Fourth failed embryo transfer on the NHS, now considering going private and need advice.

[CyclingAddict]

Hello everyone,

For some context, my husband has an extremely low sperm count and poor sperm mobility and motility. As a result of this we were told it would be almost impossible for us to conceive naturally. They couldn't find anything amiss with me, except that my cycles are longer than average. But I've responded well to all the medication they have given me, and, on our first cycle, we managed to get 6 embryos. I went on to have one fresh transfer and three FET. Well, despite them looking good (the four that have been transferred where graded either 4AA or 4AB), none of them have stuck. I've done absolutely everything I can, and I feel so lost.

I've done a lot of reading and it seems like the main reason why embryos don't take is that they are genetically 'abnormal'. And, unless the embryos are genetically tested, they don't know this at transfer and even well-graded embryos can still be 'abnormal'.

I have two more frozen embryos but I'm not even sure I can bring myself to go through it again. I'm at a point where I'm considering going private to get the genetic testing done (they don't offer this on the NHS). I know this is the expensive option, but time is more valuable to me, and, honestly, I'd just rather know.

Can anyone who is in or has been in a similar position or who knows about genetic testing please help.

Thank you.

[Bonaire]

Hi there

I’m in similar situation my husband has low sperm in all the areas too. I’ve had 2 transfers and both have failed.

I think we are going to have to go down the testing route too. I don’t have much info at point but we will be booking our appointment with consultant who I hope will give us more info. There is also somthing called DNA fragmentation testing of the sperm - which i think looks more in depth at the genetics of the sperm.

Sorry not much help - but in similar situation! Will let you know if I get any further info oh I don’t think it’s cheap Either… but I guess could be worth it!! X

[ChloeDE in reply to Bonaire]

There is something called MACS that they use to overcome issues highlighted by fragmentation testing. We didn't do the testing but went straight to MACS as it looked like it was a possibility. It cost €500 at our Czech clinic.

[Jokiekin11]

hi I’m sorry to hear you e had failed transfers. Have you had tests to check the endometrium, is it the ERA, Emma, Alice tests? X

[Mudra85]

Hi, I'm doing IVF with PGT-A testing. Happy to help if I can. Do you have any specific questions on testing?

[DreamingOfTwo79]

Hi CyclingAddict, I'm sorry your treatment has not yet been successful but I'm glad to hear you have two more frozen embryos. My partner and I decided to try IVF primarily because of the option to have our embryos tested for chromosomal abnormalities prior to transfer as I wasn't prepared to risk losing another baby without knowing I had given ourselves the best chance of carrying the next pregnancy to term. It is possible to thaw your embryos, take a sample of cells for PGT-A testing and freeze them again. Our consultant advised that embryos can survive the freeze/thaw process up to 6-8 times, however there is always a risk that they won't. We were recommended to do two back to back embryo banking cycles to allow for a good number of Day 5 blastocycsts that can then be tested (our clinic charge a base fee for PGT-A that includes testing up to eight embryos and then charge per embryo thereafter).

Prior to starting IVF, my consultant suggested the following tests for me: Thrombophilia screening (for blood clotting disorders), thyroid profiling (higher TSH levels or certain type of thyroid antibodies can contribute to MC), anatomy checks for uterus and ovaries (ultrasound scans in my case but ladies on this forum also recommend 3D saline infusion sonography and 3D HyCoSy) and EMMA/ALICE to check the endometrial microbiome for signs of infections or chronic endometritis. If you never had a positive test after transfer it may also be worth having the ERA test as Jokiekin11 mentioned, as your endometrium might not have been receptive with the chosen protocol timings. You may also have underlying immune issues, Natural Killer Cell testing can help to identify that. My partner's Semen Analysis indicated we need ICSI as fertilisation method, but after reviewing his Sperm DNA Fragmentation results our consultant went a step further and prescribed PIMSI (a combination of PICSI and IMSI) to increase our chances further that only chromosomally normal sperm is being selected. Due to my age (43) my consultant further prescribed Melatonin for me (only during stims phase) and a human growth hormone (Zomacton) as well as DHEA, all in aid of increasing egg quality and resilience. We managed to achieve five good quality blastocysts across our two back to back cycles which I was so happy about, we are now awaiting our PGT-A results. There is an argument that it is preferable to have a larger number of embryos available for testing as some may not survive the freeze/thaw process or the biopsy when there's a chance they would have thrived in utero, however my partner and I were very clear that even if we got only one blastocyst we would have chosen PGT-A as the emotional and physical impact of not achieving an enduring pregnancy, never mind the precious (fertility) time you lose with each attempt was something we didn't know how to keep coping with. PGT-A can shorten the time to pregnancy but even if your embryos test chromosomally normal there may still be other issues that prevent a successful pregnancy hence it is worth discussing the aforementioned tests with your consultant along with PGT-A. Wishing you the best of luck on your journey! X

[IVFat40]

I experienced repeated implantation failure and as others have mentioned would recommend getting your uterine natural killer cells tested (if they're high this can treated with steroids). There is a great trial you can self-refer to run by Dr Brosens and Dr Quenby (Warwick University and Coventry hospital)

[JA-fnuk Partner Nurse Fertility Network UK]

If mentioning clinics etc please use PM

Thank you

Janet

[ClaireB24]

Sorry to hear you’re having such a difficult time, it’s so so horrible to go through. We didn’t have male factor but as others mentioned above after 3 failed transfers I had natural killer cell testing. My levels were high and they gave me steroids before transfer no 4 as well as adding injectable progesterone. It worked for me and now 25 weeks pregnant. But lots of other great options in the comments above too, it always seemed like a bit of a lottery to me as to which tests to do (a really really expensive lottery). Good luck with whatever road you take xxx

[HedgehogMad in reply to ClaireB24]

Hi Claire! Could I ask what dose of steroid you were put on?

[ClaireB24 in reply to HedgehogMad]

I was on 20mg until 10 weeks then slowly weaned it down. Just read your story below. It was a 4BB that worked for us after failed rounds with “better” embryos so I wouldn’t worry too much about grading. Good luck for your next transfer, got everything crossed for you x

[HedgehogMad]

Oh love your story looks just like mine! Significant male factor, everything seems fine with me. 6 blastocysts, we have had 2 X 5AA and 1 X 4AB transferred so far, all BFN.It is so shit. Our consultant has said we are just really unlucky and that the best thing is to keep transferring embryos, so we are about to do a double transfer of 2 lower quality ones (BB and CC). If this doesn't work I think we are going to push for more investigations, probably ERA and PGT-A for next fresh cycle.

I don't have any answers I'm afraid but just wanted to let you know you are not alone - it's a horrible place to be especially when you see others have success after 1 or 2 transfers. Can make you feel such a failure. Not sure your age but I am 30 and they have said PGT-A not recommended in my age group but I think I'm going to ask them whether they will do it for us next time 🤞