FET - Additional blastocyst checks and progesterone - What options might be available?

[Bookbroad]

Hey all

Wondered if anyone might have any advice?

I was delighted to have 6 good graded blastocysts collected after our first round of ICSI earlier this year. I’ve now had 2 back to back failed FETs.

I’m meeting with my clinic in a week or so to discuss next steps and wondered whether anyone had any advice on whether there are any additional checks we could explore which might give any indication as to whether our remaining embryos are chromosomally sound?

I had natural cycles for both FETs - just progesterone pessaries 3 x a day. I didn’t experience any bleeding with my first transfer but did have a small amount of spotting at day 3 and day 10 during my second. I also tend to experience 3 - 4 days spotting ahead of my period on a typical cycle and have period related migraines. A small amount of research has led me to think this may indicate low progesterone and that maybe this should be upped for my next FET?

If anyone has any advice on either of these points I’d be really grateful. Really hoping to throw everything at this next transfer in the new year as the ongoing disappointment is just so crushing and just want to feel confident we’re not missing something that could improve our chances.

Thanks

Xx

[Fruitandflowers]

Sorry about the two unsuccessful transfers. There could be other reasons or sometimes it's just numbers, but ask about progesterone pessaries vaginally on the next go and maybe ask about progesterone injections. I've spotted for up to 5 days before my periods - had load of other symptoms too - for years but my progesterone levels were always good at day 21, so doctors weren't interested. Turns out some people react better to different forms of progesterone and you can have progesterone resistance or oestrogen dominance. My blood levels were sky high on cyclogest pessaries rectally but I still spotted after one transfer which the consultant said was unusual. After two back to back early losses (by 6 weeks) I went on the vaginal pessaries and lubion, and got much higher HCG than the previous two and it rose quickly - am now 20 weeks. Apparently you can't have too much progesterone and NICE is now recommending vaginal progesterone up to 16 weeks for miscarriage risk, so it's worth considering just in case.

[Bookbroad in reply to Fruitandflowers]

Thanks so much for your reply. I’ve taken vaginal pessaries for both transfers but not been offered lubion. Besides scanning 5 days ahead of transfer to check lining and leading follicle I’ve not had any hormones checks so that’s definitely something to ask about alongside any other proposed changes to my protocol. Congrats on your pregnancy and best of luck moving forward xx

[Fruitandflowers in reply to Bookbroad]

Thank you. My clinic seemed to think it was just numbers for us and that maybe right, but I wanted to change something before carrying on with further transfers and progesterone was all we could come up with. I also took aspirin on this one in case it helped. I got my progesterone checked on transfer, and then a few times in the days/weeks after - some clinics don't seem to offer it and I did mine post transfer with my GP and then an online company. Best of luck x

[Shireen1]

Hi Bookbroad! My clinic checks progesterone on the transfer day. Mine was always lower than they wanted and they would add injections. Can you ask to have it checked on the transfer day or on the day before? I read articles that the levels are important and not all women absorb it the same way.

[Bookbroad in reply to Shireen1]

Thanks for taking the time to message. This is good to know, thank you! I’ll definitely push for that next time. Seems like such a simple thing that could make all the difference 🤞🏻🤞🏻🤞🏻

[Shireen1]

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[Bookbroad in reply to Shireen1]

Thank you. I can’t see the photo for some reason

[LSandJ]

I would ask for your progesterone levels to be checked! (my clinic do it the day before transfer and add in lubion if its on the low side). Mine was checked and was low so added it in on one of the FeTs, and now have lubion as standard for any FERs. However, that hasn't been the answer for me. But if you're spotting, it might help!You mentioned chromosomal checks - that would be PGTA testing. Controversial though and many wouldn't recommend it (it's a red add on according to hfea!). We weighed everything up though and still decided to do it. It won't affect the outcome overall, but I thought might reduce the number of pointless transfers and heartache (if they came back abnormal then I wouldn't put them in and could just use the ones that might work!). However, we had 6 to test and 5 came back normal (and one low level mosiac). So it didn't really change anything for us. We had to just keep trying them. Unfortunately, even with a chromosonally normal embryo, ours still didn't work! So then we've tested the implantation window (Era), and that's come back as needing to adjust the days of progesterone (24 hours more!). We also had a hysteroscopy (all normal). So we are about to go for another one and hope this is the change we need!

It's so hard knowing what to do. We didn't bother testing era earlier because we'd read about it potentially not being worth it. But it turns out for us we needed it (although don't know yet if that change will work).

Whereas we did test chromosonally, but didn't actually need it (and some will think the risk of losing one is too high), but I suppose it was reassuring to know it wasn't a chromosonal issue and we knew to explore other avenues. Usually the PGTA is only really relevant if you are older (and therefore likely to have less normals) so that might be part of the thought process.

[Bookbroad in reply to LSandJ]

Thank you so much for your post. That is so helpful and so clear! This is the thing isn’t it, not sure if anything will make a difference but want to know we’re doing something proactive that may help! Especially as some options seem so simple! Thanks again

[josephnsn]

I had my progesterone levels checked the day of transfer. I had a failed fresh transfer and then a failed FET but my next ICSI cycle I was successful so might be 3rd time lucky. On average they say it takes 3 attempts for success with ivf . At 42 I was told 1 in 15 of my eggs would be good and it is a numbers game (my only issue was age). So be positive, that was really good to get 6 blastocyst. I only got 4 on my 1st ICSI but now after a total of 5 ICSIs and 1 FET I have a 3yr old boy and a 9mth girl. It will happen, just believe and be determined you are going to get your baby/babies

[Bookbroad in reply to josephnsn]

Thanks so much for your message and encouragement. Will defo go into the new year with renewed positivity after my batteries recharge. Defo going to explore prog testing on day of transfer 🤞🏻🤞🏻🤞🏻