Firstly thank you so much for the support after my very disappointing PGT-A results earlier in the week 💔
We have one precious euploid embryo after attempting embryo banking all year. What's next I don't yet know, we're considering all options at present.
I have my debrief today and will be discussing what's next. To help me prepare I'm very interested to learn what tests can we do to give this embryo THE VERY BEST CHANCE. I want to ensure if we proceed with transfer that everything was done to give the embryo optimal conditions.
Can anyone share suggestions?
Very grateful for input and ideas xx
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Skittles11
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I haven't reached this step yet. If my embryo comes back euploid, I will request Hysteroscopy checkup. Although I don't think I have any immune problem, but I will request doctor offering me all the related blood tests if possible just to make sure.
I watched some Youtube shares, some ladies give birth healthy babies with only one euploid embryo, so please keep calm and relax, don't stress yourself. Best of luck!
Thank you so much Mary. I will be asking about ERA. I had hysteroscopy earlier this year so hopefully am okay in that department xx
Hey Skittles, hope you are doing ok. I have forgotten but have you had something like a 3d Saline scan on your uterus? I think its definitely worth doing to check you are in tip top shape to host the embryo.. my clinic mandate it and I always thought it was just a money spinner but it was that test that discovered all my problems and gave us something to fix and change for the next transfer. We didn't do ERA because we had got pregnant previously (MCs as you know) so the clinic didn't feel it was necessary but did give me antibiotics prior to transfer (3 day course) just to eliminate any risk of infection. I asked about steroids and was told 'if this one doesn't work (we had 3 embryos left) but it might be worth talking about that too and explaining you want to throw everything at it x
Hi Daisy. Thank you. I had a hysteroscopy in March this year and all of the findings were normal. Is a 3d saline scan something still worth doing if you've had a hysteroscopy, do you know? What are steroids actually used for as this is something I am also unclear on?
Hey lovely, I had a 3D SiS on top of a hysteroscopy. The hysteroscopy is the camera and so looking at each point individually. With the 3D sis they fill your uterus with coloured saline and then look at it as a whole on an ultrasound.. it enabled them to see shape, any lumps and bumps, scar tissue etc. My hysteroscopy found 1 or 2 fibroids, the 3D SiS found 21 (in the end I had 42!). It also found I had a much more heart shaped womb than they thought via hysteroscopy. So for me as a belts and braces approach it was definitely worth it.. the other option is an MRI which again is a similar 'complete' view.
Re the steroids, I assume its to give everything a fighting chance of working but tbh I am not 100% sure, I just have seen a load of people who have used them and its made the difference - sorry I can't be more help xx
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The only other thing I just thought of is assisted hatching, our clinic use this and we didn't even know so yours might too but I think it improves your chances, might be worth a google xx
We were in a similar position. We had one precious euploid embryo left - and we finally got a BFP a few weeks ago (and a positive viability scan just yesterday).
We threw everything at it this time, including:
(1) Addressing possible immune issues (i already have an auto-immuine condition and thought this might be a factor). I had a NK cell testing which revealed a higher than normal level of NK cells in my blood (though normal in womb lining). For this I was given an intralipid infusion and I am taking 10mg of steroids daily (which is a relatively small dose).
(2) ERA testing. This didn't throw anything up.
(3) 3D SIS.
(4) Thrombophilia blood test to check for blood clotting issues. The cost of this was eye-watering.
(5) HCG infusion 30 mins before the transfer. I had never heard of this. Apparently, it's to make the uterus more receptive to the embryo.
(6) Regular progesterone testing, including on the day of transfer, and regularly following positive pregnancy test (this picked up low levels at one point, which they addressed, and levels are now fine).
(7) I am also taking a tonne of meds (including blood thinners and a ridiculous amount of progesterone). I think it's over the top - but the clinic always say that this is what explains their high success rates. PM me if you want me to share details about the clinic.
Of course, I appreciate everyone is different, and it may be that, in your case, there is no clinical need for some of the testing/treatments above.
Just to add I did the HCG shot and the immune protocol and it was the only thing that worked - my previous PGS embryos didn’t work without HCG or immunes as I had issues between communication of the lining and the embryo x
wow! I have never heard of half of these things. I’m going ask about these as I’m in the same situation as skittles! Thank you! and massive congrats 😘 xx
I'll share the stuff that has been in my head lately for my issues, but obviously they might be slightly irrelevant or different for you.
1) Endometriosis - I think I remember you saying you had an endometrioma before, so maybe you want to consider a endo suppression protocol before transfer? My doctor recommends 3 months Prostap and Letrozole, and then right away start the FET meds. A laparoscopy maybe, but obviously that is so invasive! (I just had mine).
2) I'm not sure whether you feel like there is enough reason to go down the immune testing route, or had any done? HLA / KIR testing, Chicago bloods, ANA test, blood clotting, thyroid antibodies, etc. This can get very expensive though 😰 There is a lot of medications to fix this stuff though thankfully!
3) My doctor also has me do double antibiotics for 2 weeks before transfer, as he feels this is important too.
Let me know if you want any more info about anything. I'm quite far down the immune route, but hopefully you won't need all that xx
If it was me, I would do a scratch, a 3DSIS, have an HCG shot 30mins before transfer and do a full immune protocol (25mg steriods and immunes through Epsom clinic that specialises in recurrent miscarriage/implantation). Let me know if you want more details x
Thank you Seren0119 really useful info. I've not heard of the HCG 30 mins before transfer but you and Haf05 have both mentioned it so I will definitely take note of this. The immune protocols, do they only get done at very specific clinics do you know, you've mentioned Epsom? Thanks so much xx
Some doctors/clinics believe in immunes, others don't. Most clinics give limited doses. The immune specialist I saw (at Epsom, I can give details privately as we can't mention clinics) believes that only 25mg of steroids together with intralipids will work - a lesser dose is not worth it.
He does a batch of tests (cost me £2,000 in blood tests - took 10 vials, nearly passed out) - everything from vitamin d, to TSH, to natural killer cells. Then he puts you on an immune protocol. I did his protocol together with my IVF clinic's protocol (they are rigorous anyway and as standard they give blood thinners and three types of progesterone - anal, injections and oral). So basically, I was being looked after by two doctors (IVF medical director and also an immune specialist).
After two failed PGS normal embryos (one miscarriage, one chemical), I literally threw everything at my last (and lowest grade) PGS normal embryo and it worked. Each case is different, but if you have one PGS normal and want it give it everything, I would recommend doing all of the above (and make sure your HPV is fully cleared etc) xx
I had had tests for recurrent miscarriage and implantation failure. These were thrombotic risk profile test, Natural Killler Cells test and Emma/Alice test. These were blood tests except for the latter which was a biopsy. The treatment for high natural killer cells was to put me on steroids and give me intra-lipid infusion. The treatment for MTFHR gene mutation (from the thrombotic risk profile test) was to take clexane (low dose heparin) injections. These are all part of what they called the immune protocol. I would ask about these tests. Also some people have an endometrial scratch I think to aid implantation. You could ask them about this as well. Sorry can't be more help but those would be the things I would suggest discussing. All the best with it. I hope it goes well. Xx
Thank you 😊 this is very useful. I've heard the natural killer cells test can be blood test or biopsy or both. Did you just have the bloods test? Thanks for explaining the immune profile to me. Was this something you had to be referred to a particular clinic for to run all the tests or were they able to do it all from your chosen clinic? I've had a scratch before so that is one thing I do know of! X
I just had the blood test for Natural Killer Cells. I don't know how much it cost as I had discovered my new work health insurance covered me for fertility treatment by the time my most recent clinic recommended this. My original consultant who was a fertility consultant in London eventually suggested the thrombotic risk profile test and the Emma/Alice tests when after my fourth failed full cycle I posed the question, "Just suppose it wasn't to do with my age and just suppose I was a 25 year old woman getting the same results as me in IVF, what tests would you suggest for me then?" He was able to do the blood test and the Emma/Alice biopsy himself and send it off to the relevant place. When at the beginning of this year I found that my new health insurance policy covered fertility treatment but only if you used one of their two chosen clinics, I found one of those clinics was the one I had been sent to for all my egg collections as a satellite patient by my previous consultant so I knew and trusted them and knew they didn't have an issue with my age etc. I therefore chose them and signed up with their most experienced consultant who had an interest in complex cases, older patients and immune issues. She was the one who recommended I have the Natural Killer Cells test which I then tested positive for high levels of NK Cells and inflammation! They took the blood test at their clinic but it had to be sent off to Chicago apparently! Hope this helps! Xx
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