Failure of a PGS Tested Embryo, why??

[Tryingtostaycalm]

Hi There

It’s been a while since I’ve been on here. We had a missed miscarriage last year and 2 other failures, so decided to move clinic.

The clinic we are now at, have thrown the kitchen sink at this round. We have had IMSI, a hysteroscopy (where they found I had an infection), the ERA, PGS testing, Intralipids and the HSG flush.

We had one normal chromosome day 6 embryo transferred and found out this morning it didn’t work. Honestly I was shocked after everything we did that it failed. I’m 40 next year so time is ticking and I am feeling really down today.

We have 2 low mosaic embryos in the freezer but I know the consultant is reluctant for us to proceed with them as she is concerned of other loss.

I’m just trying to understand after having the PGS testing why the embryo would fail 😔?

Thanks

[Mary2022]

Sorry to hear that. You mentioned you have an infection, did you treat it before transferring? Also could it be the immune issue, I know there are some blood tests for finding the problem? I hope you can get those answers from your clinic.

[Tryingtostaycalm in reply to Mary2022]

thanks for your reply. I had a course of antibiotics and a repeat hysteroscopy before the transfer. It seemed like they were trying to do everything they could to ensure my body was receptive, but sadly it wasn’t. I don’t have a follow up appointment with my consultant until 30th November which is quite a while away to get some answers and plan for next steps. I think my husband is questioning how much we are putting into this journey (not just financially). I’m just not ready to give up.

[Mary2022 in reply to Tryingtostaycalm]

It is so stressful on the financial, the treatments are expensive, totally understand. I know some people have low dose aspirin or anticoagulant (blood thinner) to prevent blood clots from forming and block arteries. Also have you had any blood test for antiphospholipid, thrombophilia?

I hope you can find those answers from clinic. I also did some research on the low mosaic embryos, the low mosaic embryos have the same chances as the euploid embryos, so still hopes there. All the best X

[Tryingtostaycalm in reply to Mary2022]

Due to my recurrent implantation failure I was also given Aspirin so I think i had it all! Hopefully I will get some answers next week. Thank you!xx

[Boo718]

I’m so sorry your going through this. Have you had the bacteria in your womb tested. I had 95 percent good bacteria so was fine but a friend of mine only had 5 percent good bacteria xxx

[Tryingtostaycalm in reply to Boo718]

Hi there, thanks for your response. I was put on Cannesflour for the bacteria right up until I began progesterone. they said it was within normal range when they retested.

[Mudra85]

Hi, I'm so sorry your latest transfer didn't work. It's really gutting when you know the embryo is chromosomally normal and you've thrown loads of other treatments at it too.

I've had two failures with euploid embryos, the first was a chemical pregnancy and the second didn't implant. Both embryos were good quality, although the second one had been biopsied and thawed twice, which may have reduced it's ability to implant. It's often impossible to day why an embryo, particularly when it's chromosomally normal, doesn't work. I've learned that at best there's only about a 50% chance of having a live birth after transferring a tested embryo. Other embryonic factors that play into it can include what morphological grade the embyro was, it's rate of development (what day it reached blastocyst) and other factors that they can't currently measure or we don't yet know about.

There are whole host of other reasons why it may not have worked, including uterine factors, immunological, hormonal, sperm DNA fragmentation etc. However, the most likely reason is often said to be the embryo itself, even in spite of it being tested.

The two low level mosaics you have may be worth pushing for as a fairly recent very well done study has provided strong evidence that low level mosaics (20-30% abnormal cells) and moderate level mosaics (30-50% abnormal cells) can have similar ongoing pregnancy, live birth and miscarriage rates as euploid embryos. However, this will of course depend on the type of chromosomal abnormality the embryo has.

Do you have a follow up consultation arranged with your clinic? Hopefully they'll be able to provide a bit more insight.

[Tryingtostaycalm in reply to Mudra85]

Thank you so much for your detailed and informative reply; - i really appreciate it. We have a follow up booked in on 30th November, but i am asking for an earlier appointment so we can get some closure on this cycle. I am also booking a Genetic Counselling appointment to discuss our Low Mosaic embryos. I'm also so sorry for your loss too. Its so hard isn't it? I had changed clinics last December and we took almost a year to get to this stage. For it to fail is just crushing and i feel with my age, i don't have time on my hands which makes me panic.

[Mudra85 in reply to Tryingtostaycalm]

I can totally relate to how you feel. It's taken us over a year to get to this stage after our first failed embryo transfer with our only tested embryo. After that we decided to bank tested embryos because I didn't want to be left with the feeling that we were going back to square one again. It's incredibly frustrating and soul-destroying when you're doing everything in your power to move things along quickly and have successful treatment, just for those efforts to be met with disappointment after disappointment.

I hope you're able to move your follow up appointment to an earlier date, as I'm sure you don't want to wait any longer than necessary. Getting an appointment with a genetic counsellor also sound likes a good idea. I've found that genetic counsellors in this country can take a very risk averse approach to transferring low level mosaics, but I've not seen any evidence to support that risk averse approach, unless of course it's one of the three main chromosomal issues which can lead to birth defects. I hope you're also able to speak to the genetic counsellor quickly, so you can decide on your next steps.

[ourbundleofjoy]

Dear Tryingtostaycalm,

I am so sorry for your news, it is heartbreaking. I was there a little bit more than a month ago. Same age, same story, we put everything in this cycle as well. I couldn’t stop crying for a while. It is still raw and painful. I am sorry this happened to you.

With this last round of egg collection & FET we did:

IMSI+ Calcium Ionophore + Time-Lapse incubation and imaging+ Assisted zona hatching + PGT-A + tests (ERA, EMMA, ALICE, NK cells) + Intralipid Infusion + FET (with hCG flush)

3d scan – checking for polyps, hydrosalpinxes

Sperm DNA fragmentation test

We are both on so many supplements & vitamins that we rattle 😊

Before transfer, my lining was textbook perfect (according to my doctor) and I had good progesterone levels.

We had a consultation with our doctor afterward and in her opinion, there are few possible reasons:

1.“central abnormalities”

Could it be (even though PGT-A normal, tests are 98% sensitive) the genetic screening does not ascertain “central abnormalities”, this is the center of the embryo. And they feel that the “central abnormalities” are contributed by the sperm. They say, that if a genetically normal embryo does not implant, could it be something inherently abnormal in the embryo that was not detected on genetic screening therefore my lining rejected it.

Therefore the embryo is actually abnormal even though it came back genetically normal (PGT-A normal)

2.Is there more of a selective issue that we don’t know about? Could it be that my lining is quite used to getting abnormal embryos and so, therefore, it ignores the normal embryo – embryo selectivity. Embryo/ endometrium selectivity issue.

3. This might be some sort of immune pathology that we have not been able to suppress. Our Dr. thinks that this is not the issue, because they gave me intralipids, therefore she doesn’t believe it is the issue.

Our Dr. is leaning toward cause 1 or cause 2. The thing is, there are so many things that they know, but also there are millions of things that they don’t know.

So, our plan is to take 2 months off and have another and our last egg collection in January. We have another consultation with our doctor in a month’s time where we will agree on a new treatment plan, so far she advised us to add PIMSI.

We just started seeing a Traditional Chinese medicine doctor, we do acupuncture and take their herbal products. I should have drank their tea twice per day, but unfortunately couldn’t drink more than 2 sips and it made me sick. I cannot make myself do it. I would like to have a baby so much, but I still cannot convince my body to drink that tea. My partner got herbal tablets, so it is easy for him.

What just happened to you is traumatic, so perhaps take some time off and look after yourself. Pause. Take time to heal a little bit and then make plans for the future. But right now allow yourself to be sad and angry, let it all out.

If you would like to talk, I am here…

I am sending you one massive hug xx

[Tryingtostaycalm in reply to ourbundleofjoy]

Thank you for this. I’ve just looked at your profile and seen we are at the same clinic! Will DM you.cx

[Seren0119]

I am also at the same clinic - two PGS tested embryos failed. One missed miscarriage and one chemical. I was so shocked, honestly. I really thought PGS was the answer. It was my third PGS embryo which was the lowest grade and day 6 that worked - I was on 25mg steroids, HCG flush etc etc. unfortunately PGS is not a guarantee but it is a numbers game - evidence shows 3 PGS embryos gives over 90% live birth rate. Thinking of you xx

[Ranchu90]

My first normal embryo transfer ended in chemical pregnancy. On next transfer we transferred 2 normal embryos and we added steroids on the cocktail 🍸 and now I have twins. I tested for NK cells and they weren't elevated...so God knows!! Take care 💕

[JuicyLu]

So sorry to hear this. You’ve really been through a lot there, especially with all those treatments. Did you have your progesterone tested at transfer? Mine was often low so I was on mega-amounts, which I think made a difference, although I did get the feeling the whole thing was a bit of a crap shoot and a numbers game! 🙈 x

[Tryingtostaycalm in reply to JuicyLu]

Yes i had it taken straight after the transfer and it was fine (although i was on alot of progestrone).xx

[pink_lemon]

I am sorry to hear your embryo did not take. My consultant tells me there is about a 50% chance of live birth from an euploid embryo at this age. Compared to 10% with untested embryos. Not what we want to hear…

[Tryingtostaycalm in reply to pink_lemon]

Indeed! But good to know the odds. Our consultant had said, with everything we were doing she was trying to achieve a 70-80% chance, so we were so confident.