscarriage.

[Anonymous]

OP: has anyone put you on baby aspirin? Also I had to do progesterone vaginal suppositories as soon as I found out I was pg.

[Anonymous]

Anonymous wrote:I'm so sorry for your losses. It is SO hard when you can't figure out what's wrong. That's the situation we were in and the not knowing why we kept miscarrying was excruciating. I think the hard thing here is that even if this is your issue, which I'm not convinced it is if you're miscarrying normal embryos, there really is no treatment besides maybe seeing if progesterone helps, but I'm not sure if that has any basis in science and you're already doing it. I could possibly see Clomid to reduce the receptivity of your endometrium (which is a side effect of Clomid), but I'd stay VERY far away if you get pregnant easily. I don't think any doctor would prescribe that to someone with a hyper-receptive uterus unless in the context of a single IVF cycle transfer. When RPL is unexplained, the answer is often just keep trying until you can't take it anymore and hope you get lucky eventually. Or surrogacy of course.

But when you say you've been through all of the testing, have you done RPL testing with a RI? When you say early miscarriages, how many weeks? What's the highest HCG? Do you hear a heartbeat ever? Is it all at the same stage gestationally or do they vary?

OP again. Thank you for this. My RE has actually repeatedly told me that euploid embryos (two tested as euploid and she has said don't bother testing anymore because we have established that I miscarry euploids) doesn't always mean that my embryos are healthy, only that the chromosomes are normal and there isn't additional testing that can tell us anything about a problem that could be sub-chromosomal. So it's possible that I have poor quality euploid pregnancies... Every one of them miscarried between six or seven weeks. We've seen a heartbeat twice and it's likely that it was there for the others too but we didn't have a US until 8 weeks when the pregnancy had already stopped progressing. I'm not sure what my highest HCG was but they have always been within the normal range.

I've actually used Clomid twice (my spouse was pretty excited about the twin risk but we didn't get any) and we've stopped because what's the point.

I was hoping to do a full RI work up (we did NK cells already, which were normal to maybe borderline 10.8 we did prednisone just in case.. no dice) and a second opinion with Dr. Abasai once we were feeling emotionally up to it, but we are pregnant again instead.

[Anonymous]

The thing with hyper-receptivity is that the theory is that your uterus doesn't correctly distinguish between normal and abnormal embryos. Your body miscarries normal embryos after they've developed long enough to see a heartbeat. That sounds like your body is rejecting viable embryos, not like your body is holding onto embryos it shouldn't. I've seen tons of awful quality PGT normal embryos have success during IVF, and it feels like a stretch to think you have some unidentified sub-chromosomal issue that genetic testing doesn't catch but is bad enough to cause 5 miscarriages in a row. It just feels unlikely. I had 4 miscarriages in a row, likely due to embryo quality issues, but I also could never make blasts during IVF and always had low HCG and losses before we could detect a heartbeat. That's different from your situation which is why I think it's more of a "soil" issue than "seed" issue. I think you're right to seek a second opinion and get the full RI workup. FWIW, my RE at GW did the full RI panel that Abassi does as part of their regular RPL panel. Treatment would have been different with Abassi, but she didn't find anything so it was a non-issue.

[Anonymous]

Anonymous wrote:The thing with hyper-receptivity is that the theory is that your uterus doesn't correctly distinguish between normal and abnormal embryos. Your body miscarries normal embryos after they've developed long enough to see a heartbeat. That sounds like your body is rejecting viable embryos, not like your body is holding onto embryos it shouldn't. I've seen tons of awful quality PGT normal embryos have success during IVF, and it feels like a stretch to think you have some unidentified sub-chromosomal issue that genetic testing doesn't catch but is bad enough to cause 5 miscarriages in a row. It just feels unlikely. I had 4 miscarriages in a row, likely due to embryo quality issues, but I also could never make blasts during IVF and always had low HCG and losses before we could detect a heartbeat. That's different from your situation which is why I think it's more of a "soil" issue than "seed" issue. I think you're right to seek a second opinion and get the full RI workup. FWIW, my RE at GW did the full RI panel that Abassi does as part of their regular RPL panel. Treatment would have been different with Abassi, but she didn't find anything so it was a non-issue.

OP here again- I am very interested to hear that they did the same testing at GW as with Abassi. I'm currently at GW and we've done an NK test, but I thought Abassi would run a number of additional tests. What RI tests did you get? I also think that my RE at GW is more conservative in terms of a "normal" result. I think she was happy with NK as high at 30...

[Anonymous]

/\ I’m not entirely sure. I did a RPL with Lalwani before she left and Abassi reviewed those records and said they included everything she needed. Maybe she would have asked for other things for a client with a different history, but when I looked at the labs, they seemed to include everything I saw online for a RI work up. That said, my understanding is that Abassi isn’t as thorough as some of the out of state RIs, but all of these things can be very deep rabbit holes and you have to decide for yourself how far you’ll go with no guaranteed answers at the end. There are recurrent miscarriage groups on Facebook, consider joining those and seeing what others in your situation ended up finding. But fair warning, often people just have 8, 10, or more miscarriages and eventually get lucky. Not everyone has the money or resources to go down every rabbit hole, and sometimes they do and still don’t have answers at the other end. Good luck to you, it’s terrible bad luck and I’m sorry you’re in this situation.

[Anonymous]

I've had a lot of early losses. Have you had bloodwork down to check for MTHFR and a blood clotting disorder? You can take folate vs folic acid, b6-b12 vitamins, baby aspirin, have OB start on progesterone, and check homocysteine level. So sorry you are going through this, it is very hard. Best of luck

[Anonymous]

Hi OP, I don't frequent these boards anymore, but because I did eventually graduate from them. I had 8 losses and do consider myself one who was able to get pregnant easily. I miscarried twice under Abbasi's care (with IVIG, IL, lovenox, dex etc) and eventually found success using Neupogen with Dr. Braverman. I have 3 Braverman babies thanks to him and Dr. Hamersley who oversaw each high risk pregnancy and coordinated my care. We were even able to bring my IUGR baby back into normal growth curve with IL infusions. It's a long and dark road but it is possible to come out on the other side with success. RIP Dr. Braverman I'll forever be thankful to that man and his willingness to not give up on my dream to have a family. Best wishes to you OP.