IVF - Surrogacy Blog

15Jun/17

Recurrent miscarriage – causes & treatments

Recurrent miscarriage is the loss of three or more consecutive pregnancies of 13 weeks or less, with the same partner.

Miscarriages and early loss of pregnancy are so common that many obstetricians consider it a normal part of reproduction. That doesn’t make the loss easier but the fact that you were able to get pregnant at all should give you hope of having a baby in the future.

 

How many women have miscarriages?

Even after the confirmation of pregnancy, about 10-25% of all pregnancies end in miscarriage, according to the figures published by the American Pregnancy Association

It also says that as many as 50-75% of all pregnancies end in first trimester miscarriage; a portion of those women are not even aware that they are pregnant when the loss occurs.

Henry Lerner, MD, clinical professor of obstetrics and gynecology at Harvard Medical School and author of Miscarriage: Why it Happens and How Best to Reduce Your Risks, said, “Since you got pregnant once, the odds are 80 percent that you will go on to have a healthy baby, and as many healthy babies after that as you want.”

About recurrent miscarriage

 Also known as recurrent pregnancy loss (RPL), recurrent miscarriage is acknowledged when:

  • You had 3 or more consecutive miscarriages (within 13 weeks of pregnancy), OR
  • You had 2 late miscarriages (13 – 20 weeks of pregnancy)

1-2% of all pregnant women face multiple miscarriages due to different reasons.

 

Recurrent miscarriage causes

1.      Chromosomal Abnormalities

60% of pregnancy losses are attributed to chromosomal abnormalities in the fetus.

There is 50% risk of miscarriage if you get pregnant after 40 because chances of aneuploidy (addition of extra chromosomes) are much higher. The risk of miscarriage is only around 10% in women under 35.

The egg quality of women starts to deteriorate as they start aging and that further increases the risk of miscarriage. Pre-implantation genetic screening (PGS) could be helpful, if:

  • If you are experiencing multiple miscarriages due to chromosomal reasons
  • If you are aware of a genetic problem in either of the partners
  • If you go for natural pregnancy or IVF after 40 years of age

 

2.      Anatomical factors

13% of recurrent miscarriage patients are noted to have anomalies in their uterine cavity—arcuate uterus, septate uterus, unicornuate or bicornuate uterus and a didelphys uterus.

A septum in the uterus (septate) is the most common abnormality in which the uterus is separated into two. A hysterosalpingogram can be used for diagnosis, which can further be confirmed with an MRI and a 3D sonogram. 

A weak cervix also leads to second trimester miscarriages repeatedly or preterm deliveries.

3.      Antiphospholipid syndrome

Upto 42% of recurrent miscarriage patients test positive for antiphospholipid antibodies.

Testing for these antibodies can be carried out in RPL patients but only after the anatomic, hormonal, and chromosomal causes have been ruled out.

If you test positive, Low doses aspirin and heparin are part of treatment regimen.

 

4.      Immunologic problems

Reduced maternal immune tolerance towards the fetus is considered one of the causes of RPL but immunologic factor for recurrent miscarriages have not been clearly proven by research so far.

 

5.      Hormonal and metabolic factors

  • Hypothyroidism – Thyroid levels should be evaluated and TSH levels should be below 2.5mIU/L before trying for pregnancy.
  • Diabetes – Highly elevated blood sugar can be associated with loss of pregnancy.
  • PCOD – Excessive androgens as in PCOD/PCOS may cause loss of pregnancy.
  • Increased prolactin – Elevated prolactin levels hamper follicular development and luteal function. This leads to reduction in progesterone levels in the luteal phase of the cycle.
  • In patients with repeated miscarriage, progesterone supplementation can be given to improve chances.
  • Thrombophilia (propensity for blood clots) – About 15% of recurrent miscarriages are attributed to this problem. Anti-coagulants may help, but more research is needed to establish their efficiency.

 

6.      Lifestyle factors

Excessive consumption of alcohol, cigarettes and cocaine use have been reported to raise the risk of miscarriage.

Too much caffeine (over 3 cups a day) is also linked to miscarriages.

7.      Unexplained repeated miscarriage

Over 50% of patients are unable to find the reason for repeated miscarriages. However the chances of a successful pregnancy after recurrent miscarriage in these cases are as high as 50-60%.

 

Recurrent miscarriage treatment options

In recurrent miscarriage tests, the Karyotype analysis (genetic or chromosomal make-up) of both partners is tested, but not all doctors choose to get these tests done because these problems are relatively rare.

Detecting the cause of recurrent miscarriage is important, so treatment can be tailored accordingly. The below treatments are considered:

  • In women with anti-phospholipid syndrome or congenital thrombophilia, anticoagulants may increase chances of successful pregnancy.
  • Certain chromosomal situations call for the usage of PGD testing with IVF to check the genetic makeup of embryos before implanting them in the uterus.
  • The womb and its insides are also evaluated with an ultrasound, hysterosalpingogram X-ray, MRI, and/or hysteroscopy. These will help the doctor to determine the shape and size of the uterus, any abnormal growths, polyps, fibroids, uterine septum or scar tissue that may be interfering with pregnancy.
  • If the problem is with the uterus, you can opt for surrogacy – an arrangement in which another woman agrees to carry your baby in her womb.
  • For miscarriages due to thyroid or other endocrine problems, hormonal pills may be given and pregnancy is attempted only after the hormone levels are conducive.
  • In cases of unexplained recurrent miscarriages, there is no universally acceptable recommendation for any RPL treatment. The chances to conceive after recurrent miscarriages of unknown reason are quite good, but every additional loss worsens the prognosis and increases psychological and physical risk to the mother.
  • Consider hiring a surrogate mother if you are miscarrying every time and the doctors cannot point to any specific cause for that.

Recurrent miscarriage after IVF

Unsuccessful IVF or early loss of IVF pregnancy is usually attributed to poor genetic condition of the female egg.

The quality of female eggs worsens over time and the chances to get embryos with abnormal genetic makeup are high as you touch your 40s. If you have undergone IVF several times but miscarried early, it is probably due to embryo arrest.

Talk to your doctor and consider IVF with donor eggs or surrogacy.

 

Recurrent miscarriage experts in Chandigarh – Contact Dr. Harpreet Sidhu or Dr. Nirmal Bhasin for your specific case.
20Apr/17
Mild IVF

Mild IVF

IVF is expensive, distressing, and physically difficult for some, and if that is you, maybe you should consider the option of mild IVF, also known as micro IVF or mini IVF.

In mild IVF you will be given a smaller dosage of fertility drugs for a few days, which means lower cost, lesser discomfort and side-effects. However, with this method fewer eggs are collected, which in turn could result in lesser chances of success.

 Read the below to understand what mild IVF is, what are its pros and cons, and if you should opt for mild IVF at all.

 

What happens in mild IVF?

As the name suggests, mild IVF is a softer approach to the conventional IVF, which means a lesser aggressive drug therapy is used.

The suppression of gonadotropin hormones, as in the antagonist protocol of IVF, is not done in mild IVF so your body will never go into the temporary menopausal stage.

 Eggs will be collected after only a few days of ovarian stimulation and fused with the sperm from your partner.

The resultant embryos will be then transferred to your uterus.

So, it is more convenient and cheaper than conventional IVF, why don’t all doctors offer it all the time and make it the standard treatment? Because the success rates are believed to be lower. Mild IVF is not for everyone and you must read the pros and cons before making a final decision.

Pros and Cons of Mild IVF

Pros

  • A lower dose of fertility drugs is required
  • Injections are given for a shorter time period
  • Unlike in conventional IVF, the suppression of natural cycle is not done, which means you will not face any menopausal symptoms
  • Fewer side effects on your body
  • In case the treatment is not successful, it can be repeated more quickly because the body recovers more easily
  • Cost of IVF is lower per cycle

Cons

  • Fewer eggs are collected
  • Fewer embryos are formed, which means there is little choice to select and transfer the best quality embryos
  • Success rates are lower
  • Could prove to be more expensive if multiple cycles are required

 

What are my chances of success with mild IVF?

It wouldn’t be fair to draw conclusions on the limited data that is available yet. However, it is surely stated that fewer eggs result from mild stimulation IVF, which result in a lower success rate.

The above chart is based on data shared by the Journal of Human Reproduction

Should I go for mild IVF?

Only a detailed discussion with your doctor after completely studying your reports can reveal if mild IVF is for you. It is offered in selective cases where:

  • You have a history of PCOS
  • You are at a high risk of ovarian hyperstimulation syndrome (OHSS)
  • You have chances of adverse reactions to fertility drugs
  • Your ovarian reserve is so low that even after taking standard amount of fertility drugs only few eggs are collected (as in older age women)

 

Mild IVF has become a little bit of a trend with some clinic aggressively promoting this technique over the conventional method. However, as of now, the available data suggests that the chances of IVF success are higher in cases where more eggs are collected.

Have an honest discussion with your infertility doctor about the ideal protocol of IVF given your conditions.

 

Do you have any experience with mild IVF? Please share it with us in the comments below.

16Apr/17

Natural Cycle IVF

In Natural cycle IVF, the egg you naturally release during your monthly cycle is collected and fertilized with the sperm under controlled conditions of the IVF laboratory. Fertility drugs or hormone injections are not used in natural IVF.

The world’s first IVF baby—Louise Brown—was conceived with natural IVF but due to the lower success rates and higher number of abandoned cycles, the natural cycle treatment is hardly followed these days.

 

Natural IVF success rates

The success rates of natural IVF are not very encouraging. At around 8.8 percent success, as reported in a study by Assisted Conception Unit of King’s College School of Medicine and Dentistry (between 1993 and 1996), natural IVF is not considered an option by most doctors, which is why more recent success rates are not available.

However, there a few cases of natural IVF success, wherein women who failed to conceive with the usual IVF procedure, got positive results on trying natural IVF later.

How does natural cycle IVF work?

Natural IVF is a delicate treatment process, which must be performed with great precision and care. The process is similar to conventional IVF but it is less time-consuming and less invasive because no drugs are administered.

You will be tested first to check for your natural ovulation and if you are still ovulating, there should be no problem.

The rest of the steps in natural IVF are as follows:

  • Visit the clinic on day 1 of your period and schedule your scans
  • You might have to visit the clinic for scan every other day until around day 12, when egg pick up will be done under anesthesia
  • The same day, that egg will be fertilized with sperm from your partner, and the resultant embryo will be kept in the lab for growth
  • On day 3 – day 5, the embryo transfer will be done

However, the egg retrieval rate, embryo transfer rate, and the final success rates of natural IVF are all way too low, and most doctors recommend mild IVF over natural IVF.

Below are the noted advantages and disadvantages of natural IVF:

Advantages of natural IVF

  1. More patient friendly and safer – No hormones are administered to suppress your natural cycle and then to increase the number of eggs. You do not have to make multiple trips for dug injections and there is no risk of ovarian hyper stimulation syndrome (OHSS)— when too many eggs develop in the ovaries, making them large and painful—or the nausea and uneasiness that some women face with IVF drugs.
  2. Less expensive – IVF is expensive and almost about half of its cost can be attributed to the expensive drugs. However, with natural cycle IVF you only have to pay for the doctor’s fee and the lab charges.
  3. Good for older women – Women in their 40s or those with low ovarian reserves do not respond very well to IVF drugs, and even after taking all those injections, the doctor is able to collect only 2-3 eggs. So, they might want to take a chance with just one egg as collected in a natural cycle IVF.
  4. Can be repeated sooner – Due to the effect of stimulation drugs on the body, patients of conventional IVF have to wait for 2-3 months before they can go for the next cycle of IVF. However, in natural cycle, you can repeat the treatment every consecutive month.
  5. AMH, FSH levels not considered – Irrespective of your AMH and FSH levels, natural cycle IVF can be performed.

Disadvantages of natural cycle IVF

Cycle cancellation is high because the doctor is not controlling your hormones and ovaries. Only about 50% of patients who start a natural cycle IVF are able to go upto the stage of embryo transfer.

  1. Low chances of success – Higher number of eggs and embryos means there are greater chances of success in stimulated IVF, but in natural cycle IVF success rates are dismal.
  2. Failed egg collection – In a number of natural cycles no egg is collected because spontaneous ovulation can occur anytime before the planned egg retrieval.
  3. Failure to fertilize the egg – Since there is only one egg, the failure of egg fertilization (which happens in about 10% cases) means cancellation of the cycle.
  4. No embryo selection possible – When the doctor has multiple embryos, he/she is able to choose the best quality ones to transfer to the womb. But in natural IVF, since we are relying on only one egg and one embryo, embryo selection is not possible and the chances of the entire cycle being wasted are much higher.
  5. More chances required for success – With around 8% average success rate, the chances of conceiving in a natural cycle are 1/5th as compared to a conceiving in a stimulated cycle.

This above chart is made on the data shared by Lister Fertility Clinic, which states that IVF success improves with number of eggs used (irrespective of age)

Is natural cycle IVF for me?

Given the shortcomings noted above, natural cycle IVF is recommended only if:

  • You are prone to OHSS or cannot take fertility drugs because of any other reason
  • You do not want extra eggs or embryos because of some personal beliefs
  • Your ovarian reserve is so low that even after being stimulated multiple eggs are not collected

Even though Louise Brown was conceived with natural cycle IVF, it took over a hundred attempts over ten years to get that one success.

Mild IVF or modified natural IVF—that use lower doses of stimulation drugs—may bring the desired results in patients who cannot undergo the regular stimulated IVF for any reason.

Discuss the options with your doctor to know the best course of treatment in your case.

Have you undergone a natural cycle of IVF? Can you share your experience? 

To consult with any of our registered doctors for advice on natural cycle IVF, fill-out the form on the right.