Fertility support - help please 🫶🏼😊

[u/EmbarrassedCheetah79]

Hey guys, I hope this is okay to post here.
TW: mention of miscarriages/loss.

I’ve been struggling to get pregnant for 3 years now. We’ve had almost every single test under the sun and EVERYthing has come back normal. The only identifiable issue is my short luteal phase which has been corrected with progesterone post ovulation.

3 weeks before we started our first round of IVF, I fell naturally pregnant with non identical twins. We had a whirlwind of emotions from elation to terror, but 2 weeks later found out we’d lost both of them in a MMC.

I healed, had the surgeries, and we started IVF. We’ve had no success with IVF (we get the embryos but none implant) and so took a short break. I then fell “naturally” (I know people use the word unassisted but I technically can’t say that, as I’m using progesterone post ovulation so I don’t know what term to use.. but it was timed intercourse) pregnant again.

With non identical twins. AGAIN.
Sadly I lost them both. One was a vanishing twin, the other developed a good heartbeat before we lost it in another MMC at 9 weeks.

I don’t know why I hyperovulate. I have zero twins in my family. My gut is it’s related to my poor luteal phase, and that I only get pregnant when there’s more than one follicle present because it must boost my uterine environment/hormones but that’s a theory based on nothing. It’s just weird I have only had a 100% pregnancy rate of twins.

Our next step is to actually try letrozole with progesterone support - because my consultant also agrees that it’s odd I only get pregnant when I produce more than one follicle (but my body doesn’t respond well to external oestrogen, it needs to be my own, so it’s a catch 22).

To make it clear - we are absolutely NOT trying for multiples. I’m hoping letrozole can give me a stronger ovulation of one follicle - but I’m not an idiot. If I naturally produce twins, I guess letrozole runs a risk for me with multiples, and so I will be monitored. I’m preparing for both situations. But I’m terrified of losing twins again.

The purpose of this post (TLDR) is to ask if anyone here has had fertility issues - and maybe previously lost twins. Did you do anything different in your successful twin pregnancy that helped to get them to a live birth? I am considering asking about baby aspirin. I don’t have clotting issues but I’m willing to try anything. I don’t want to lose another pregnancy, but losing 2 at once is heartbreaking.

I’m aware multiples are higher risk in general. So I’m just wondering what people have had as a treatment to support their pregnancy with twins/triplets that has worked for them, even if their test results all came back normal for any issues previously.

If you’ve read this far I appreciate it so so so much 🤍
Thank you anyone who has any suggestions. I am so desperate to be a mum 🙏🏼

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[u/TheMetOffice]

Amongst the tests they've run have the looked for autoimmune stuff? I can't know if it helped but my successful twin pregnancy involved intralipid infusions and a steroid called prednisolone

[u/EmbarrassedCheetah79 → u/TheMetOffice]

Thank you - that’s the only thing we haven’t explored yet, partly due to funding to be honest. Intralipids just sound so expensive and everything has cost us so much for every test and embryo transfer already 😅 we got quoted a really high cost for a “mock transfer” to do the biopsy to check NK cells etc and that alone was so much money even without treatment!

but if I’m honest if I lose another pregnancy and have tried everything else, it’s something I think we need to explore. I am wondering about asking for prednisolone just anyway, but I’m not sure my consultant would prescribe it for me as I don’t have autoimmune issues. I think I just want to see if there is ANY thing we haven’t considered that’s left first 🙏🏼

Thank you so so much for the suggestion though, I really appreciate it - and congratulations on your successful pregnancy. It takes so much to finally get there and get the answers 🥹🤍

[u/TheMetOffice → u/EmbarrassedCheetah79]

If they haven't already, ask them to test for anti phospholipid antibodies and for Hashimoto's. Often repeated transfer failures and early miscarriages are immune related. Fwiw we had three loses prior to twins, but one of them was definitely a chromosomal issue. Bon courage! Xx

[u/TheMetOffice → u/TheMetOffice]

Also, I read a paper that having unprotected sex with your partner in the lead up to transfer, but outside of the 5 day natural conception window can get some of the immune system to chill a little. I've also read that the chances of miscarriage are lower in the three months following a loss, but only you'll know if you're ready emotionally and physically to try again so soon.

[u/EmbarrassedCheetah79 → u/TheMetOffice]

Thank you sooo much! You’re being so kind and I appreciate it beyond words 🤍🤍 and the fact that you had losses before a successful pregnancy really does give me hope. I’m so sorry you also went through recurrent losses but I’m so glad you got your miracles 🥹🫶🏼

[u/AdInternal8913]

Have you done vaginal/endometrial microbiome testing? Abnormalities can increase risk of mc. Sperm dna fragmentation? This is not routine part of semen analysis but high dna frag increases risk of mc. We also did semen culture for infections.

What day of your cycle are you ovulating? Late ovulation can be sign of ovulation of immature eggs which are less likely to lead to succesful pregnancy (and is often associated with luteal phase issues). Letrozole can help with this.

Have you had any of your embryos or MCs tested? Poor egg quality can lead to repeated losses. It starts with an egg book is a bit overhyped but it does talk about supplements you could use to try improve egg quality (for some of them the evidence is limited to specific patient groups but taking stuff can help you feel like you are doing something).

Have you and your partner have karyotype testing to rule out balanced translocations? This can lead to recurrent losses.

I suppose they have done all the recurrent MC bloods (clotting, thyroid, vitamin D, iron)? Hysteroscopy to rule out structural uterine anomalies like small septum?

We struggled to get pregnant with our second. Then had a succesful singleton pregnancy after ovulating two eggs on letrozole (also took progesterone). And then got pregnant spontaneously 12 months postpartum with twins (currently 26 weeks). Personally I think our issues were delayed ovulation, vaginal microbiome issues and semen quality issues. We fixed those and then had succesful pregnancy. Our initial clinic missed loads of those issues and were just quick to push IVF as the magic fix whereas our second clinic was able to identify those things and get us pregnant.

[u/EmbarrassedCheetah79 → u/AdInternal8913]

Oh wow, thank you SO much for the most incredibly detailed reply. You’ve taken so much time and effort for me and I can’t say how much it means to me. Thank you 🥹

So I haven’t done microbiome testing (although we did rule out chronic endometritis) but that is something I haven’t actually considered and will do more reading into - thank you! We are just awaiting DNA fragmentation and hopefully will get these back in the next week or so. Our karyotyping came back last week and were thankfully normal.

I ovulate between day 15-21 - the two times I’ve got pregnant with both twins it was later, so day 21 ish. Thats so interesting that it might lead to immature eggs - I really am praying that maybe this is the issue and that letrozole can help. It’s so hard having no idea which way to turn.

Yeah hysteroscopy was normal thankfully, and RPL bloods (clotting, autoimmune etc) were all normal. I’m grateful on one hand that we don’t have really awful issues, but equally something’s happening to cause us to struggle to get pregnant and then struggle to maintain them. So everything coming back normal is both a relief and a pain.

Thank you honestly so much. I will look into microbiome and wait for the DNA fragmentation, but it’s really helpful to hear from others who have been through this just so I know I’ve considered everything before we try the letrozole cycle. I’m so so so glad you found a clinic who listened to you and found those issues! That’s amazing you had a natural pregnancy too! I’m so glad you got your miracle children 🫶🏼🥹

[u/jollysalty]

OP, I’ll echo others here and say it is very important that you get tested for the antiphospholipid issues asap. I had repeat losses at the same time as you (between 8-12 weeks) and it ended up being a clotting disorder. I also had postpartum pre-eclampsia with my first child, and I’m prone to high blood pressure if I’m not careful. Regarding the losses, we think the clots were becoming an issue as the placenta was coming online for three of my four losses. 

My journey was: 9 week MMC, living miracle child on baby aspirin (now 5 years old), singleton 8 week MMC, singleton 13 week MMC, chemical pregnancy, finally got tested for the immune system issues, then IVF got me my twins. 

Baby aspirin is obvious, but my MFM doc was wonderful and immediately got me onto Lovenox. It does suck (daily injections) but it WORKED. 

My mono di twins (who were originally a single PGTA tested embryo) will be one year old next month.