Recurrent miscarriage

Dear Professor Winston,

My husband and I are experiencing a terrible time trying to conceive. Actually, the problem isn’t for us to get pregnant, but it is to keep the babies. I have had four miscarriages over the past two years. I have done series of tests after series of tests, and nothing abnormal shows up. I have the right levels of hormones, thyroid is doing fine, no blood clotting…no one knows why the fetuses die in the first trimester (one fetus died at 10 weeks, another one at 7 weeks, and we don’t really know about the other two). I have just turned 40, and my husband would like me to freeze eggs as an insurance in case we cannot have babies over the next two years. If we can’t he would want us to have IVF. I have great reservations about IVF, and I would be very grateful if you could advise us: 1) our issues are not to get pregnant but they are about keeping the fetus alive. IVF seems irrelevant here as the same issue might happen. Am I correct? 2) am I right in thinking that my chances of having a baby via IVF are very slim due to my age? 3) I have looked around the internet regarding risks for mother and babies, and I cannot seem to find any precise results. As if no or not enough studies had been made, or if the consensus was to keep quiet on the topic as not to alarm patients. Where can I find any data on the risk of developing OHSS?, any possible increase in cancer etc…. and where can I find any results on the risks for children born from IVF? I would be very grateful for any guidance. I need to be able to go to my husband with tangible and proven facts. From the bottom of my heart, thank you in advance for your time and patience. M

Dear M,

I take it you have been fully investigated, including these four absolutely key tests – FSH, AMH (both blood tests at the beginning of the cycle), hysterosalpingogram and chromosome tests for both you and your husband?

Having said that, you are right about the slim chances for IVF, and incidentally much slimmer chances for egg freezing. I really would advise you against egg freezing. This is a much advertised and greatly over-rated technology and in any case it is far too late, in my view, to consider it at 40. But the bottom line is that the chance of freezing increasing your likelihood of a pregnancy is very small indeed, and the chance of having another miscarriage increased if anything, particularly if the problem is with your eggs which is the most likely issue.

IVF may be helpful but without having a full understanding of the test results, and the results of the key tests I mention, it is very difficult to give sound advice. But IVF may be helpful, particularly if there is any chromosomal abnormality with the embryos – because screening may be possible. Incidentally, what were the results of any laboratory investigations on the fetal tissue you miscarried? Did you have a scrape?

As to OHSS, this is really not likely to be a problem, particularly if the hormones are administered carefully in a good clinic, and secondly, there is no evidence of an increased risk of an abnormal baby after IVF though of course, at the age of forty, all pregnancies carry a very slightly increased risk but so many people are having normal babies at this age that I cannot see why that should frighten you. The slightly increased risk of Down syndrome is still less than 1 in 100.

Best wishes
Robert Winston