BFN- what to do next thoughts appreciated? 🤔

[Twiglet2]

Long post sorry 😘

Morning everyone…so BFN from our last embryo from our 2nd collection and I’ve had a wee cry last night and moved my head into what next and would be really grateful for any thoughts or opinions please as I’m a bit stuck. I think today I’ve realised I’m strong enough to do one last round with the 1 donor sperm we have left 💪🏼

Here’s our track record

2016/17 6 x IUI all BFN

Round 1 ICSI 2018 lowest does menopur (75?) age 36 AMH above normal range for age

13 eggs 10 mature 7 fertilised 6 blasts

Fresh transfer BFN

2nd double transfer Chemical

3rd transfer (our little boy 💙)

4th transfer BFN

5th transfer BFN

Round 2 ICSI 2022 lowest dose menopur age 40 (amh has stayed the same)

7 collected, 7 mature 6 fertilised, 3 5 day embryos

Fresh double transfer BFN

FET (this month) BFN

this last FET we flung clexane and lubion at the situation and the lubion has stopped me bleeding before test date but didn’t help get a BFP obvs.

The consultant had said that if this last one didn’t work she wanted to put me on the highest does of stims for a freeze all and hopefully gets lots of embryo for testing… I dont know how I feel about any of that, the high dose, the no fresh transfer and most of all as I have no know genetic condition and only 1 miscarriage I really do t like the idea of testing the embryos for some reason all the research is so mixed in it but I might be letting my emotions rule my head on that.

Thanks for making it through all that! Thoughts and what would you do ladies? 💜

[PrincessGurn1984]

Sad to hear you got a BFN 😞 it’s so heartbreaking.

If I were in your position I would probably do another round but at high dose though, maybe 450, (maybe mix of stims drugs combo as some of them are good for egg quality if you’re over 35), and go out with a bang!

I’d also do a fresh transfer as you say (maybe a double one if you get enough) then freeze remaining.

I can’t comment on the testing part as I always like to give every embryo a chance inside, so we don’t test. Trust your gut feeling, no regrets and all that x

[Twiglet2 in reply to PrincessGurn1984]

That’s really helpful thanks 😊 my clinic don’t allow fresh transfers if your levels go above a certain threshold due to risk of OHSS and give you a different trigger so you can’t go for fresh (which she said was more than likely if they did highest dose stims for me). I’ve always been of the same mindset as you re give every embryo a chance too so when she said that was the purpose of the highest dose approach to get enough t to test it just put my head in a bit of a spin tbh xx sometimes you think are they just after more money 🤣🤷🏻‍♀️

[PrincessGurn1984 in reply to Twiglet2]

I see, could you do a middle of the range dose like 300 and do a fresh? If you’re collecting say approx 6/7 eggs not sure what the risk or OHSS would be with that but I’d imagine quite low. It’s a tricky one! Playing devils advocate what if you tested them all as they suggest and say they come back mosaic, and they get disregarded, but mosaic can self correct inside. This is why I struggle with it, too many what ifs for me 😂 but I think it’s such a personal choice testing, of course if genetic conditions are known it’s 100% worth it but it sounds like you wouldn’t need to do it for that reason x

[Twiglet2 in reply to PrincessGurn1984]

yeah I might suggest that and there’s still a risk of OHSS upping the dose but not as much as a full blown dose. My gut reaction to the testing was no due to the reasons you’ve said but I do t know if it’s logic or a mindset/blocker I have. I also know there’s a chance of damage with the testing too and without any known genetic conditions I’m not sure of risking that either xx

[PrincessGurn1984 in reply to Twiglet2]

I think it’s worth playing devils advocate with yourself to judge how you would feel if say you did test them, and say they all came back either not normal or mosaic, then what would your next steps be after that? X

[PrincessGurn1984 in reply to Twiglet2]

Also I’m not against freezing, I think freezing works just as well as fresh, but could you freeze without testing then you can still have max dose of stims that might be a good compromise x

[Twiglet2 in reply to PrincessGurn1984]

yeah my little boy was from a FET so I actually favour them so the no fresh transfer bit doesn’t bother me quite as much xx

[Hidden]

Hi Twiglet2, so sorry about your BFN. It’s who hard knowing what to do next. I would probably go with what the clinic suggests. We have had to freeze all which all of our collections due to OOHS. I always look at it as giving me time to get into the best possible place & mindset for transfer. I can’t advise on testing as this was never offered to us. Good luck with whatever you decide & big hug for now as it’s just so hard sometimes.x

[Twiglet2 in reply to Hidden]

thanks so much for kind words and advice 🤗 I defo don’t have any issue with freeze all (my little boy was from a FET so I have faith in that process) it’s just the thought of deliberately filling myself up with that much drugs when I dont really wasn’t to test I think is what’s holding me back xx

[Skittles11]

Hi Twiglet

Sorry to hear about your negative result.

I know PGT-A testing can be daunting however it may be a more efficient way to get pregnant if you are going through numerous BFNs (or miscarriages).

I think you should request a chat with one of the embryologists at your clinic about the PGT-A testing. And you should ask about what they would do if the embryos were mosaic, what they'd expect to see for someone with your history at your age and how likely there is to be damage to the embryos. Just generally arm yourself with a bit more info about it before you decide.

It is a very personal decision and not an easy one. Xx

[Twiglet2 in reply to Skittles11]

thanks that’s a really helpful and sensible idea! I didn’t thinking asking them as just normally consultant at review so thanks I much xx

[Fairytale22]

sorry for your BFN. It’s a hard choice to go with the clinic’s option or not, it does seem abit drastic.

Like another ladies said maybe speak to them again and see if you can up the dose and freeze all?

So emotional and draining decisions to be made.

Good luck and thank you for your advice on my post xx

[Twiglet2 in reply to Fairytale22]

thanks lovely I do think I need to ask them lots more questions and scenarios. It’s so hard to just understand my new (lovely and wonderful) consultants accent too over the phone so might see if I can get a wee face to face chat this time xx

[Millbanks]

hey love, sorry to see your news 💔

Have you thought about steroids? I feel like such a pusher but I really think this was what did it for us on transfer number 6….

I’ve heard others say that after their first pregnancy their immune system was an issue the second time round so might be worth a check?

Or just throw them in the mix anyway xx

[Twiglet2 in reply to Millbanks]

Hey lovely 🤗 I hadn’t as tbh I’m not sure what they help with 😂 will have a wee look into them and ask if I should get any testing done. My immune system has been terrible since I had my wee boy so if that can be an issue then it’s defo worth looking at xx

[Millbanks in reply to Twiglet2]

so the theory is that when you conceive naturally your body lowers it’s immune system to accept the 50% foreign dna.

It seems as though a lot of people struggling to conceive may need a little extra help in doing this…. I know my immune system was attacking my embryos and it wasn’t until we lowered it with steroids that we had our first ever implantation xx

[Twiglet2 in reply to Millbanks]

ah I see! Do you happen to know the name of the test they did to tell you that’s what your immune system was doing by any chance? Thank you so so much xxx

[Millbanks in reply to Twiglet2]

yes it’s called the Chicago blood test xx

[Twiglet2 in reply to Millbanks]

thank so much!! Xx

[Solly-44]

I’m really sorry this one didn’t work out, it’s just shit and doesn’t get any easier does it!

Personally ld be tempted to go with your clinic’s recommendation, ( if I had the money too - it doesn’t sound like a cheap option 😵‍💫) I’ve never done a fresh transfer due to the risk of ohss, so the lack of one wouldn’t bother me. I was impatient at the time but with hind sight it was definitely the right move.

I like the idea of testing them. If you’re going hard with the stims you’d potentially have a few transfers ahead. I know a tested embryo isn’t a guarantee but it could save some of the heartache that this process always seems to being. Sorry if any of that sounds pretty negative and it’s easy for me to say go for it because my 1 and only fresh round was years ago and a distant memory!

It’s so hard to know what to do isn’t it? We have a similar number of transfers/success rate and I still have no idea. Xx

[Twiglet2 in reply to Solly-44]

that’s all so helpful and helps me think of the different angle of avoiding heartache 🤗 thank you sooooo much 💜 xx

[Gerti2020]

hi, I’m sorry to hear about your result. I had 6 good embryos my last round, I had 1 fresh transfer which ended up as a BFN and the other 5 went for testing, only one has come back normal. My last round I had only 3, 1 positive (my daughter) and the other 2 failed. They reckon it’s all down to poor egg quality, and based on my test results - this may be true! Testing is expensive and risky but I would have spent a lot of money (and time) for 4 transfers that would have definitely failed? X

[Twiglet2 in reply to Gerti2020]

yeah it’s a really good point I dont really have time on my side so might help cut down time on ones that weren’t ever going to work thanks so much for your comment it’s really helpful to hear your views xx

[LadyM2019]

I’m so sorry Twiglet2 . I’ve had three rounds of ivf using donor sperm. We’re a same sex couple too.

Round one 225 meriorfrrt: age 33, 5 blastocysts but 4 did not meet the nhs embryo freezing criteria (at least 3bb by midday on day 5). BFN with a 4AB.

Round two 300iu meriofert: age 34, 3 blastocysts grade 3BB. Fresh bfn, 1st frozen chemical, 2nd frozen viable but lost at 24 weeks.

Round three 450iu meriofert: age 36, 2 blastocysts grade 3cc and 3ab. 3ab frozen.

On 450 iu my embryo quality was much poorer - most of my embryos stopped developing on day 2/3 and only two made it to day 5.

I’ve had a consultation with two doctors and they’ve both said higher doses don’t mean more eggs or embryos. Although as your doctor has suggested this she must have had success with this before.. I know you’ve only one vial of sperm left so it’s a really big decision (if you want to use the same donor) Some clinics can partially thaw sperm vials (but I’d suggest a consultation with a specialist clinic for sperm issues, like the L!ster).. I know how awful this ivf rollercoaster is.. I really do empathise.. xx

[Twiglet2 in reply to LadyM2019]

oh gosh what a journey amd im so sorry for your late loss as well that must have been so tough 💜 thanks for sharing it with me it’s so helpful to see the difference in the doses and that’s all I’ve ever read as well lots of eggs can mean huge drop off rates and not great embryos in some cases and I did get 3 blasts on the last round on low dose so I don’t think that’s a bad result but I think I need to know more about why they’ve suggested it tbh so whenever I finally get to speak to them I’m defo gonna ask (and about the partial spent freeze as that’s a big worry for me not having any of the same donor left as my little boy as if my wife decided to donate eggs etc if mine turn out to never work then a new donor would mean no biological relation at all!) so many things to think about sometimes it makes your head whirl 🤪 xxx

[Mudra85]

Hi Twiglet2 I just wanted to chime in on your question about doing another cycle and testing your embryos. But before that, I'm so sorry your last transfer didn't work.

I'm doing IVF where I'm testing embyos for a genetic condition and we're also doing PGT-A to test for chromosomal abnormailities in our embyos - so I've spent an inordinate amount of time over the past couple of years reading about all things genetic testing.

Here's what I've gleaned from obsessing over the subject (apologies in advance for the level of detail!):

PGT-A only tests to see if an embryo has the correct number of chromosomes. It cannot tell you if there are other issues with the embryo. It's not a perfect science, but it has been shown to reduce the chance of having a miscarriage and the time to a viable pregnancy, other than for women under the age of 35 who are much more likely to produce chromosomally normal embryos.

As we age, and our eggs age, it becomes harder and harder for our eggs to go through meiosis (where the egg drops half of it's 46 chromosomes) without being left with chromosomal errors (either too many or too few chromosomes). Once an egg has chromosomal errors as a result of not being able to go through meiosis efficiently, it cannot correct itself and if it's fertilised it will become a chromosomally abnormal embryo. Abnormal embryos cannot correct themselves and will either not implant, end in a miscarriage or worst case scenario result in birth defects.

My first cycle of IVF when I was 35 produced 5 blastocysts, of which just 1 was normal, 1 was a low level mosaic and the remaining 3 were abnormal. I was shocked that at that age I only got 1 completely normal embryo. That embryo despite being normal still ended in a chemical pregnancy, so PGT-A is certainly no guarantee. However, I'm very glad we had the testing as we could have wasted a lot of time going through many more unsuccessful transfers of our abnormal embryos which would never have had a chance of leading to a healthy live birth.

Others have mentioned mosaic embryos above and if you do decide to go ahead with having testing then an important thing to ask your clinic is whether the lab would report if you had any mosaic embryos, particularly low level mosaic embryos. You'd also want to know from them whether they'd let you transfer mosaic embryos and under what circumstances they'd let you transfer them. I have a low level mosaic embryo, which my clinic weren't comfortable with me transfering because they are very risk averse. However, the understanding of mosaics is moving on and there was a very well done study in 2021 that shows that low level mosaics have the same chances of leading to a live birth as chromosomally normal embryos.

From what I understand the risk of an embryo being damaged by testing is very low, around 1%. The risk of misdiagnosis is also very low - my lab reports a 2% chance of misdiagnosis, but I've seen others report this being lower than 1%.

The last thing to say is that the testing process can be brutal. The wait to find out how many you end up with is really hard, but if you can get some normal ones it can be reassuring knowing that you're putting back a good embryo. But on the flipside, when it ends in a loss (as it did with me with a chemical pregnancy) it can be difficult to understand why when you've ruled out the most common reason for it not to work (chromosomal errors in the embryo). It's also worth saying that transfering a chromosomally normal embryo levels the playing field with age. For example, the chances of having a live birth for my age group (35-37) per transfer would normally be around 25%, but with a tested embryo it's more like 50%.

I hope that helps and good luck with your decision on the next steps in your treatment.

[Twiglet2 in reply to Mudra85]

thank you so much 🥰 that’s all really helpful info and I am much more informed now from your summary, really appreciate you taking the time to impart your knowledge from all your research that’s so lovely of you xxx

[Mudra85 in reply to Twiglet2]

I'm glad my obsessive researching has some benefit, other than driving me around the bend 😉 xxx

[Skittles11 in reply to Mudra85]

I found this a really enlightening read too Mudra. Thank you for sharing your knowledge xx

[Mudra85 in reply to Skittles11]

I'm pleased you found it helpful too Skittles. Xx