Are there any tests you wish you'd done sooner?

[Lola33]

Hello,

I'm looking for guidance on any tests you'd recommend doing before my next cycle?

My history is 1 mmc from natural conception two years ago, one implantation failure from fresh transfer (although I'm convinced it may have been chemical if I'd tested earlier) and one chemical from FET. We have a few frosties but have decided to do another egg collection due to my low amh but that won't be until new year now, and I'd like to do some proactive testing in advance but I can't do it all, so I'm wondering if you have any 'must do's' and perhaps tests you'd wished you'd done sooner in your journey.

My husbands basic semen tests have come back fine. And we have had quite good fertilisation rate. Does that mean I can put aside any worries about sperm issues? Or should we still look into DNA fragmentation or oxidative stress tests?

Are there any I should do? My basic results so far have come back normal apart from low AMH. I do have a short cycle (21 days) and I don't think I regularly ovulate which I think explains our issues naturally conceiving. But now with two failed embryo transfers of 5 day blastocysts, I wonder if there could be something else going on too.

I've got a bit confused with antiphospholipid antibody tests. Is that the same as sticky blood? Or are these different tests? It's so confusing!

I'm 33 and my husband is 34.

Thanks in advance for any help!

[JA-fnuk Partner Nurse Fertility Network UK]

Feel sure you will get a few replies to help you at this difficult time. Have you asked your clinic if there any tests they think would be helpful? The tests you mention are the same. Take a look at Treatment Addons at hfea.gov.uk

Thinking of you

Janet

[Chantysal]

sorry to hear about your mmc, I was told that Era test is important for implantation failure, I have not done it myself but it was recommended by allot of ladies in this group.

[Marisa32]

I would definitely do DNA fragmentation test on sperm just to make sure no issues there. The 21 day cycle seems a bit short, so that's something I would look into.

[IVFat40]

I would recommend getting your uterine natural killer cells tested, if you've struggled with implantation failure/chemical pregnancy/early loss. I was prescribed steroids to address high nk cells after testing (and was then successful). Good luck hun.

[GJW2018]

we were in a similar position and had immunology testing -NK cells and Chicago test which showed an issue, treated for this and now have our lovely daughter to show for it. Not saying this will be your issue but we just wanted no stone left unturned and found that this was the stumbling block for us, easily addressed but expensive to do so! Xx

[JuicyLu]

I would consider the EMMA/ALICE test - usually can be combined with ERA. I think it helped me as I had an infection in my womb I had no idea about. Also, if you get a lot of embryos it may be worth considering PGA screening. It turned out most of ours weren’t euploid 😞 but it saved us from having them transferred when they wouldn’t have been viable. Good luck x

[Koala365]

I would have the thrombotic risk profile test, the NK Cells test and possibly also the Emma/Alice test and an ERA as you are doing an FET. These are all tests for implantation failure and some also for recurrent miscarriage. If you want them though you will probably need to push for them as consultants in my experience wont suggest anything until you have had at least 3 inplantation failures or recurrent miscarriages.I was told that the sperm DNA fragmentation test wasn't really worth doing if we were getting good fertilisation and the normal sperm test had come back normal and that in that scenario, even if the dna fragmentation test came up with something all the consultant would do would suggest my OH took Impryl for 3 months before the next IVF.

[AracLl in reply to Koala365]

I agree. Definitely request a test for blood clotting conditions. I suffered two miscarriages before the NHS would test me for this. I was found to have two blood clotting conditions. I have since been taking Inhixa and aspirin for my other cycles. I'm currently 28 weeks pregnant. All the very best for your next cycle xx

[minnesota_girl]

Have you had your progesterone levels tested after transferring as this can impact also...have you been taking extra progesterone shots or anything?

[Fruitandflowers]

There are probably a lot of tests but a more basic one is progesterone and ensuring you have the right progesterone support - I had two chemicals and always had spotting before my period so suspected an issue, but it's not something all clinics take much notice of and it was was only after insisting on having loads more progesterone on my FET that we were successful. It could have been chance but my consultant said you can't have too much and if you have a very short cycle it may be relevant.

[Hopeful1981]

for me the biggest one was having a scan to confirm ovulation. We did this for two consecutive months. The first month was fine tracked ovulation with the sticks and EWCM along with a scan. The follicle was get bigger and the consultant confirmed it’s release. The second month the same thing caught the surge but this time instead of it being released it collapsed. My tests would have shown I ovulated but I actually didn’t.

[soccerkt6]

I second the suggestions about having the DNA fragmentation test done. In our case, my husband's standard semen analysis had come back fine and we also had good fertilisation rates, but our embryos were never great quality and we had several chemicals. After our first round of IVF, our consultant finally recommended testing DNA fragmentation and my husband's results came back very high. We then saw a urologist who discovered a varicocele that hubby had fixed which, in combination with diet and supplements, has hugely improved his numbers. High DNA fragmentation can be a cause of pregnancy loss and frankly, it's a less expensive and invasive investigation than a lot of others, so no reason not to start with the low-hanging fruit, imo!

I would also go to your GP and push for them to order a recurrent miscarriage blood panel for you. This will check for bleeding and thrombophilia (clotting) issues, as well as a range of other things. Antiphospholipid Syndrome (which is the same as 'sticky blood') is a thrombophilia issue, so that should already be included in the standard panel.

If the above tests don't turn anything up, I would probably suggest moving on to having your NK cells tested and insist on close monitoring of your progesterone in any future cycles. The ERA test might be worth doing down the road, but it's only relevant to FETs. Since you've had a few losses that weren't from FETs, it prob wouldn't be my first choice if you had to choose... Best of luck, lovely xx

[Lola33]

Hi everyone, sorry for my very delayed reply to this, I took a little time out. Thank you for all your very helpful replies. The first step we took was the dna fragmentation test and the results haven't come back great, despite my husbands very good standard semen results. It isn't terribly high, but significantly higher than you'd expect to see for his age. We've been recommended MACS ICSI for our next egg collection which we will give a try! It amazes me how not one professional has recommended the dna fragmentation test to us! I wouldn't know about it if it wasn't for everyone in this group!

I will do further tests on me in due course but going to focus on the egg collection in Jan first and likely a FET at a later date.

Thanks so much to everyone who replied to this! ☺️