Hi all, the community has been great support through our IVF journey so far and we're hoping you can help us consider our options for next steps. We've had 3 rounds of ICSI so far with 4 transfers, all reasonable quality day 5 blasts but sadly none have implanted successfully.
Our clinic is suggesting we look at 3 more rounds, bank the embryos and carry out genetic testing on the best ones before transferring.
Our thoughts are before going into a new 3 cycle plan, perhaps we should look at some investigative tests for underlying factors. The clinic seemed less than keen on this, and said statistically there are unlikely to be any underlying issues and as it is a numbers game doing more cycles is their recommended approach. We're both in our early 30s.
Any suggestions on what we should be considering doing next? We've done some research and looked at options like DNA fragmentation (male side) and ERA/EMMA/Alice (female side) but unsure if we should push for this or some other tests.
We're also assuming if we do the tests elsewhere (as our clinic is not keen on doing it) and there are results that impact future treatment plan then clinics would be open to using these findings in a future IVF cycle?
Any help would be greatly appreciated! 🙏
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happilyevershahs
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Are you a private patient with your clinic? If so, have you considered changing clinics for a fresh perspective? I ask because I did this myself after three unsuccessful transfers with seemingly perfect embryos, and when we’d explored all the tests my old clinic were willing to without answers. After each unsuccessful transfer, we explored a test such as HyCoSy, a hysteroscopy and kayortype testing on both me and my husband. All was normal. I was being told that it was just bad luck and due to my age (30/31), I just need to keep going. But my gut was telling me that I needed to explore more - I was always getting poorly with my transfers with swollen glands for example and I really wanted to explore immunology tasting because I tick the criteria for someone with immune issues (incl. recurrent miscarriage, recurrent implantation failure, family history of autoimmune disease…).
I was also mentally drained from repeating the same process and seeing no results so I needed a fresh perspective. When I spoke to my original referring gynaecologist, he advised that I explore a new clinic that are willing to test immunology. So we did.
With this new clinic, we repeated all our tests incl. my husbands sperm analysis and DNA fragmentation test and immunology on myself. I have raised NK cells and TG antibodies, both of which are usually treated with steroids. I’ve also been on a lot more meds this time incl. higher dose blood thinners (I have raised anti-cardiolipin) and started them much earlier than I did with my last transfer that ended in a CP (transfer no.3).
I’m now newly pregnant and I believe that’s down to me making a change and my immunology treatment. It’s controversial in the field of fertility but it may be worth exploring if you continue to experience unsuccessful implantation.
I think sometimes on this journey we have to be our own advocates and push for the tests we want so it helps us feel like we are moving forward and learning.
Some other tests I know others have explored incl. the ERA which checks your window of implantation is correct. I never did this as I’ve been pregnant naturally before (miscarried) and had a CP and I didn’t believe this was an issue for me.
I didn’t do the EMMA/ALICE either as didn’t think it was needed and my consultant agreed. She prescribed me probiotics though as she said this clears things up!
I know some other ladies have PGS tested their embryos but there are other tests you can do before you get to that stage. One clinic we were talking to suggested we do that as a next step, but I’m 31 and just couldn’t believe that all the blastocysts we managed to create were chromosomal abnormal (at our age, 70% of our eggs should be hopefully normal, so I’m told). But that was going to be our next step of this transfer didn’t work as we’ve got a good number of blastocysts now in the freezer.
Hope this helps. Sending you lots of luck with your next steps 🍀🤞🏻 Xx
Thank you so much XOXO13. Reading your journey gives us courage to explore a second opinion and look at having some additional tests done. How did you go about researching a new clinic? We are Bedfordshire based and if you have any recommendations in or around London area we'd be happy to hear by PM 😊
So far we have been NHS funded, but we will now need to look at going privately for future cycles and perhaps it is a good time to change clinic too. Thanks so much for your input and very pleased to hear you are newly pregnant! Congratulations!
I knew we needed a clinic who specialised in recurrent implantation failure, recurrent miscarriage and who were known to explore immunology tests (being NK cells) so that helped narrow our search. We used the HFEA website, read success rates and read reviews. The two we narrowed it down to are very well known clinics (I’ll DM you). We booked consultations with with both that I think cost £250 each and sent them all of our medical records. When they talked us through what they would do for us, we felt more calm and positive and hopeful with the clinic we chose than the other one and that’s who we went with. It’s a little more money in terms of rolling costs, it’s definitely more intense but it’s gotten me to where I am right now and whilst early days, I’ve been really happy with them.
I’m so glad I moved because even that made a big difference to my mental health and gave me something new to focus on. Xx
I would definitely stick with your gut and do more investigations before embarking on any more cycles. At your age, 4 transfers with good embryos should have given you a reasonable shot at success, so your clinic's advice to just keep doing the same thing seems a bit underwhelming. Xoxo's advice to speak to a different clinic is a good suggestion. Even if you decide to stay with your current clinic for treatment, a consult with someone new will almost certainly provide you with a new perspective and new considerations that you can take back to them.
As for which tests to do, it kind of depends on your circumstances. Have any issues been found to date or do you have unexplained infertility? How did your cycles go? How many eggs collected/ fertilised/ made it to day 3 and then day 5? Have you ever had breakthrough bleeding before OTD/ has your clinic ever checked your progesterone around transfer? Any family history of autoimmunity or reason to suspect immune issues? How have your husband's sperm analyses been? Or just any gut feelings about something that might be off?
I'm sure we can come up with a list of suggested tests once we have a bit more info about your situation 😊 xx
Hi Soccerkt6! Thanks for the support, I think we will look for a new clinic and explore some tests. Because we were NHS funded so far we sort of fell into our nearest clinic and took it to be our best option. Are there things we should consider looking for in a new clinic in particular?
Regarding our circumstances, my husband's count and motility is below average hence we were advised ICSI would be good to address that. He has been taking Impryl too for about 12 months, although there hasn't been significant signs of improvement (he's had about 3 sperm analysis over past 18 months with small fluctuations up and down ). On my side we haven't had any specific issues highlighted. On average, we collected between 8-10 eggs each cycle, about half would fertilise (with ICSI) and then we had approx 2-3 reaching day 3.
On cycle 1 we had just 1 early stage blast at day 5 which we transferred. On cycle 2 we had two average quality blasts which we transferred, one fresh and one frozen. On cycle 3 we had one good and one average blast at day 5. Unfortunately developed mild OHSS so no fresh transfer, instead waited a month and then transferred the good blast. We do still have the average quality FET waiting on ice to consider using if we want. Just to add cycle one was using bemfola and cycle two and three switched to menopur which seemed to improve quantity and quality slightly.
No gut feeling that something is off 😔 and no history of infertility or immunology issues in our family. We have realised it's also not a topic that is discussed openly with friends/family and perhaps it should be to share knowledge and awareness!
Hiya, so sorry for taking a while to respond! Thanks for sharing all this additional info.
Since your husband's count and motility is low and your fertilisation rate seems a bit low considering you're using ICSI, I would prioritise investigating him further. The first step would be to either have him do a DNA fragmentation test through your clinic or contact a urologist like Dr Ramsay and set up an initial consult. Dr Ramsay can always order the DNA fragmentation test for your husband if he thinks it's necessary. Just curious - did your clinic ever say what the low fertilisation was down to (immature eggs or sperm issues)?
If you can afford to do multiple tests in one go, I would also have your NK cells checked. While I personally haven't had mine checked, it seems lots of women on here have done the test after multiple implantation failures and had success once they had the appropriate treatment. So it seems worthy of investigation.
Those two tests are probably where I would start, but you could always consider additional ones once you know where you stand.
I don't have any specific advice re looking at other clinics, but I would go with the one that gives you the best consult. Meaning, they really look at your file and are able to suggest new/ different protocols or investigations based on your past cycles. IVF seems as much art as science, so I don't want a clinic that puts everyone on a similar protocol just because it's easier. They should also be able to point to studies and research to support what they're recommending. Since you're doing ICSI, I would also look for clinics that have top-rated embryologists. Lots of NHS clinics are teaching clinics, so it's possible you may end up with a less experienced embryologist at an NHS clinic.
unfortunately, I dont have a success story for you (yet), but your situation is very similar to mine. We have been through two IVFs and a total of 14 great quality blasts, which either resulted in a chemical pregnancies, early misarrange (week 8) or a BFN. We did 5 transfers in total in two different clinics. The reason why we did IVF was because if my husband's 2% morphology.
All doctors said it was 'bad luck'. I was adamant to do as many tests as I could, just to make sure that we dont have a problem that we are ignoring. I did a hysteroscopy and removed 'few small fibroids', which was followed by an early miscarriage so that obviously was not the solution. I did a blood work up which included NK cells, Karyotype chromosomes tests (my partner as well), blood clotting, TSH, prolactin and many more. All came back normal expect for my blood clotting, which showed I had the MTHFR mutation gene. I already knew this and was taking Clexane & Aspirin in each transfer. I also did Intralipid transfusion during my early miscarriage.
After our second retrieval, we found out that my husband had 45% DNA Fragmentation which is very high and explains the several miscarriages we had. We were also advised to do EMMA & ALICE, but my current RE didnt want me to spend the extra money on the test and just prescribed probiotics and antibiotic for this round, just in case. We also decided to go ahead with TESA (surgically removal of sperms) and to PGS test the blasts. We ended up with 2 PGS normal embryos out of 5 blasts. we had a total of 12 eggs fertilized but we lost some.
It is also important to note that mu husband managed to decrease his DNA Frag from 45% to 31% by taking vitamins and eating well, but we still decided to go ahead with TESA.
I will be transferring one of the two normal embryos this cycle and hoping for this to be the solution of our problems.
Best of luck to you and hoping my long message was helpful and not too long to read.
Hi MamaWeez, thanks for your detailed response, of course very helpful and not too long at all ☺️ Wishing you all the best with your upcoming transfer!
Sounds like the additional tests you've had done along the way on your journey have been helpful, at least for peace of mind that there are no other underlying factors. Did you generally have these tests at your decision at the same clinic or did you visit other specialist clinics eg for the DNA fragmentation and immunology checks?
Also do you mind me asking what supplements your husband is taking for the DNA fragmentation? My husband is on Impryl but I'm not sure how effective it is compared with others.
Also if you have any recommendations for clinics you've used on your journey please feel free to PM us (we're London/Bedfordshire based).
Hello Happievershahs! I’m glad you found my post helpful. I tried to put as much details as I could. The tests do give us a peace of mind, but they still confuse us even more. Not knowing why pregnancy isnt happening for us, is harder than knowing what the problem is and fixing it. Hoping we cracked it this time with the DNA frag (tesa + pgs). I’ve had the tests done within a year or two. After miscarrying the second time, I went to different doctors ( most are Gyno or RE) who recommended different tests. One of my doctors sent me a full list of tests. Let me know if you would like me to share. I haven’t done them all though.
As for the vitamins, my husband and I were taking the below for almost 6 months:
For the husband
2 sachets of FertiloForte or Fertilix Max or proxeed
Vitamin D 2,000Iu a day
Vitamin C 1,000 mg a day
Vitamin E 400 IU a day
Ubiquinol (coenzyme Q10) 200mg twice a day
Serapeptase 80,000 IU
Zinc + gingec + omega3 (not prescribed by my doctor)
For the wife
Vitamin C 1,000 mg a day
Vitamin E 400 IU twice a day
Vitamin D 2,000 IU a day
Ubiquinol (coenzyme Q10) 200mg twice a day
Serapeptase 80,000 IU
Methylfolate 800mcgr 1 tablet a day
We don’t live in the UK at the moment but we consulted with mr Ramsay who is a urologist specialized in DNA frag and male factor infertility. I really recommend him, if you have MFI.
No advice but my clinic is saying the same thing as yours. That the first thing you should control is the embryo since that is markedly more likely to be the issue. I'm waiting on the results of my 4th transfer but I just know it will be negative. After that I'm onto donor eggs so I'm inclined to just continue to listen to my clinic because donor eggs are expensive and I'm not sure if we'll be able to swing paying for extra testing on top of that. I follow this awesome RE on instagram who does weekly Q&As and I asked about extra testing after 4 failed transfers and she also said no she wouldn't pursue so I'm feeling a bit better about that. Sigh, it's so hard. I'm sorry you're in this position x.
Hello, I'd definitely recommend having further tests as you don't want to waste any embryos and also to give your self the best possible chance.
Ive previously had 3 failed transfers with good quality embryos and knew something wasn't right
Before my next transfer I had an ERA test, that came back that I needed an extra 12 hours of progestrone and also increased the amount of progresterone I was taking to 4 cyclogest a day plus one lubion injection daily.
I also had a biopsy off my uterus, that tests for NK Cells. They found my NK cells were elevated and my lining was inflamed. I got prescribed steroids (20mg prednisolone), also clexane injections
My clinic also increased the amount of estrogen I was taking from 4 progynova tablets to 5 daily plus 2 evorel estrogen patches daily.
Without testing I feel your going in blind, I wish I done it sooner to avoid heartache and it would have saved a lot of money.
I also had my thyriod levels checked as that can affect fertility and that was another issue. As it was higher than they wanted, your thyriod needs to be below 2.5 for a successful pregnancy mine was around 3.7, so I started taking levothyroxine and my levels dropped to 1.6 within a few weeks.
Another change I made, was I took buscopan 30 mins before transfer and every morning and night for 4 days. It's supposed to help calm your uterus and prevent it from cramping.
After those changes I finally got a positive test. It's still early days for me, I'm only around 5 weeks pregnant but having those tests have definitely helped and got me this far 🙏
If you have any questions.. I'm happy to help 🥰🥰🥰 xxx
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