I hope you're all doing OK on this journey. I'm new to the forum but don't know where else to turn for advice.
My husband and I have unexplained infertility. We had a successful round of ICSI in April 2021, resulting in 9 good quality blastocysts. Since then we had one fresh transfer and 3 FETs (transferring 2 blastocysts, 1 and then 2 in latest transfer). None have implanted.
Although it has sometimes taken a bit longer than anticipated, we've always managed to get my lining up to 10mm before transfer.
In advance of my last transfer, I had an endometrial scratch and they also tested my progesterone on day of transfer (which was fine).
We're currently being treated on the NHS and our consultant doesn't seem to think there are any other tests or treatments they can offer and just says we should go ahead with another transfer and hope its a numbers game.
I want to bottom things out before we have any further transfers and so was wondering if any of you have any recommendations on other diagnostic tests we should do, potential treatments and also, any clinics or particular clinics you'd recommend who specialise in repeated implantation failure? We're in the West Midlands but can travel.
Thank you!
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EllaBC
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Hi Ella. I’m in exactly the same position. I’ve just finished with NHS treatment and they told me the same thing but my new private clinic recommended NK cell testing and found my levels to be high. So we are adding prednisolone for my next cycle. I know lots of ladies on here have had ERA testing which I think will be my next move if this round doesn’t work. It may be a numbers game, but I just felt so frustrated doing the same thing repeatedly that I was willing to pay for extra test. Best of luck with whatever you decide to do next x
It is definitely not a number game trust me. I had 4 transfers in total 3 chemical pregnancies and one successful and I know is not about luck or number 😤. It frustrates me so much when clinics or doctors think this way. I don't believe also in unexplained infertility, there is not such a thing...is more likely an unknown cause...You are producing a great number of blasts go for PGS testing, will definitely shorten your crazy journey and ERA test to start with.
Similarly to others I would really recommend getting your uterine natural killer cells tested. Mine were high, I was prescribed steroids for my next transfer and I'm now 30 weeks (this was after 5 previous failed transfers of 7 embryos). There is a research project run jointly by Warwick University and Coventry Hospital (I think Tommy's are also involved) which you can self-refer to, I thought they were excellent (it does cost but in IVF terms I think it's very reasonable, I think because it's a research project not a money making company).
Thanks IVFat40. Great shout on the Warwick and Coventry clinic - I've signed up for an initial consultation with them. I hope everything continues to go well with your pregnancy
Just wanted to add to what the other ladies have said, don’t believe them when they tell you it’s a numbers game! It’s not! You need to get to the bottom of why it’s not working. I stupidly listened to the nurses and Drs telling me it’s a numbers game and continued to have transfer fail after fail. I’ve now had 12 embryo transfers in total and lost 15 embryos. Mine is a complex case (immune related) but it only started to make sense to me after I read ‘is your body baby friendly’ by Dr Alan Beer. I’m under the care of a reproductive immunologist now but if the nurses and Drs had it their way, they would be still be transferring embryos with no chance of them sticking calling it a numbers game! So frustrating!
Could I ask you to pm me with details. I’m not in exactly the same situation but I’ve had recurring miscarriage and I’m wondering if I has anything to do with my immune system. Thanks xx
I agree with all the ladies. I had multiple failed implantation time after time with good embryos. Eventually had an ERA test which was ok except here was an imbalance in the good and bad bacteria inside so I took a probiotic pessary for 10days on he run up to transfer. My consultant also prescribed me blood thinning injections which started after transfer....no reason for this from a test point of view but she felt it was 'no harm'. It was successful with a twin pregnancy (sadly lost one at 11wks but the sibling is due soon) Nothing else was different from all other failed cycles. Certainly worth trying the ERA. I'm in Ireland, we had to pay private for it at about €1200 for all 3 tests. Best of luck.
I think it is a good idea to push to see if you can have some tests, you've had a great number of blastocysts so you can run the risk of testing them. We are in a similar situation re implant but don't get nearly as many blastocysts so haven't been able to test. We spoke to our consultant and he did make the point that in all of their research whether testing eggs or womb everything points back to the eggs, even quality blastocysts are not always viable. He made the point that the subsequent success rates with donor eggs often proves this out, that there's nothing wrong with implantation. Of course not always, and there are exceptions, and as I say you have a phenomenal success rate of getting good blastocysts...there must be a lucky one in there!
Thanks for sharing your story Trytryandtryagain. I'm going to look into getting our blastocysts tested. I hope you find success sometime soon - its such an unfair struggle!
Exactly the same thing. I am 34, 25 eggs, 23 fertilized 11 embryos (3 day embryos, as my old clinic was actually terrible and decided this arbitrarily, without informing me and with not medical reason... they should have been 5 day embryos). I had 2 failed FET with them, which failed . Then I moved my embryos and myself to another clinic, and there they decided to do the logical thing: to let them grow to day 5 blastocyst. I have had two more failled FET with them (plus the 2 medicated cycles, 6 inseminations and two 3 day embryo Fet from the other clinic), and not even 1 implantation (never seen a positive test, except once that was an error in the HPT). I have PCOS (now treated with metformin and myoinositol, so symptoms, insuline, and hormons are now under control), I ask them what is next, that I believe I have recurrent implantation failure (because I have never had an implantation, so seems logical to me). I just get the: "calm down, you are young, you have many tries left" and lots of smiles. Once, when I was with the old clinic I got a "have faith" and a "IVF is not natural so think it well" (like, lady, natural failled me, what is there to think? Doubt that herbs, yogurt, and pineaple will help. That is why I am here, not because it is a blast to see you every day... and if it is just faith then I would just go to the priest of my church and ask him to pray for me for free). It is like they sometimes don't see that I don't want to try many times more. I want for it to work so that I can stop having to go there everyday, I can stop being absent at work, having depression for all the hormons and failled tries every month, and specially, to stop getting prodded with needles, ultrasound tools and whatnot and stuffed with hormones. I am now waiting for all the rest of my embryos to fail (because it seems that I am the only one that sees that something is wrong with them or with me), so that I can start a new IVF cycle in the new clinic and see if they propose something new. Maybe they can offer PGS testing or invitro maduration (seems a good technique that is winning support). ERA, aspirins/herparin (for trombofilia) are apparently not offered anymore in some European countries because some person did one of those studies (that are not even very big or complete and not confirmed with other studies and not tested for subgroups of infertile patients that might have special circumstances), that says they don't make a difference. So governments now jumped the saving money train: "it doesnt make a difference, so we don't offer it... so we save money lets tell them to have faith a couple times more until their free tries are finished". It is the same with the waiting 15 minutes after the insemination. American studies (with thousands of participants) showed a significative difference in pregnancies and live birth rates. An European one with maaaany less participants (don't remember how many, just thatvit was ridiculous), showed none... guess which one we follow? (Because it saves time and money to the clinic/government)
Sorry for my negativity, i was just informed it failled again
Hi,I feel exactly the same after another failed try. I am emotional from the hormones, waiting for my period, wondering what next after wasting my last embryos on a cycle I didn't believe would work. I don't know where doctors think we get the money from to just keep trying.
I've decided I'm going to have everything. ERA, hysteroscopy, PRP etc... 2 different doctors have told me my TSH is high, so I'm going to try and solve that problem. I think we've got to push for everything and keep going.
Tsh is a very good starting point! It can cause Implantation failure. I recommend you tk also check your insuline. That one is a silent problem. Doesn't give you many symptoms (unless you have PCOS) and most docs overlook it... but also causes implantation failure (I had mine very high). Also cortisol and D vitamine...
Omg! The same happened to me last year! They did not tell me! This is why I am so angry at all this! Insuline resistance in PCOS can cause gestational diabetes and preclampsia and metabolic syndrome and diabetes later in life if you are not checked and treated and they just don't seem to care. I was diagnosed with PCOS at 14 (I was thin and sportive when my periods just stopped). And all doctors were just giving me Diane 35 and hormones since then to make me "menstruate" and palliate symptoms. 4 years ago, I told the fertility specialists in my old clinic, when I started, that i had not had a natural period since I was 14... they just said "ah ok, don't worry, not necessary for this" and stuffed me with more hormones and told me to lose weight. I talked with a friend about this that was diagnosed with pcos too, and actually she told me that she went to an endocrynologist and they just found out she did not have pcos after all, but hypothyroidism and adrenal hyperplasia (she was misdiagnosed for years, with the wrong treatment) and told me to go to an endocrinologist and to ask for a full Hormonal Profile, just in case. I went there and he found that my insulin (the main cause of PCOS is high insulin. In most cases, pcos is a sign of insulin resistance or even prediabetes), was very high (possibly since I was a teen, and independently to my weight), my d vitamin was very low (which also worsens PCOS). He gave me metformin and myoinositol and d vitamin (both together make your insuline ok). My hormones are now under control (like textbook numbers), and 3 months after I started metformin I was ovulating every month with no help (28 to 35 days periods) for the first time in my life... and because of this I changed clinics (new clinic is a lot better). Because doctors that tended to me acted like "ah of course pcos is high insulin in most cases" and I had been asking for that test for years and the answer was "don't be silly your glucose is amazing, you are not diabetic", and then suddenly they were saying they knew it all along and decided to ignore it. Insulin resistance and diabetes are not the same (i case they try to convince you like they did with me). Your glucose can be awesome, and still your insulin can be on the clouds, causing you infertility and all sort of troubles in the long term and often is overlooked. Apparently it is the first test they should do to PCOS patients in a fertility treatment, it is just a blood test. High insuline can cause low quality eggs, and recurrent implantation faillure. Some reaserchers even mentioned increased TSH. Before the metformine my tsh was also slightly raised... now it is normal. My testosteron, lh, estrogens, progesteron are now ok too. But my embryos were collected when my insulin was in the sky, because I still did not know it. My hope is that this is the reason of the faillures.
Sorry for the long answer, I just wanted to put as much information to help.
So the test: full hormon profile (blood test). They should check all your hormons, thyroid function, insulin, cortisol, carbohydrate metabolism, vitamines (it is a blood test), and there is a sort of progesterone that is very important (to discard adrenal hyperplasia) and adrenal function prolactine, etc. So it is like in fertility, but more.
Doctor: endocrynologist (I recommend to try one that specializes on diabetes, prediabetes, testosterone disturbances, pcos... they see pcos not as an "ovaric" problem but as an holistic thing, so these doctors check it all)
Treatment: metformin, myoinositol (and if it is low, just if low) d vitamin.
Tips from my new fertility doctor (that actually is an expert on pcos): the best thing you could do is finding why you have pcos. Full hormobal profiles that invlude adrenal glands, carbohydrate methabolistm, insulin, etc. Should be the basis. And don't take vitamins if you don't need them. They may affect fertility, as the dosis from the pharmacies are too much.
My goodness, I had read some of this recently, but didn't quite realise some of the links. Sorry you have been through this. I'm going to take your advice and find an endocrinologist. Let's keep in touch. I was only diagnosed with pcos after 2 rounds of ivf and I'm not even sure that's what I have. Thank you so much for sharing your story, you might just have helped me out.
I would love to keep in contact. We can talk with direct message. I know lots over PCOS as well, I have had it all my life and like the most extreme symptoms. So any question, you can ask me 😀
Thanks for sharing your story Maria. Its so bloody tough isn't it? I'm so sorry to hear about your struggles and your recent failure. I had my most recent negative test last week and it has made me start doing my own research (hence this question) and I'm going to hold off on my next transfer until I least have some theories about why none of my embryos are implanting.
Dear EllaBC, First of all, sorry for making such long answers and for hijacking the thread.
It is very difficult. Specially because it sounds silly that they tell you it is just a case of numbers or to be patient, when we seem to have a clock stuck in our forehead saying "the older you get, the harder it will be".
I don't think it is normal that I ovulate each month, I respond to each treatment, and still i don't have even a faint positive. But well, every cycle is a new hope.
I think it is great that you will pause for a bit to check what is happening. I did it last year and it made me discover other health issues. In my case i just want the embryos of the other clinic to be over (even if they are not implanting) so that I can start the full treatment (and not just the transferences) in here. Maybe the metformin and the fact that my insuline is now ok, will help (the other embryos were collected when insuline was high). Some research says that high insuline can cause implantation problems, even if you respond to treatment (bad egg quality). And then if that aso fails, I will see if I can ask them to do tests.
PGT testing .. had all of my embryos tested and they all made it to day 5 looking great and were pgt tested abs frozen. Only after the pgt testing they were all confirmed bad ..but one ..my daughter we got from round 10.. only ever did one transfer in those 10 rounds.. her and it worked…most common reason for non implantation and miscarriage is chromosome abnormalities..
This might be the case for you but I make high quality blastocysts without any problem. As mentioned I’ve had 15 (day 5) embryos of high grade quality transferred into my uterus over the past 18 months and still haven’t had success. In many cases, it’s not the embryo at all but the environment. Eg immunological factors… I wish I’d known this before I wasted so many good embryos…
Were they biopsied and PGT tested Day 5 though ? I have heard of embryos said to be high quality by looks turning out to not be.. mine did look good day 5 as well it was only after testing .. but mine aside I’ve heard of others said to be good quality but found abnormal after PGT Yes at times it is other things such as environment as well ..
I did have the era uterus biopsy as well which was also helpful in giving the perfect timing to transfer as well .. might be helpful
Was also told it's a numbers game and finding the right embryo etc after two transfers led to chemical pregnancies. Could have been the case but after these transfers I had a couple of natural chemical pregnancies and so felt more sure it was something going on with implantation. Followed it up myself separately (NHS clinic wouldn't do immune tests) at a recurrent miscarriage clinic and the Coventry clinic mentioned above. NK cells were tested and uterine NK cells also. Blood ones high activity levels and uterine numbers low. Bit of a confusing picture but enough to think something was off so I did steroids, uterine scratch and intralipids for most recent transfer and I'm now in third trimester with this pregnancy. The pattern was so similar each time that I feel sure that something was off at the early stage for me. Best of luck x
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lets tell them to have faith a couple times more until their free tries are finished". It is the same with the waiting 15 minutes after the insemination. American studies (with thousands of participants) showed a significative difference in pregnancies and live birth rates. An European one with maaaany less participants (don't remember how many, just thatvit was ridiculous), showed none... guess which one we follow? (Because it saves time and money to the clinic/government)
Recurrent implantation failure
Endometriosis and repeated Implantation failure
Treatment after Implantation Clinic Results
KIR or LAD tests for recurrent implantation failure
