WTF consultation tomorrow after 3 failed transfers, any suggestions on what to ask or suggest for next steps?

[PaulaDag]

Hi All

I have my follow up consultation tomorrow after another failed transfer. This time it was a natural FET (my first ever frozen) with endo scratch and glue. Grade was a 5BB.

I previously had two fresh transfers after two back to back ICSI egg collection cycles. Grade was a 5BC on one of them. Then a double transfer of a 5AA and a 5BA on the other with glue.

I guess this is now classed a recurrent implantation failure along with my recurrent miscarriage history and I am hoping for any help or guidance you can give me for the consultation tomorrow, and what I can ask for next steps or tests to see if something else is wrong?

I've had 4 natural miscarriages between Oct 2018 and March 2020 (we stopped trying naturally since starting IVF in June 2020) and we know the March 2020 was a trisomy 15 as it was tested. NHS recurrent miscarriage clinic blood tests showed nothing out of the ordinary and we had karyotyping which came back clear for me and my partner.

I had my progesterone tested the last two transfers and it was better on the fresh cycles at 190 nmols, and the frozen was 55 nmols but upped the lubion and ended up with a 74 nmols reading. Yet i bled before OTD on both fresh transfers, but not the frozen, which is odd as I had less progesterone level on the frozen so doesn't make sense 🤔. Maybe my progesterone was low in my 3 natural miscarriages, not including the trisomy 15.

I have slightly out of range prolactin level tests here and there (last one was 800) - can this stop IVF implantation? I was told high prolactin won't cause miscarriage but can stop you conceiving. But I'm not sure about it stopping implantation.

My period are normal except fluctuate from 28 to 34 days, more towards the 33/34 days recently. AMH was 5.4, on retest was 4.4. AFC was 8 follicles and not had that rechecked. I take pre natal, folic acid, vit D and ubiquinol.

My partner and me are pretty fed up that we've spent all this money and not even had one positive pregnancy test. It's as if we had more success (if you can call it that) trying naturally. I know it sounds terrible but i'd almost prefer to have a CP or something just to know the IVF is working or implanting.

At the last failure follow up they said again its probably chromosomal abnormalities but can't be sure. I asked about ERA/Alice/Emma and NK cells, aspirin and they didn't recommend any of them. Only recommended natural FET for our last embryo and an endo scratch, clearly that hasn't worked either.

Any help or guidance about what next? I was looking into Mild IVF, does this help older ladies? I'm 43 in July and running out of time, its so frustrating, I had 300 IU of ovaleap first round and 450 IU menopur 2nd round. Im just wondering if its too strong and damaging the eggs...

I've now started to consider donor eggs but don't really want to give up on my eggs after 2 cycles. My partner is v logical and see it as we've tried 8 eggs (4 natural m/cs and 4 in the failed transfers) and thats quite a lot. I don't really think its that many to try to get a good one. We ruled out PGS due to low embryo numbers (2 first cycle, 2 second cycle).

If we just go back to trying naturally as my partner wants it will take longer to try as many eggs as were running out of time.

I want to do ERA and NK cells. Clinic don't do alice and emma. Maybe I can't get them done somewhere other than my ivf clinic.

I'm wondering about going to a private miscarriage clinic, maybe i should have all the bloods run again incase anything has changed.

I'm running out of ideas and steam 😒

xx

[Lovemylion]

Hi. Wow sounds like you've looked into a lot. Did you say you've had your thyroid checked? It might be worth checking out a clinic that deals with recurrent miscarriages....heard on the grapevine there's a popular specialist one in Epsom....no idea where that is in relation to where u live.....I think intralipids and such other methods are used. However, (as you are probably well aware) unfortunately as we get older the quality of our eggs declines quite rapidly and we're more likely to get abnormal than normal embryos.....but that's not to say people don't get pregnant on here with own eggs in their 40's..... I guess it depends on your finances and emotional state as to whether u want to pursue further rounds or go straight to donor. Good luck with whatever you decide! Xxx

[PaulaDag in reply to Lovemylion]

Hi. yes thyroid was check end of 2019 by nhs recurrent m/c clinic. I've emailed the clinic in Epsom to make enquiries. Thanks for your reply. Its a tough journey for sure xx

[Lovemylion in reply to PaulaDag]

I hope you get some answers and get the outcome you want. Keep us updated! I read somewhere (can't quite remember where but I'm sure dr.google will find it) that statistically they say that patients should try about 6 rounds of ivf on average but what they don't consider is the emotional and financial impact of that. It's a very hard and personal journey. I wish u the best of luck xxx

[Lovemylion in reply to PaulaDag]

O also forgot to say. Have u tried/asked about long protocol? I think u can get more eggs that way which may mean you get more embryos which could the pgt test ? Just a thought. Xxx

[PaulaDag in reply to Lovemylion]

I've been having a break from all things IVF so sorry for the late reply. both of my cycles were long protocol. I may do pgs test as looking to try one more time with my own eggs. xx

[Miracle43]

Hey lovely, I just wanted to wish you good luck for today.

I’m in a similar position. I’m also over 40. I’ve had 3 natural miscarriages between May 2018 -Oct 2020, I’ve also had 3 ivf failed cycles where I’ve produces good quality eggs but the have failed to implant 😢.

Like you bloods have come back ok, Ive if I can be investigated due recurrent implantation.

Unfortunately I get ‘it’s more than likely age related’ 😢.

When I conceived out last pregnancy the only thing I did differently was to take low dose Aspirin.

I’ve recently had a follow up with our consultant and was shocked to hear she sdvised IUI.

I thought it was the last thing they would recommended over 40s. Her reasoning was that I’m producing good eggs which they know are fertilising both in the lab and naturally, because I’m yet to get a positive test with Ivf they said to try and that I have the same odds with both.

I’m struggling to get my head around it at the mo.

Hopefully you’ll a plan going forward xx

[PaulaDag in reply to Miracle43]

Hi, I've been having a break from all things IVF after the last failed attempt so sorry for the late reply.

We are in very similar situations aren't we, yep they just don't implant so don't know if its a secondary issue or abnormal chromosomes due to age. All of the embryos have been good grades and good fertilisation rates ( in lab and naturally) but just don't implant.

I asked my consultant about aspirin and they don't recommend as said it can cause bleeding, especially with recurrent miscarriage. I might push them on this again. They said i could take Clexane next time whatever that does.

I asked about IUI and she said its even lower chances than IVF and doesn't recommend.

What are trying next? We are trying naturally at the moment and thinking one more cycle of own eggs and consider donor eggs. I don't really want to if i can have my own so might try DHEA now as last ditch attempt.

xx

[Knittingababy]

Hi Paula, it sounds like you have been through the mill recently, and I get the whole time ticking...aged woman thing that doctors always through at women. I am not an expert- I gave up due to cost and low probability after one IVF cycle... I did manage to get pregnant naturally after so it can happen..I'm 44 in a few months. Straight after my failed IVF round I looked into donor eggs and was pleasantly surprised to see that in some clinics you can do tandem cycles. Northern Cyprus hopefully when things ease up in a few months...offer tandem cycles where you try with your eggs and they match you with donor so that you can make your choices based on what happens.... If it were me I would try iui as for our age group the odds apparently are pretty similar. I did take some natural supplements from fertility smart (conceive for women) which helped with my cervical mucus quality and quantity the month I got pregnant so... You just never know. I wanted to wish you luck but please try and take a few weeks off thinking about all of this as it's such a strain on your mental and physical health.... It's a major form of stress. I described it to my friend as a shadow that was constantly with you and nobody else could really see how much it coloured everything..... X

[PaulaDag in reply to Knittingababy]

Hi, I've been having a break from all things IVF after the last failed attempt so sorry for the late reply.

Yes the whole time ticking is a big stress and pressure for me.

I might look into tandem cycles then, i've never heard of this.

I asked my consultant about IUI and she said its even lower chances than IVF so i just left it at that.

I'm so glad I took a break for a month, you're right it has such and impact on mental and physical health. It is a constant shadow and even my parents don't seem to understand how it impacts me as i've always been the strong person. xx

[Knittingababy in reply to PaulaDag]

So tough Paula. We are here for you. Just message me if you ever want to chat...no matter how strong people think you are this can really slice away any sense of happiness..future planning etc. We can't help what is happening emotionally deep within us xx

[PaulaDag in reply to Knittingababy]

Thank you. It has taken its toll on every area of my life. Its so hard but you have to try and battle on everyday. Thanks for the support xx

[TTCYEAR3]

Hi Paula,

I read your post and I feel that we some similarities - hopefully I can share some insight. I got pregnant naturally very easily and then miscarried early on. This led me to 3 IUIs and ultimately 2 rounds of IVF. I did have a high AMH for my first round and my RE at the time was very concerned about my dose - it was quite low and she was still worried about OHSS. Your suspicion that a high dose can affect egg quality is correct - there is research on this. My first round I had 27 eggs retrieved and ultimately 12 made it to blast but my clinic only froze 10 - they said the last two weren’t as great quality as the rest. I was counselled not to do PGT testing because they said I was young (34 at that time) and didn’t see the point. I then did 3 FETs and one was medicated and the second was natural the third was a double. No luck. I had triple lining so I knew that lining wasn’t an issue. My RE seemed very blasé and not concerned but I was. I told my RE that I wanted an ERA. I didn’t give her an option. I learned that you really need to be overly direct and firm and that if your clinic is not listening to you then you should find a new doctor. I ultimately did this in the end. I did an ERA and it showed I was prereceptive. My first clinic adjusted my transfer by adding 12 additional hours of progesterone. My clinic also sent a sample of my endo lining to their lab to conduct an Endo bioposy to look for endometriosis etc. I asked to be tested for thrombophilia due to the repeat implantation failure I was dealing with. My RE refused and said that there was no point. I then did 2 more transfers with my first clinic. My 6th transfer was supposed to be a long protocol. They were suggesting downregulating me and then upregulating me before the FET but COVID happened and my transfer was canceled. At that point, my husband and I decided to find a new clinic. It turned out that I had Hashimotos - - had both TPO and TGO and my TSH was climbing and almost at 4.0. I know you mentioned your TDH was tested in 2019 but were you tested for thyroid antibodies as well? Also, are TSH levels are constantly changing (even throughout a day) so I would suggest that you get tested again. You need be below 2.0 If you are trying to conceive. I found an new RE who immediately suggested thrombophilia testing and full panel of blood work which primarily focused on anti-bodies and immunological investigations. My new RE also tested my liver (AST) and for PCOS. She did a new endo bioposy and ran a mock cycle. And at the same time I saw another RE for a consult to decide whose perspective I agreed with more. While I didn’t end up going with this RE he was very helpful and said that despite my high quality embroyos it looked like I had an egg quality issue - he was ultimately right - and that for my next round I should be put on saizen and do PGT testing. He also took a look at my first endo bioposy and noticed immediately that my progesterone was out of sync with the cycle. It turned out that I have luteal phase defect. My first clinic didn’t pick this up. I ended up doing a second round with the second RE I consulted and again did well with my retrieval - 29 eggs retrieved and 10 ultimately made it to blast but this time had OHSS from early on. The difference is that I did PGT testing this time and it turned out I had a serious egg quality issue. Only 2 out of 10 were euploid and two more were mosaic - although I do wonder if the OHSS affected the quality. I was 35 at the time and the embroyologist said my eggs resembled a women who was 40-43. They also noted that they very fragile and hard to ICSI etc. Anyways, I had a lot of faith in my new REs medical skills. She has a very high success rate. Because I had luteal phase defect she put me on progesterone in oil not suppositories like my old clinic. She also put me on baby aspirin to help with circulation and aid implantation. I also asked for intralipids due to my Hashimotos and she didn’t laugh or discount this suggestion. She agreed. I was put on intralipids and prednisone which is proven to result in more live births in IVF. My husband and I were also given antibiotics right before the transfer. My RE is also very skilled in the OR. I noticed a huge difference in the way she transferred the embroyo compared to my first clinic. All that being said, although I only had 2 genetically normal embroyos - my first FET (6th in total) with my new clinic worked - I am 16 weeks pregnant. I still go in for intralipids and am still on baby aspirin and prednisone. I came off my pinoil and estrogen at 12 weeks. I do see value in knowing that that embroyos you are transferring are genetically normal because it saves you time and heartache and doesn’t leave you guessing - with my first clinic I have no idea if 1 or 2 or 4 that were normal. If I were you I would find a new clinic that is agreeable to putting you on intralipids and prednisone and testing you for thrombophilia to rule that out. Investigate and rule out whether you have progesterone resistance or have luteal phase defect. Also, believe it or not but that quality of the lab really makes a difference. It is where the magic happens. So research to find a lab that is using the most recent technology. And, try to find an RE that has high success rates - ask this question. If they don’t know the answer or tell you that you have a 50% chance then they probably don’t have a high success rates - if they did they would like track it. There is research that shows that some doctors are more successful based on their skill in placing the embroyos in the right position. I also did acupuncture and was on around 15 different supplements. I hope this helps!

[Babytocome in reply to TTCYEAR3]

Hi TTCYEAR3, thank you so much for such information. It has very useful. Can I ask which doctor did you go for the second clinic?It makes so much difference the place! i totally agree on that. all the best of luck with your baby!

[PaulaDag in reply to TTCYEAR3]

Hi TTCYEAR3,

I've been having a break from all things IVF after the last failed attempt so sorry for the late reply.

Thanks a lot for all the insight. We seem to have had very similar situations.

Congrats on the pregnancy, thats such great news.

Yes I asked for an ERA twice now and my clinic said they don't recommend and its much more likely chromosomal issues with my eggs. I guess I should consider PGS as I cried away from it last time due to only getting four viable embryos over 2 cycles. They never implanted so i don't know ifs an implantation issues or chromosomes. I wish I had PGS now just to know.

I had triple lining so it should have been fine. My consultant said no to aspirin and won't issue intralipids and prednisone without a test saying its needed - is that NK cells test?

I don't know if I had thyroid antibodies. Will that show as a particular code or T something as on the test results report? Is thrombophilia that same as TSH?

I just checked my report as my serum TSH was 3.29 mIU/L (normal range says 0.27 - 4.20 mIU/L). Does it need to be below 2.0 mIU/L to get pregnant? My GP said it was fine. Its all so demoralising and I feel like the left hand doesn't know what the rights doing!

What is saizen, I've never heard of that?

I am on Bromocriptine at the moment to bring down my prolactin as it kept going slightly out of normal range.

xx

[TTCYEAR3]

Hi Sonisonix! Thank you and Np I have learned so much from all of you amazing ppl on here so I thought I would share what I have I learned personally during my journey. I am actually in Canada not the UK - the clinic is called Anova fertility in case it helps. My husband is from the UK and during my journey of TTC I would frequently look at what is being done in the UK vs Europe vs leading clinics in the states. That’s how I found this forum.