Would you see an immunologist after miscarriage of 1 PGS normal?

[Anonymous]

I am torn, as I have an additional frozen embryo and want to move forward with transferring, but don't want to waste it. My SG RE is willing to put me on a steroid and possibly blood thinners (because i'm pushing for them, not because he thinks i need them) for the next FET. i don't think he will work with kwak kim or beers center. as a side note i don't think i would do be willing to do the more controversial immunological treatment (like LIT)

I had a missed miscarriage at 8 weeks of a PGS normal embryo. We tested the products of conception and it came up normal female.

Thank you for your help.

[Anonymous]

Depends on your age and your resources for doing another retrieval to obtain more embryos. If young and could cycle again, you could try with the prednisone at SG. For some people with immune issues, prednisone and high-ish dose fish oil are enough to get you through. If this is really your last embryo because you can't cycle again, you would be better off being under the care of someone who can properly manage things. Is your embryo PGS tested? If not, you could be looking at something that won't work genetically anyway but you won't know until you transfer and see what happens.

Could you just do a consult with someone willing to do the testing who takes a lot of insurances (Abbasi locally or SIRM in NY, for example)? Then you'll know definitively what your issues are. You could then take that information back to SG. Even if they don't "believe in" immune issues, you would feel more confident that what they can offer either is or is not potentially enough.

[Anonymous]

I'm sorry for your loss OP.

I am of the mindset that miscarrying a PGS tested normal embryo is a red flag for potentially something else going on. (That "something else" could be many things) That said, there is also evidence to suggest that a subsequent pregnancy could work out because your body may be better prepared this time.

I think the steroid and blood thinner are a good start to do empirically, but then when you go off them you won't know if they helped or not. It seems reasonable that you could do the FET with the extra meds you requested and then if it doesn't work again you can explore further.

If the FET doesn't work would do cycle again or is this last embryo your very last one? Your answer may change my answer... On a side note, there are some doctors who will do the immune treatments on the side without really working with your RE, but that puts the management on you.

[Anonymous]

I am very sorry for your loss

PGS normal embryo doesn't guarantee success. There are many factors that come into play when it comes to implantation. One PGS normal not working doesn't mean you have immune issues. However, if someone has repeated pregnancy losses or repeated implantation failures or repeated miscarriages of PGS normal embryos, then it's a good idea to look in to immunology. Till date, I have never seen a person going to an RI and coming back with "no issues". Everyone who sees an RI does an immune protocol. So even if you go, I am quite sure they will find something. The decision is personal though. You are your best judge. I had 3 chemical pregnancies and 1 miscarriage along with failed cycles with 3 PGS normal embryos. That's when I saw an RI. I had 3 failed cycles even with immune protocols. The fourth was successful after all.

[Anonymous]

It's sort of a toss up with only 1 miscarriage. If this embryo is your last chance, or if you would be very upset having to do another cycle, then it is probably worth going for the testing for your own peace of mind. Just so you know you gave it the best chance possible.

[Anonymous]

Thank you so much for all the helpful responses. I am 41, actually have two PGS normal frozen embryos remaining, and would be totally ok with doing another retrieval (or more). I think I will go ahead and do a consult with an RI, just to see what issues there are because even though I can do more retrievals, time is definitely not on my side. I talked to the Beers clinic and they will work with me independently.