Steps for successful pregnancy after recurrent miscarriages

[mumto1]

Here is my history.  I gave birth to my son a little over 2 years ago when I was 37.  I had no problems getting pregnant, had a "perfect" pregnancy and vaginal delivery at full-term.  Since then, I have had 4 consecutive miscarriages.  With all of the pregnancies I have gotten pregnant very easily.  My first miscarriage was at 8 weeks (fetus measured 6 weeks), second miscarriage at 9 weeks (baby measured 8 weeks), third pregnancy was also at 8 weeks (fetus at 6 weeks) and the fourth miscarriage was considered a chemical pregnancy (fetus about 2 weeks).  I had a D&C with only the 2nd miscarriage and testing showed trisomy.

After the 3rd miscarriage my OB referred me to a reproductive endocrinologist.  I have had a FULL work-up (bloodwork, Hysterosalpingogram,Hysteroscopy, etc.)  and nothing abnormal has shown-up.  Under the premise that it couldn't hurt, with this most recent pregnancy I was put on a regimen of taking 1 baby aspirin daily, I had acupuncture and I used progesterone vaginal suppositories (50mg morning and night).  Seeing that this pregnancy wasn't successful and I still miscarried, I'm wondering what's next?  Should I just try again for another pregnancy and forego the aspirin and progesterone?  Are there additional medications that I should be taking?  Would Clomid be helpful?  

I am currently 39 years old and my husband just turned 37.  I can't believe that 4 pregnancies in a row would all be chromosomal issues.  Before my latest pregnancy, the endocrinologist had also suggested IVF with PGS/PGS.  If we did go this route for the next pregnancy, do you see any potential issues based on my history of recurrent miscarriages?  My first pregnancy was so easy, I can't believe that in just 2 years my body would have changed so much.  One key thing that I have noticed with all of the pregnancies that ended in miscarriage is that I have experienced minor pelvic pain on the right side.  Something that comes and goes so it feels more muscle/ligament related.  My OB never had any concern with this during my pregnancies.  I never experienced this during my 1st successful pregnancy.  Any known cause, or possible link to my miscarriages?  I know that the ligaments stretch as the pregnancy progresses, but I feel like this pain kicks-in the moment I become pregnant.

Thank you for your input.

[Tryingfornumber3]

Hi there, I am so sorry about what you have been through.  I too, have had 4 bad pregnancies.  I have 2 healthy children as well... Did you ever find out what is the cause?  Have you conceived yet?  I wish you the best.

[Shayne Plosker, MD]

Dear mumto1 - I am sorry about your history. This is always a difficult problem. Has the testing that you had included a chromosome analysis (karyotype) of both you and your partner? Were you tested for lupus anticoagulant, anticardiolipin antibodies, Factor V Leiden, and other inherited hypercoagulable states? Tested for diabetes? I am sure from your explanation that you have.

Since everything has come back normal, I too agree with the plan you had for your last pregnancy, which was progesterone and low dose ASA.

If you choose IVF with PGS, it is very important to understand what the expectations are. IVF with PGS will probably not improve your chances of getting pregnant, because if you are destined to become pregnant successfully again, you will whether or not you do IVF or IVF with PGS. If, on the other hand, IVF with PGS shows that all, or almost all, of your embryos are abnormal genetically, then you will have an answer about why you have had the 4 miscarriages. IVF with PGS will likely cost in the $20,000 range in a non-mandated state. You will need to consider whether the cost of IVF with PGS justifies the information it will provide for you. Of course, if IVF with PGS identifies "normal" embryos, these will be the ones to transfer back - even in this scenario remember that PGS can only test for 9-12 of the 23 chromosome pairs, so a normal result only increases the chances but does not guarantee a genetically normal embryo.

Finally, even after four consecutive losses, there is always a chance, probably in the 40% range, of a normal pregnancy on the 5th try.