Extensive history - how far to push testing before returning embryo

[Skittles11]

Hi I have had what feels like an extensive fertility journey with a lot of emotional pain along the way. Started trying at 33, am now 37.

I'm in a position now where I have one PGTA tested embryo and one untested embryo. I don't expect to achieve further embryos in the future so see these two as my last two (I do recognise I'm lucky to have two as well though it was far from easy getting them).

Because of the time spent trying to collect embryos via embryo banking, nearly a year and a half has passed since my last embryo transfer which resulted in saying goodbye at 15 weeks.

It feels like the time is literally being sucked away. I have been focusing on ruling out what I can to optimise things before returning my precious remaining embryos. So it feels huge pressure, like it's all riding on these 2 remaining.

Because of that I have been doing a kind of testing phase to try and make things optimal for return of my embryo/s. Eg ERA, EMMA, ALICE and immune tests.

But it's a question of how far to push the testing, knowing I probably won't have any more embryos in the future.

Do I wait it out and do things like the hycosy and 3d sis scan as I've never had these done or do I move to transfer as soon as the outstanding issues e.g. immunes, are addressed?

Any views welcomed.

Thanks xx

[Nenad]

hi Skittles, I see what you mean. If I were in your shoes I’d probably do all I can in terms of testing and any treatments needed before transferring the embryos, especially if you’ve decided they’ll be your last two. I’d want to give it my all so there are no regrets after. It’s such a trial and error process and we don’t really have much control over the outcome, but it’ll at least eliminate the “what ifs”.

Wishing you all the best with whatever you decide xxx

[Skittles11 in reply to Nenad]

Thank you for replying with your thoughts. I really appreciate it xx

[Koala365]

Hmmm. It's a difficult one. You know something of my journey and how it really hasn't worked out at all so you need to take that into account when assessing my answer as our experiences do feed into this. I have been thinking lately that my MMC whereby baby had to be removed by op must have caused some sort of damage to my body such that I am incapable of having an embryo implant and been thinking about whether for peace of mind I should have a hysteroscopy. In my current frame of mind I would say do every possible test you can so that you don't look back wishing you had done a particular test and potentially (hopefully not!) blaming any bad result on not having addressed something as I hadn't done the test for it. That said, however, I did have a hycosy done as when I got a second opinion from a different clinic, they did suggest it, even though they acknowledged that at least one of my tubes must have been working or I wouldn't have got pregnant naturally (which is what resulted in my MMC which started this whole journey). I paid a load of money for the hycosy only for them to confirm everything was fine then tell me I had to take antibiotics as there was a risk they could have pushed bacteria into my tubes through the procedure which could end up blocking them and nobody could confirm 100% to me whether this was only if you had the chlamydia bacteria and I just ended up feeling totally sh*t about the whole thing and the money I had spent on it which turned out to be absolutely unnecessary ultimately. Even despite that, I would still do every test I could in your position as I would want to feel like I could have done anything I possibly could! Wishing you all the best. I really hope you get your rainbow Xx

[Skittles11 in reply to Koala365]

Hi Koala. Thank you for replying and I hope that you are doing okay. I can see your point and have been trying to make my way through some of the tests to maximise chances but it feels like there are always more tests to do! And it's hard when you get different views from different doctors too as to what testing to do. Wishing you all the best too and I hope that if you choose to have the hysteroscopy that you feel it gives you the peace of mind you mention xx

[Koala365 in reply to Skittles11]

I'm okay thank you. Trying to make the most of the childless not by choice situation I find myself in. It's really tough but I am getting there. I hope things are going well for you and you are getting closer to being able to put one of your embryos back and are successful! Xx

[Hidden]

hey Skittles, you might know my thoughts already but as you know we did round after round with BFNs or MMCs and it was only after round 6 that my new clinic insisted on the 3D SIS and that then lead to my surgery and all my fibroids being discovered, my heart shaped womb etc. I did also obviously move onto DE as well so I can’t be sure that was the difference but I really think if my previous clinic had been more thorough and looked at my womb in more detail I might not have had all those losses and BFNs before I finally got my sticky BFP. The procedure is quick and can be done just before transfer so I personally wouldn’t hesitate to do that one xx

[LadyM2019]

Yes to the 3D SIS scan. It discovered I have a polyploid endometrium, whatever that is! I think possibly tiny polyps but I’m not sure. Womb always looked perfect on a 2D scan and I’ve had a 24 week pregnancy in the past. I’d do what you can to rule out other issues. My consultants plan was to get at least one pgta normal embryo then do 3D sis, Emma Alice and Era testing as well as nk testing xx

[CassieJ]

Hi Skittles, I can really appreciate wanting to do everything you can. In my experience and opinion a 3D SIS would be worth it -just to double check your uterine cavity. I can’t see much value in you doing a hycosy but I might have missed something in your history. If you don’t have fluid in your uterus and your lining is building up ok-given that you conceived and carried past 12 weeks before I think it’s pretty unlikely that the 3D SIS will find anything -but it is a pretty simple test and good to know you’ve tried everything you can. Xx

[Lolalules]

I’d recommend the hycosy, i had 2 natural MMCs with tests returning normal and my 3D scan showed my uterus was also fine. They offered the hycosy as optional and i decided i didn’t want the what if so i went for it. It showed a blocked tube which i then had surgically removed. Sometimes the fluid comes and goes but will show during hycosy so it was worth it for me. There is a risk of infection with it, which is why they offer it as optional but if they think it’s required they give you a strong antibiotic to take straight afterwards to circumvent that x

[Mudra85]

Hi Skittles, this is such a tough call to make. As you know, I've gone down the testing rabbit whole after failed transfers in the hope of finding things that may help in the future. I think testing can be very helpful in certain cases, but the more I Googled and searched for answers the more I got on board with the general consensus that for most people it's about finding the right embryo (there are of course exceptions to that). As you have been pregnant before, and have had clinical pregnancies (please correct me if I have that wrong), the chances are that you probably don't have any issues that would significantly impact implantation (either due to uterine or immune factors). That said, I do think it's worth doing a 3d SIS and HyCosy before doing a transfer as things in the uterus and tubes can change over time.

I think immune testing and treatments can be helpful in certain specific cases. But I think most women probably don't need this. The women I've seen who've had immune treatment that's helped them to get pregnant or have a baby have had very specific circumstances and have either had recurrent implantation failure or recurrent miscarriages with good quality PGT tested embryos. I went down the road of basic immune testing, but the more I read into it the more it didn't make sense to me that I'd been able to get pregnant and stay pregnant without any issues other than the baby inheriting the gene I carry. My immunology could have been the same then as it is now, the only difference being that I now know that some of my immune markers are off where I didn't before.

I think my view would be to go ahead and transfer after you've checked for uterine factors. I'm not sure whether it's worth getting the immunes in range first given your history. It could be very expensive and time-consuming, and even if you wait until the perfect time to transfer it still may not work due to the key component which I believe is the embryo itself. On the other hand, your transfer could work in spite of the immune factors you've uncovered.

The other thing to consider with immune testing is that you don't want to over-treat things, as this may have unintended consequences. For example, I've come across women who've had intralipids and it's had the reverse effect on their immunes, and instead increased things like cytokines.

I know it is very difficult to know what to do as it's terrifying to think you may make the wrong decision. Good luck in whatever you decide. Xx

[DreamingOfTwo79]

Hey Skittles, like everyone already said it is so hard to know when to draw the line and take a leap of faith and it's a very personal decision and only you know what feels right and what level of reassurance you need before you're ready to go into the next transfer feeling completely confident that you've done all you could. The fact that you're still in two minds about this perhaps suggests that you need a little bit more to feel absolutely ready and trust the process. Like you, I wanted to give my embryos the very best chance as I also only have these two and there won't be any more with my own eggs. I did the Endo Quartet and NKC testing and was also considering 3D SIS and HyCoSy. My consultant took this decision out of my hands when she recommended to combine the EndoQuartet biopsy with a hysteroscopy as she suspected my D&C and multiple MCs might have left some scarring in my uterus. During a hysteroscopy they could then remove any polyps, fibroids, adhesions or scarring. I now feel absolutely ready and know that there's not many more bases I could have covered ahead of transfer. Wishing you the best of luck for your next steps, trust what your heart or gut tells you, you'll make the right call! xx

[Seren0119]

I would certainly do a 3D SIS - it is not very invasive or expensive and important to check the lining is clear with no abrasions (especially with a previous loss). It sounds like you have done everything else - so I would do 3D SIS and then go for it (each embryo one at a time to maximise your chances) then eat nice food, sleep, rest and just indulge yourself. Be kind to yourself xx