[rosie1K]

Hi,
I have just had yet another poisitive pregnancy test which has then turned negative after a few days.
I am 47 and got pregnant naturally when I was 45 but baby did not grow properly and miscarried at just over 11 weeks, this I was told was due to my age. I went for an IVF cycle which was cancelled due to poor response and then moved to DE. MY first cycle in february this year brought success but unfortunaly this was ectopic, then went for frosties in July and had a chemical pregnancy and have jsut had a fresh cycyle in Nov and this lasted less than a week and the pee tests were always faint, by the time I went for a blood test the level was 5.

I have had loads of blood tests with a local haematologist which have all come back normal, thyroid, IG's, clotting, rheumatoid etc, I have had the hidden c test which came back normal, I have had hysteroscopys which show uterus to be normal, for the last cycle I took clexane and prednislone (but only 10mg) and baby aspirin 75mg as well as the usual progesterone and oestrogen. I had my progesterone level checked at the same time as my hcg this time as thought that might be low but was 47.

I really do not know where to go from here, I cant really afford to go whole hog and have the "special" tests done but also not sure there is any point as everything else has been normal, is it just bad luck?? I have some frosties waiting for me but wondered if anyone had any pearls of wisdom on how I should proceed, are intralipids the way forward? I am now feeling like I should give up but this has been such a journey for me since finding my special bloke I really was hoping to have my bite at the cherry of life as had a rocky road until my 40's, any advice gratefully appreciated.

Rosie xx

 

[agate]

well...

if we ignore the OE cycles, we are looking at an ectopic and then 2 chemical pregnancies?

we think it isn't

something anatomical (scarring, asherman's, fibroids, polyps, inadequate lining)- because you've had the hysteroscopy and presumably your ultrasounds before ETs have shown ok lining?

a C infection - cos you had the test

not thyroid, APLAs or diabetes because you are sure you've been well testing
so... we are thinking...

is the sperm a factor (m/c etc increases with age)
could be DQa issues - but hopefully its less likely because you are using DEs - but we can't rule it out without testing
could be elevated NKas - you've been on prednisolone but only a low dose... either that isn't sufficient or it isn't enough on its own - so the logical next step would be a higher dose of pred (at least 25mg) started at least 7-14 days before ET, with the clexane started at the same time (you say you've had clotting testing, but not sure if that would include genetic tendencies towards clotting e.g., factor V leiden, mthfr and prothrombin factor II - those are tendencies so they may not show anomalies on clotting tests, but if you have those genetic mutations, clotting problems MAY be triggered by pregnancy - and may need a higher dose of clexane... but adding intralipids as well could make sense - but without testing for NKa and cytokine ratio, you probably wouldn't want to try IVIG or humira.
low LAD is a possibility - if it was still low despite your miscarriage, you'd definitely want to consider LIT - but again, its nothing you would do without testing for low LAD.


if further testing isn't a possibility... I think you might want to think about

checking your vitamin D levels or at least taking 25-50mcg of vitamin D
making sure your diet is low in saturated fat and high in omega 3/unsaturated fats and high in veggies
avoiding dairy or gluten if either of those don't agree with you
taking 800mcg of folic acid for at least 3 months before TTC (and all through pg)
discussing trying again with at least 25mg pred, plus 40mg clex, plus a much higher dose of progesterone (say, 100mg gestone + 2 x 400mg cyclogest), and ILs if you can get that px'd by your clinic.
discussing with your clinic whether they can do anything to reduce the risk of another ectopic (ultrasound guided placement of embryos, blastocyst transfer etc)

hope this helps, but basically, yes, it could be bad luck but its starting to look as though it might not be... to get to the bottom of it, you'd probably need more tests, but maybe the plan above might be a possibility for you if your clinic agrees?

hope this helps

 

[rosie1K]

Thank you so much Agate for this lovely and informative reply, you are really kind to take the time to help.

I know I should have more tests really but not sure how much further intervention I would want if they showed problems,  it is also difficult for me to see the wood from the trees and have been going into panic mode and thinking i must have everything wrong with me, your reply sounded calm and measured and there are some things I can get my teeth into and  talk to my clinic about and I am sure they will help.

Can I just clarify

I did have the clotting tests that look for the genetic mutations so I presume that is ruled out but would it probably be better to continue with the clexane anyway ? certainly my haematologist said it wouldn't hurt.

Am I correct in thinking the Gestone is the IM injection form of Progesterone, and is cyclogest similar to crinone or utrogeston?? what is the thinking behind having a much higher dose?

Many thanks again for your time

A much calmer Rosie xx

 

[agate]

yes, gestone is injectable progesterone.
the thinking is that a) progesterone has anti-inflammatory properties
b) some ladies may have anti-progesterone antibody activity (auto immune related), so they may need extra just to have 'normal' levels in the body

if you've had the genetic tests for factor V, mtfhr, prothrombin II etc and they were all clear then you could stick to 400mcg of folic acid, but you might still want to have, say 40mg clexane because if you did have high levels of NK cells, they would tend to compromise blood flow to the uterine lining etc