Tests for failed implantation - worth it at 43?

[Orangeflowers]

Hi all, sorry, it's me again.I've had 4 failed fresh cycles last year (1 single and three double transfers). I think the main reason that these have failed is due to embryo quality. Some of the transfers were early blastocysts/ morulas and they weren't top grade.

However my consultant has suggested that as a next step tests for failed implantation would be recommended, followed by transferring my 2 frozen embryos and then if they fail going to donor eggs. That is not my preference as I feel time is ticking and want to give my eggs a go. My understanding is that a minority are viable and it's about fishing them out in multiple cycles and relying on luck, with the understanding chances are getting ever slimmer.

We agreed I'd do another 1 or 2 fresh cycles with my own eggs. I don't feel I can give up yet as my AMH, egg numbers, lining etc are great. My issue is with poor development and I only get a max of 2-3 blasts on day 5 or 6.

For context, I am trying for a sibling after success getting pregnant at 41 with a day 6 blastocyst and giving birth at 42.

The tests for failed implantation suggested are

(i) testing for sticky syndrome called antiphospholipid syndrome.

I'm not sure if this is relevant given that I've had no chemical pregnancies or miscarriages.

Treatment is Aspirin or Heparin. I am told that Aspirin shouldn't be taken without the rest as it may cause harm. This seems controversial as my clinic in Greece prescribed mini aspirin in any case.

Even if this test is positive, it would need to be repeated so takes an additional 10-12 weeks

(ii) Endometrial Trio (which I think includes ERA)

This would involve taking medication for a cycle with no collection or transfer so would be a time delay. From what I've read, there is no strong evidence for it and the adjusted timing for transfer may be detrimental in some cases

(ii) Uterine natural killer cell testing in Coventry with Prof Selby

Ultimately I think the most probable reason for my cycle fails is egg quality rather than issues which might be found with any of these tests. Also, since I've had a successful pregnancy, are NK killer cells something that might be relevant for one cycle and not another or a developed condition?

Thoughts and experiences much appreciated xx

[AMJean]

Hi Orangeflowers, I’ve not got there yet but had some thoughts as I was reading. I’ve had 2 fresh transfers(one single, one triple) and 2 frozen transfers (both double)now. I got preg with 2nd frozen transfer but miscarried at 12 wks. I’m now in tww for the 2nd fresh transfer, which were put back at Day 2, which is new for me. One thought was…I know my consultant has said fresh is best, but I read something about frozen being good for 40+.Other thought was when they put fresh ones back in eg Day 2,3 or 5, which came up us this time. Like you, I’m thinking it’s a numbers game at this stage, which is what my consultant said too. Nice to hear of your prior success 👍.xx

[Orangeflowers in reply to AMJean]

Thanks for this. Wishing you success x

[Anonymous543210 in reply to AMJean]

fwiw, I’m 42. My doctor refuses to do a fresh cycle because many studies show that FET are better for older women. Both because I PGTA test (which may not be an option for you) but also because stimulating the ovaries and prepping the lining are 2 different tasks. My RE approaches them in separate cycles. She’ll give me a protocol to increase progesterone weeks ahead of time and decrease inflammation prior to an FET. She says the drugs for egg retrieval increase inflammation in uterus so fresh transfers are less likely to implant. I have a little bit of adenomyosis but no endo, and that’s her approach.

But at our age, embryos being normal are the limiting factor, esp as you have successfully carried before (which is so wonderful!). I’ve done 3 banking rounds and finally got 1 PGTA normal blast on the the last one. Across all 3 rounds - total of 22 mature eggs, 17 fertilized, 6 blasts were biopsied, 1 is normal.

also fwiw, my amh is 1 and fsh is 13. Afc is 7-11 depending on the scan.

Such a massive decision to move to donor eggs. If my FET fails I’ll be considering it too!

[Orangeflowers in reply to Anonymous543210]

Thank you so much. All this sounds sensible. Is your lining on a fresh cycle not optimum for transfer or is the Dr recommending FET anyway? I could transfer one fresh and one frozen if I get 2...

[Tarasunny]

I had the thrombophilia panel done which showed a mildly raised antiphospholipid level. I've only had 1 test so far, they agreed to give me inhixa off the one test but I do have a history of miscarriage. Not sure I'll bother getting the second one. They also mentioned the EMMA and ALICE before my last round but also said I could just do 30 days of vaginal probiotic pessaries so I did that it was cheaper!

[Orangeflowers in reply to Tarasunny]

Thanks for this. It is the time delay and cost which worries me. Also some of the potential interventions the test may suggest might be applied anyway such as aspirin and dalcin. I do worry that some consultants promote the tests on commission. Hope all is well with you x

[Tarasunny in reply to Orangeflowers]

You do wonder sometimes! I have my follow up on Thursday so see I'll see what the plan is after that 🤞

[TeddyBear5]

hey lovely, I agree. I think PGT testing (if your clinic do it) is probably a better use of money as it’s totally a numbers game at our age given most eggs have chromosome issues. It’s so frustrating and expensive 😞

I’m the same as you, good AMH for age, all other stuff fine (I’ve just turned 43). I had a cycle just before Christmas and had a chemical. I have one frozen embryo - my last try. I also don’t want to use donor eggs.

I took ubiquinol religiously for ages before this last cycle - was really hoping it would work. Embryo was a 5 day 5AB so good quality- not that this means much is chromosome land!

I’ve got a day 6 4 AA to try now - pinning all my hopes on it. I didn’t do PGT as I don’t get many embryos and didn’t want to rule out possible viable embryos. If I could afford it I’d do 2 or 3 back to back cycles and get them all tested then frozen if any were good enough

[Orangeflowers in reply to TeddyBear5]

Thank you. Same as you I don't get enough to test. My daughter was a day 6 embryo and 4AA is great! Hoping the next one works for you x

[TeddyBear5 in reply to Orangeflowers]

thanks that’s so good to know! Xxxx

[Tnthketnf]

HiI kind of agree with your thinking if you are set on continuing with your eggs then why waste time and money on these tests. I am not a doctor so it's just my view. I would be asking the same question. Especially since you have had previous implantation.

The clinic in Greece I am talking to although they offer endomeTrio they don't recommend it. Not in my case- similar scenario with yours decent AMH & egg numbers and max of 2-3 blasts on day 5 or 6. Almost 40.

I don't know about the aspirin but I was prescribed clexane just in case for one transfer. I then had antiphospholipid syndrome or Thrombophilia panel and was negative so opted not to have claxane again.

After this, one of the consultants I spoke to recommended both aspirine and clexane for future transfer despite the negative result. i have an autoinflammatory condition and she said it might trigger Thrombophilia during pregnancy so not to assist implantation.

No experience of uterine nk cells. the clinic Greece didn't recommend it either.

[Orangeflowers in reply to Tnthketnf]

Yeah it's really hard to know isn't it. HEFA are pretty damning of these tests. I've heard the result varies from cycle to cycle so not at all sure if my previous successful implantation is relevant or not, but then surely if the results vary cycle to cycle their results are a bit meaningless anyway!?

I think I've been to the same clinic as you in Greece and they didn't mention the tests either.

Good luck x

[Muppetgirl]

I was 44. Never had any make it as far as Blast. Always transfered after 3 days. Dis test for NK cells at 44. Had some treatment. Got pregnant. Now my dreams have come true. I am Mama to a gorgeous 3 year old.

[happypupp in reply to Muppetgirl]

Great to hear about your success, could you tell us more about your NK cell test and treatments?

[Muppetgirl in reply to happypupp]

The test for NK cells is a blood test and at the time (3.5 years ago) it got sent off to USA. Results were back within a few days. Then if you need treatment they test you for latent TB as the medicine wakes that up. My TB tests were positive for some strange reason and I was looking at 6 months of antibiotics - not exciting as I was 44 and another 6 months was like a long term prison sentence. However, my doc was trialling a different treatment and I had a drug that's given to transplant patients so that their bodies don't reject. And a month later I had 3 3day cells put back. And now I have a little 3 year old who loves to dance to Baby Shark.

[Orangeflowers in reply to Muppetgirl]

That's amazing, congratulations. Thanks for sharing. It's really hard to know what leads to success but this seems to have worked for you x

[Gerti2020]

hi, I have a similar background. I had a successful pregnancy at 41 with a frozen embryo (untested). When trying for a second at age 43, I had 2 further FETs (untested embryos) which both failed. I then had a second round. Fresh embryo transfer failed but I did get the other 5 tested. They were all good quality but only 1 normal. Like you said it is down to luck, they told me the odds are 1 in 10 to have a normal embryo at my age. I am currently pregnant with this one embryo. I do recommend PGTA testing to pick out the good ones to save time and money, and also do as many rounds as you can afford now to bank embryos, i was told to take asperin and a higher dose of folic acid this time (as I was diagnosed with diabetes) plus I had a progesterone test before transfer which was low so had to double up on pessaries. Wish you all the luck in the world x

[Orangeflowers in reply to Gerti2020]

Wow, thanks for sharing. It seems you produced a excellent number of blastocysts for this age. Congratulations x

[Conceivingblee]

Hey Orangeflowers.Has OH sperm been checked via SOS test ot COMET to make sure all is ok. Good sperm is also critical to development?

I had the ENDO TRIO done. Had a really bad infection with zero good bacteria in my womb. And also needed 12 hours extra progesterone so this for me was a good shout

I'm 44 now still not pregnant after 4 round own eggs 2 rounds DE not had a hint of pregnancy since 2017. My next step is now NK test. I've asked my GP to refer me to Tommy's which is where I believe the prof you quoted works.

Such a minefield isn't I feel my clinic gave up with me and pushed me into DE as my only chance. Stand your ground if you are still getting good numbers. But I'd deffo get OH tested if he hasn't been.

Good luck.

[Orangeflowers in reply to Conceivingblee]

Hey, other half hasn't had advanced sperm analysis. He probably should but I'm not sure what interventions might make a difference if it's confirmed as bad - antioxidants and antibiotics I suppose, which he's tried.

I hope the NK testing works for you. Do let us know your experiences. Good luck x

[Anonymous543210 in reply to Orangeflowers]

if he has wonky sperm (scientific language!) the lab can help a lot with that, even if it’s considered add ons. So worth checking out! Plus, it’s a cheap and non-invasive test for him compared to what we all go through!

[Orangeflowers in reply to Anonymous543210]

Thanks, do you mean PIMSI, IMSI etc?

[Lucyann13]

you sound exactly like me. I’m 40 and have had 3 fresh rounds and only make 1 poor quality blastocyst or day 5 morula. Doctors say it’s pointless and I should move on to DE but I’m not ready. Unlike you I’ve not been pregnant before. Only started this process at 38 as my husband has azoospermia. The clinic I use only seems to have a one size fits all approach, will only use day 5 blastocyst and high dose stimming. They mentioned implantation tests but think it’s pointless at this point. Im at a loss what to do.

[Chantysal in reply to Lucyann13]

u should definitely change clinic if u dont feel they do a personal approach to your case and needs. Evertime i did high stins j got the wirst quality embryos. What worked for me was low stims or natural cycles. And on top of it i got more eggs retrieved when i used low stims

[Orangeflowers in reply to Lucyann13]

Thank you for sharing. It sounds like you are using the same clinic as me! My partner also has morphology issues with sperm (3% normal). Compared to me your age is much better, don't give up. As a general rule consultants become less positive after 3 cycles. All the best, good luck 🤞 x

[Ganges]

I’m turning 40 next month, no success so far. 5 transfers, 1 being frozen. Had all the blood tests for implantation failure, just had the ERA. All ‘normal’ my clinic put me on steroids for NK, my issue with the NK is it’s another month of no treatment, as the ERA was. Plus you can’t try naturally. It’s so difficult, I keep telling myself what an embryologist sees as not a great embryo can still produce a live birth. Good luck x

[Orangeflowers in reply to Ganges]

Thank you. The wait is so hard and I don't have much time. I also didn't realise that you can't try naturally when testing! Good luck x

[HedgehogMad]

Hi lovely, I would agree with you it may not be worth doing those extra tests as you have had a successful pregnancy in the past. Most evidence suggests that implantation failure particularly in women over 40 is embryo defects. I would probably ask about embryo banking and PGT-A testing instead, if you are keen to still try with your own eggs. I think that would be a better use of your time and money. Best of luck with it all xxx

[Orangeflowers in reply to HedgehogMad]

Thank you. I will keep this in mind. I tried before but they weren't ready to biopsy on day 5 so I transferred two fresh x

[Chantysal]

i would recommend the PGT test since u feel it mite be a quality issue

[Orangeflowers in reply to Chantysal]

Thank you

[Bomboncita]

Have you tried FET? Are you taking ubiquinol?

[Orangeflowers in reply to Bomboncita]

My only success was from a frozen transfer. I am wondering if that's what works for me. Issue is that I only generally have 2 blasts and the way the costings work it would be crazy not to transfer fresh.

I'm taking ubiquinol at 400mg and my consultant just recommended to up it to 600mg x

[Bomboncita in reply to Orangeflowers]

I understand. I mention the FET and the ubiquinol because I'm your age and this was the only time it worked for me too. Good luck!

[Anonymous543210 in reply to Bomboncita]

I’m about to transfer at 42 and that’s also the recommendation of my RE

[Bomboncita in reply to Anonymous543210]

Fingers crossed 🤞

[Orangeflowers in reply to Anonymous543210]

Thank you. Do you mean FET, ubiquinol or both?

[Orangeflowers in reply to Anonymous543210]

Good luck xx