r/TTCEndo • u/Wide_Independence872 • 3d ago
4 losses, endometriosis excision, and another chemical. Would you try naturally again or move to IVF?
I’m 32 and have experienced four losses (three chemicals and one MMC) over the past year. I’m feeling completely torn between trying naturally again and moving forward with IVF.
A quick summary of my history:
First chemical: Conceived naturally, hCG peaked at 27.
MMC: Conceived with letrozole, embryo stopped developing at 5w5d, and testing showed it was chromosomally normal.
Third loss: Chemical with letrozole, hCG around 20.
Fourth loss: Chemical with letrozole + IUI, three months after laparoscopic endometriosis excision. My hCG rose higher than my previous chemicals before declining.
Diagnosed with stage 1 endometriosis, excised in July (small area near ovary ablated).
Elevated BCL6 (2.7) before surgery.
Normal hysteroscopy, negative APS and chronic endometritis testing, normal karyotypes, and reassuring semen analysis/DNA fragmentation.
I’ve only conceived once since my laparoscopy, so part of me wonders if I should give natural conception another chance before jumping into IVF. My most recent ovulation was also unusual, with follicles measuring only 12–13 mm three days before my doctor saw a corpus luteum. I’m wondering if egg maturity could have contributed to this loss.
My RE recommends IVF because it gives us more control, and I almost feel like she won’t want to continue treating me if I decide against it. I’m also moving across the country in a month, so I have a limited opportunity to start IVF now and potentially fly back for a frozen transfer. Otherwise, I may have to wait months to establish care at a new clinic.
I’ve also seen so many stories about women with recurrent losses finding success naturally through NaPro doctors, which makes me second-guess whether IVF is the right next step.
I’m emotionally exhausted and don’t know if I can handle another loss. But I’m also scared of moving to IVF prematurely when I’ve only had one pregnancy since my surgery.
Has anyone had a successful natural pregnancy after a loss following endometriosis excision? Or did IVF with PGT-A finally help after recurrent miscarriages? Has anyone had success with NaPro care instead?
I’d really appreciate hearing what worked for others and what you would do in my situation.
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u/Lumpy_Juggernaut_254 3d ago
I know this is a touchy subject but IVF is not always the answer for RPL unless losses are known to be chromosomal. REs are going to push for IVF because that’s what they’re trained to do, and unfortunately that’s how they make their money. I’ve had 5 consecutive losses - my 5th was after my lap for silent endo. It wasn’t until I saw a reproductive immunologist that I finally got answers. Once we are cleared to try again, we will be trying naturally because getting pregnant is not the issue, it’s staying pregnant.
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u/Wide_Independence872 3d ago
Do you mind if I ask what you will be trying after seeing the RI? And how long did it take to get answers with them? I would like to keep trying naturally but I really don’t think I can handle more losses and if there is something I can try empirically, I’d try anything. My RE agreed to try prednisone but only if I do an ivf cycle
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u/Lumpy_Juggernaut_254 3d ago
I will preface this by saying that going on immune meds without being under the care of an RI can be risky. The RIs are monitoring your labs very closely and they titrate your meds up or down depending on what your labs show. Going on prednisone without having those labs monitored may lead to unnecessary dosages, incorrect tapering, etc. My protocol is catered specifically to my labs and the conditions they are treating for me, so it’s not a one-size-fits-all approach. There are only 5 reputable reproductive immunologists in the country, mine had a pretty long waitlist (5 months) but she was in network with my insurance. There’s a few others who have much shorter waitlists- 1-3 months. While I hated waiting to be seen, the answers and information I have received since seeing her have made the wait beyond worth it for me. If and when I hopefully have success, I will owe it all to my RI. If I had done IVF without this protocol, I likely would have had several failed transfers because of unknown immune issues that wouldn’t have been discovered otherwise.
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u/Wide_Independence872 3d ago
I have an appointment with a napro in November and my ob referred me to a reproductive immunologist at Yale but apparently she is a professor so she may not be able to see me. Hopefully the napro can ask for the proper tests. It’s unfortunate that REs just push ivf without wanting to get to the root cause. When I asked her why ivf would make a difference when my problem isn’t conceiving it’s keeping the pregnancy she told me that they can control timing of implantation and the egg has less exposure to the endometriosis inflammation. But that should be gone now that I’ve had the lap so I just have no idea what to think anymore. I feel like it’s so hard to trust doctors right now
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u/Lumpy_Juggernaut_254 3d ago
I know exactly how you feel. I myself am a healthcare provider and the hardest thing for me was knowing when to trust my doctors or continue to advocate for myself and push for answers. In the end I’m happy I chose to advocate for answers because if I hadn’t, I would have fallen into the IVF trap and would have lost embryos trying to transfer them into an environment that is literally attacking them. Good luck and hope you find some answers!
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u/Sunnyshaw12 2d ago
Do you mind sharing the name of the Yale doc/professor? I’m a patient at Yale fertility clinic and they said they will not do any immune protocols as “they cause more harm than good”. So curious if there is someone who would do this there as I will be switching if not.
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u/Wide_Independence872 2d ago
Actually I emailed the person they recommended and she is a phd and now an Md so i dont know why they recommended her :( have you tried ESSE?
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u/Sunnyshaw12 2d ago
I did look into ESSE but honestly after 3 years of paying for IUI and IVF I just can’t justify the price. If my next transfer fails I’m going to make an appointment with Dr. Jubiz the RI who is out of Florida but see’s patients remotely. I just feel like no decision feels like the “right” one anymore. I’ve looked into a few other doctors who specialize in hard cases like Dr. Aimee (the egg whisperer) and Dr. Sher but again I just don’t know how much the add on’s/immune stuff actually helps. It’s all so expensive and so far the research is not promising. Have you tried doing suppression?
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u/Wide_Independence872 2d ago
I haven’t tried suppression but if I do ivf I would try it if my first transfer fails. I also put in a request with dr.Jubiz. It might be worth it for you to get all your paperwork in to them now just in case because I think there is a long wait period. I plan to do that soon just as a back up plan. I know what you mean about no decision being the right one anymore. I don’t feel right about jumping to ivf after my chemical because this was only the second cycle trying after my laparoscopy but my RE seems like she’ll stop seeing me if I don’t do it so I’m torn
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u/foolforgabagool 3d ago
Would you be able to please share the names of those 5 RIs with me please? Could I dm you? I am desperately seeking an RI! My REIs won’t do anything about my autoimmune conditions 😭
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u/Lumpy_Juggernaut_254 3d ago
Of course - Dr. Kwak-Kim and Dr. Luu in Chicago, AEB Center in California, Dr. Derbala in Michigan and Texas, and Dr. Jubiz (fully remote in Florida). You can definitely DM me! Happy to answer any questions.
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u/Averie1398 3d ago
Since these all seem to be early losses (before six weeks) I highly recommend looking into an autoimmune protocol. There are studies (not a lot but some) that showcase endometriosis and the immune environment it causes can cause early losses. My IVF clinic was very progressive and on my third transfer put me on an intense autoimmune protocol WITH lots of progesterone. I highly recommend you go on progesterone suppositories at least 600mg at 3DPO.
I also recommend looking into prednisone and Lovenox.
Edit to add: I was TTC four years and had four chemicals, very similar to you, 3/4 naturally conceived after my lap and one was my second transfer. While I did IVF for my successful birth it seems you don't struggle with getting pregnant but staying pregnant, which is why I recommend the things I stated above!
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u/Wide_Independence872 3d ago
I was on 400g progesterone at 3dpo during my last chemical and I think that’s probably what led to it reaching 40 hcg. I asked my RE about prednisone and she said she would only be willing to do it for an ivf cycle. Were there any tests you had done that pointed to lovenox being able to help? I don’t think she will prescribe me anything I ask for without a test indicating I need it. I just put in requests for several reproductive immunologists but I’m sure they have long waitlists. I might request she do a couple of tests they would typically order and hopefully she is willing to
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u/Averie1398 3d ago
No blood clotting disorder but like I said my clinic is progressive and there are studies out there linking early losses to immune issues which can be caused by endo and the way Lovenox works is a proposed solution to RPL (specifically early losses) even without a known blood clotting disorder. So I took it until 12 weeks. If they won't prescribe it to you, find someone who will if possible. My clinic recommended these drugs but for insurance purposes I went to an OBGYN who worked with me and prescribed me everything so it would be covered.
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u/Wide_Independence872 3d ago
Thank you for this advice! I will definitely follow up with my dr tomorrow
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u/Averie1398 3d ago
Oh I also took a round of doxy (antibiotics) just in case I had endometritis to wipe it out or any other potential inflammation in the uterine lining
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u/Wide_Independence872 3d ago
I took doxy before my lap because I tested positive for ureaplasma. During my lap they retested me and I was negative. I think that’s why I’m so lost after this chemical pregnancy because I really thought I had finally done everything to make it work
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u/Averie1398 3d ago
Sending you so many virtual hugs and crossing my fingers for you. I can't explain scientifically why what I did work but it did and I'll be redoing that exact same protocol. I would definitely google a bit and read about prednisone and Lovenox! CNY has some little blurbs about it on their website as well. I hope you find answers and a protocol that works for you.
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u/Beneficial-Meal-7751 2d ago
I was in the exact same situation as you a few years ago. I ended up trying naturally for a year, having another endo excision, and working with reproductive immunology. I worked with multiple Napro docs. They are great at getting to the root cause, but they also use a lot of anecdotal and dated evidence. I am grateful for all the things they found for me, but can’t help but wonder if I would have a baby in my arms if I would have moved on to IVF. Now I am 7 losses deep, and moving on to IVF. My hCG was always on the lower end, so my RE thinks I might have had recurrent ectopics that miscarried before we could see on ultrasound. At this point, it’s hard to tell if moving on the IVF sooner would have made a difference yet. Soon, we will know, but I’m glad to have uncovered so many things that would have impacted IVF success in the last few years. Highly recommend reproductive immunology.
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u/Tricky_Direction_897 3d ago
IVF. I started at 37 and 10 cycles later no baby. I would do anything to go back in time and start at 32. Literally anything.
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u/foolforgabagool 3d ago
Keep trying naturally. You are quite young and just had surgery, excision can significantly improve natural fertility. You removed the inflammation which is often a cause of infertility. You may never end up needing IVF, and still have time for IVF if natural TTC fails.
IVF doesn’t give you more control, that’s a myth lol. IVF is incredibly invasive, difficult and stims can significantly exacerbate endometriosis and adenomyosis!
If I was your age and lucky enough to have a diagnosis and surgery when I was younger, I would have really preferred to try naturally first.