5th BFN - what next?

[Patches86]

Unfortunately my 5th transfer ended in a BFN again. 5 failed implantations. I threw everything at this one and don’t feel like I’ve left anything uncovered.

Curious to see if anyone might have recommendations of another test / something to do differently?

What I’ve done:

- PGS tested embryo

- ERA, ALICE, EMMA

- prednisone - immune protocol

- clexane and aspirin blood thinners

- extra progesterone (prontogest)

- thyroid medication

- MTHFR gene - extra folate

What else is there to try?

A BFN hurts so much. Thinking of all of you experiencing similar x

[Millbanks]

Hi Patches, I'm so sorry to see this - I understand how it feels and the despair you feel right now.

You've tried a lot but there are still things that you can look at.

I had a load of things lined up for after our 6th transfer (if it hadn't worked) and they were:

LIT therapy - which is using plasma from your partner to help lower your antibodies and allow implantation.

IVIG - a much stronger version of intralipids - again to lower your immunities

Humira - helps to control elevated TNF-Alpha cells

Have a look at this link for more info: fertility-academy.co.uk/imm...

It might be worth exploring some of these options - did you have particularly high NK cells? And what dose of prednisolone were you on?

I also did all the things above that you have listed, and it wasn't until we did prednisolone 20mg a day with intralipids that we had success on our 6th attempt.

Maybe you need a higher dose, or something extra to lower your immunity.

Sending much love to you today - it's so heartbreaking xxx

[Patches86 in reply to Millbanks]

Thanks so much Mills! My NK cells were on the higher side of the normal range but given my repeat implantation failures my doctor agreed to prednisolone 25mg. I was hoping that would do the trick but clearly not. I’m not sure if my levels are elevated enough to warrant any of the extras, but I will definitely ask, thanks for sending this helpful info! I can’t help but think if it’s not embryo or immune issue, then what the heck is it?!

[Millbanks in reply to Patches86]

It's so frustrating isn't it. There HAS to be a reason - I always felt that and the fact that we didn't have an answer for so long just occupied my mind all the time. I felt that I couldn't try any more transfers without just testing everything after our 5th - but part of me also wonders if it is just a numbers game - just keep trying. You've already got so much in the bag.

Argh I just want to make it work for you!!! xxx

[JA-fnuk Partner Nurse Fertility Network UK]

Sorry to read your post- do not be too hard on yourself you are trying your best Make sure you have people round you who can support you - keep talking to your other half Allow yourself time to feel sad and look forward to the next step- you could ask your clinic if there is anything else they can suggest or changeSending you a hug and good wishes for the future

Janet

[Patches86 in reply to JA-fnuk]

Thank you for your kind words Janet 💜

[Chel91]

So sorry to hear this hun. It's so hard 😥 I'm in a very similar position to yourself and it is just heartbreaking. I have tried pretty much everything, and done several transfers also.

Here is what is in the pipeline for me, mostly focusing on inflammation / immune causes now:

MRI to check uterus shape, etc. and laproscopic Endometriosis surgery booked. I have very painful periods and endo can create a lot of inflammation which prevents implantation.

High ANA result for me. Immune protocol 20mg prednisone long term, intralipids every 2 weeks (including starting at least 2 weeks before transfer), Plaquenil 200 to 400mg immune drug long term (important to be on this for months). Other immune drug options are Tacrolimus, Humira, and IVIG will be one of my last options because it's a bit expensive. No luck for me yet, but I'm definitely holding on to hope for these.

Sending you lots of love and strength xx

[Patches86 in reply to Chel91]

Thank you for sharing! All really helpful to ask my doctor about.

All the best for your your upcoming MRI and surgery x

[Maryc32]

I’m really sorry this is happening patches. Have the clinic offered any insight? Was this your first PGS tested transfer? Xxx

[Patches86 in reply to Maryc32]

Thanks Mary, I have a follow up next week. No I previously used a PG tested embryo too. Congrats on the birth of your sons, I just saw your other post!! So happy to hear you are now back home and your babies are where they should be 💙💙

[AuroraXen]

Oh bless you sweetheart, I'm so sorry. I completely understand why you are flummoxed - you've tried to change and check so much! It doesn't make sense... like you say, it isn't that the embryos are abnormal as you've tested them! I don't have any pearls of wisdom, and saying maybe all is as it should be and you've just been spectacularly unlucky so far probably isn't helpful 😪 Sending you lots of love and hoping some of the good suggestions above might help xx

[Cinderella5]

Hey Patches, I'm so sorry!💔 Its a tough road isnt it! Did your ERA show anything? Are your embryos PGS tested? It could be that they are not euploid or perhaps just on this transfer if everything else was bang on which it looks like you have everything covered! We had one transfer after our ERA which didnt work with good embryos but I'm guessing they weren't right as next time we got a BFP. Massive hugs, it's so shit!!xxx

[Patches86 in reply to Cinderella5]

Thanks Cinderella! A tough road indeed! Embryos are PG tested and ERA protocol followed (which showed I am pre receptive and needed another day of progesterone), so I’m at a loss for why this keeps happening.

Thanks for your support always - hope you are enjoying every moment with your special twins! X

[Cinderella5 in reply to Patches86]

Bloody hell, what a trooper you are! It's so crap trying all you can and still nothing.😪 How has your lining been recently? Was a triple lining? Have you tried raspberry leaf tea? I know it sounds like witchcraft but I swear it helped me...drinking the tea and taking the tablets. We are ok thank you!😘xx

[JenRoy]

Sorry to hear this. I found this link when I was researching implantation failure. It’s referring to donor egg treatment but I think it’s still really relevant. I like her thorough approach. Worth a read myivfanswers.com/video/fail...

[Cinderella5 in reply to JenRoy]

Some good info there Jen! Hope you're doing ok.xx

[JenRoy in reply to Cinderella5]

Thanks hun. Doing ok. Gearing up for 3rd go at DE transfer. Keeping faith 🤞

[Cinderella5 in reply to JenRoy]

Fab news!! Good luck Jen.xx

[Patches86 in reply to JenRoy]

Thanks Jen, this was a helpful read! Best of luck with your next transfer 🤞

[Lou22xx]

So sorry for you, this is such a tough journey. I am about to try my 5th attempt and I have done the similar tests to you with no success. So this time they are introducing that prednisolone as my levels were unbalanced. I also had another hysteroscopy (3rd one) which removed some scar tissue from last year from a polyp and whilst he done that he injected tons of my own blood into my endo which basically reboots it, my clinic is private in uk but the new owner is in Spain so I went over there. Even tho I paid for ERA in uk they done a more In detail test called EMAP supposedly it gives a smaller window , then also done Immunological test which is why they have introduced prednisolone. So I am hoping this helps when I start my meds, have they tested your progesterone levels as I feel my first 3 was a waste of time as had severe low levels and they wouldn’t test until I forced them on my 4th so then went onto more lubion as the cyclogest wasn’t working xx

[Patches86 in reply to Lou22xx]

I haven’t heard of EMAP before - something I’ll look up, thanks! All the best for your 5th attempt, hopefully it’s the one that sticks x

[laffy]

I stopped and took a breather and alot of counselling with an amazing therapist. I truly believe stress was holding us back.

I ended up realising that when you even step into your gp surgery for that very first time, we are made to feel we should be down and depressed, with little hope. We had our next round and the clinic couldn’t believe how chirpy and positive we were after soo long.

It’s like all the people who stop trying then naturally catch when they’ve grieved and let all their stress out.

I truly hope you all get your babies xxx

[Patches86 in reply to laffy]

Thanks! I’m working on stress management, having therapy, taking meds, acupuncture etc. For me personally taking a break from IVF is more stressful than pushing on. But I do agree with you that stress is a factor in all this. Well done on being able to take a step back when you needed to 💪🏼

[Jana483]

I am really really sorry!!!My first question is how many fresh cycles did you have so far?

What I mean is are all those bfn from the same cycle? (same egg and sperm batch)

[Patches86 in reply to Jana483]

Two cycles, first 3 transfers from the first batch and the last 2 transfers from the second batch. I was hoping a different cycle would help but unfortunately the same outcome for me! 1 tested frosty left…

[Jana483 in reply to Patches86]

I know it's hard I've been there!They say you need 3 full cycles at least!

Is it a problem with the embryos or implantation?

[Patches86 in reply to Jana483]

Seems to be an implantation problem given they are PG tested embryos 🤷🏻‍♀️

[Jana483 in reply to Patches86]

And what explanation did the clinic give you?

[Patches86 in reply to Jana483]

I have a follow up appointment next week but so far “unexplained”

[Snoopydraws23]

Hi Patches,

I’m so sorry to read about your 5th BFN! 😔 I don’t really have any advise on any further tests but just wondered if you’d thought about alternative therapies alongside treatment - such as acupuncture. I didn’t have it on my first round which was a BFN but have on my last 3 FET. One resulted in a successful pregnancy and the other 2 were unfortunately ectopic pregnancies - however, I still find it reassuring that both of those did implant just not in the right place! Good luck with whatever you decide to do next. X

[Patches86 in reply to Snoopydraws23]

I’m sorry to hear about your ectopics. I had an ectopic pregnancy in 2020 and know the pain associated with that ❤️

I did try acupuncture this time around, I enjoyed it but didn’t seem to help with the implantation unfortunately x

[Snoopydraws23 in reply to Patches86]

So sorry to hear about your ectopic too. My last one was in 2020. I hope whatever you try next is successful. X

[Msze]

I’m so sorry.

[Koala365]

I'm sorry to hear this. I've had 4 fresh cycles and 3 transfers of a total of 6 embryos and all resulted in BFN so I feel your pain. I can't understand, like you, why I appear to have a problem with getting the embryos to implant even though apart from having the MFTHR gene mutation there doesn't appear to be any reason for it. I'm left wondering whether because I had an MMC (got pregnant naturally before I embarked on IVF jounrey) and had to have the ERPC op as the medication didn't work for me, whether because that was all so unnatural my body is still traumatised by it all. But that was 2 years ago. Or whether, as suggested to me by an acupuncturist, because that all happened end of Feb 2020 and I hadn't had a chance to recover before lockdown happened and have had to keep shielding to do my 4 x IVF cycles, my body doesn't feel safe because of the pandemic so isn't letting anything implant and that once life gets fully back to normal it is more likely to happen. Apparently the pandemic has resulted in fewer pregnancies for that reason (i.e. body doesn't feel safe) according to that acupuncturist. I note you mention taking aspirin above. I was told by my consultant not to take aspirin until I had a positive pregnancy test as aspirin can inhibit implantation. I am also not going to be allowed to take Clexane until I have a positive pregnancy test if I try naturally but can have it from embryo transfer if I am willing to put myself through another IVF which is annoying when my understanding is that the MFHTR gene mutation means implantation can be inhibited! Anyway I hope some of the above is helpful and I wish you well with your next round of IVF if you decide to do one Xx

[Patches86 in reply to Koala365]

Hi Koala, I’m sorry to hear about your failed transfers too. Very interesting what you say about the body not feeling safe. Definitely a view to consider. Thanks for taking the time to reply. I hope your next round goes as best as possible for you x

[lizheth1981]

Hi! I have been. in your shoes, and done all of that, and after my 7 th transfer, just had my bfp and the second beta this week. i go next week to confirm a sac. i was even filling out adoption papers during my wait. sometimes, i think it just happens after many attempts without reason, kind of like probabilities. each transfer is torture , and this was going to be my second to last try. i am still wary of it will last. just know that you are not the only one , i am with you, and it can happen!

[Patches86 in reply to lizheth1981]

Congrats! This is such a story of hope and shows some truth in it being “just a numbers game” which I find hard to believe, but does inspire me to push on. Thanks and all the best with your pregnancy.

[lizheth1981 in reply to Patches86]

thank you! your timeis

coming! ❤️🙏👼

[articsnowfox]

I'm so sorry about your BFN - it is so devastating...as much as a miscarriage is I think because you do become invested in those wee embryos, even before they are put back in. What is your diagnosis if you don't mind me asking? Are you older (at least 35 years of age) or with low AMH? If either of those things, I really recommend DHEA - there is strong evidence that it works for both of these situations. My job is evaluating medical data and there is an analysis of 8 studies that shows an improvement in live birth (which is usually super hard to show). I can send you the link if you like. Anecdotally, i think it helped me conceive my son at age 43 and my friend who got my leftover pills (and with recurrent miscarriage history) also conceived at age 43.

[Patches86 in reply to articsnowfox]

I’m 36, with a seemingly ok AMH as getting normal embryos, problem is more with recurrent implantation which I understand DHEA wouldn’t assist with? Wonderful to hear that you were able to conceive your son with the help of this ❤️

[articsnowfox in reply to Patches86]

Yeah, it sounds like DHEA probably wouldn't help unfortunately. I hope you manage to get to the bottom of your implantation issue (I had this as well but this was due to a thin uterine lining). It is soooo gutting to lose good quality embryos :(((

[IVFmumma]

No advice really, but I just wanted to say I'm really sorry 🥺♥️✨ That really sucks. I've just had my 4th FET in 12 months and waiting on results. I am also in the back of my mind thinking about "what next" if it doesn't work... The good news from reading these replies to you, is that there are more avenues you can go down! So that is really encouraging. Sending love x

[Patches86 in reply to IVFmumma]

Thank you for your thoughts and encouragement! I’ll be crossing all my fingers and toes for you in your TWW that this one sticks and you won’t need to think about “what next” xx

[Maui2020]

Hi Patches86, so sorry to hear about your bfn. I can relate to the relentless heartbreak. I had 8 failed before now being 18 weeks pregnant.. so don’t lose hope with the bfns, as challenging as it is. I wanted to tell you that I had some immune testing for my most recent FET which showed that even 25mg steriods would not bring my NK cell activity down. I would need undiluted intralipids, which I did without any steroids. If it’s possible to get some more specific testing done, that may help as I learnt that apparently steriods are not always the answer to immune issues. It’s really hard knowing when and what to test for but I wish you all the best for next time xx

[Patches86 in reply to Maui2020]

Congrats on your pregnancy Maui! What a wonderful story of hope after 8 failed transfers. Thank you for giving me some positivity to hold onto! If you don’t mind me asking, what further immune testing did you do to show you needed undiluted intralipids?

[PinkPanther1234]

Hey Patches, I am so sorry to hear you are going through this. It really is crap, I have had 3 failed transfers and currently in my 4th 2ww. It is so hard, especially when you feel like you are trying everything.

Just a couple of suggestions, as you already have some great suggestions from the other ladies.

Have you looked in to the KIR, LAD and DQ alpha tests? Millbanks posted a really good link. We may try LIT therapy next time, if my latest transfer fails.

I wonder if also adding in Intralipids on your next transfer might also help.

Sorry if you have already looked in to these. Good luck to you for your next steps 🤞. Just having that follow up appointment and getting a new plan in place can give you new hope. You sound like you are making great embryos, so should just be a matter of time before one sticks x

[Patches86 in reply to PinkPanther1234]

Hope your TWW is going by quickly for you and has a positive outcome 🤞

Thanks for the additional suggestions - KIR, LAD, DQ alpha from the link Millbanks sent are on my list to speak to the doctor about. I’m just nervous he isn’t supportive of more tests and we are at the end of the road!