What could cause multiple miscarriages after IVF at 41?

Question

Hello doctor,

This is my third IVF, which has ended with a negative result. I got pregnant in both previous cycles, and both ended up in missed miscarriage at week seven. I am now 41. My embryos were sent for PGT, out of which two are euploid, one of which was transferred this time. I was prescribed Estrabet 2 mg, six tablets per day, from day three until the negative result. Naturogest was administered from day three to the end. I took Ecosprin one tablet per day, Dydraboon two tablets per day, and Susten two tablets per day.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Thank you for sharing your experience, and I truly understand how emotionally and physically difficult repeated IVF (in-vitro fertilization) failures can be, especially after previous early miscarriages.

At 41, even with euploid embryos confirmed through PGT (preimplantation genetic testing), the success of implantation and early pregnancy still depends on several complex factors beyond embryo quality, such as uterine receptivity, hormonal environment, immune factors, and vascular health.

Your medication regimen (Estrabet, Naturogest, Dydrogesterone, Susten, and Ecosprin) appears standard for luteal support and endometrial preparation in a frozen embryo transfer (FET) cycle, and it is reassuring that euploid embryos were used. However, given the history of two early losses and now a failed implantation despite optimized hormonal support, it is worth investigating further.

I would suggest discussing with your fertility specialist the possibility of a uterine receptivity assay (ERA) to assess if the timing of progesterone support aligns with your window of implantation, as well as immunological testing to rule out conditions like antiphospholipid syndrome, NK (natural killer) cell activity, or thyroid autoimmunity.

Additionally, thrombophilia screening, hysteroscopy to assess the uterine cavity, and checking for chronic endometritis may also be considered. At this stage, a multidisciplinary approach involving a reproductive immunologist or fertility specialist may provide further insights.

Please do not lose hope; many women at your age with euploid embryos do go on to have successful outcomes, but optimizing every controllable factor is key.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.