Can these failures all caused by a single polyp? Help please! (4th failed transfer potentially...)

[neverdance]

Hello my dear IVF warriors!

No good news again I am afraid... My 9DPT5DT HCG blood level came back as <1. Even though doctor suggested to continue with meds but I know my chance for this round is slim.

We had Hysteroscopy + PGS tested embryo + intralipid + HCG flush.

However it is still failing in the same way as it was always before - no HCG generated at all. Three years on TTC, I've not even had a single positive pregnancy test, not even a faintest line😭.

The only thing left to try is another Hysteroscopy to remove a potential polyp - I did Hysteroscopy before this cycle. But they didn't detect any polyp during the procedure. I've had this 'suspected' polyp showing up in scans for years but my previous consultant didn't seem to be concerned (3D saline scan shows it is polypoid endometrium). However it did show up in scans during this FET cycle again (only when my lining became thicker). Doctors at my new clinic seem to get really concerned about it. My consultant suggests another Hysteroscopy next but I am wondering:

1) The potential polyp is 9mm * 7mm located at middle upper part of the uterus. Can this explain repeated implantation failure over years? I had 4 FETs, 3 IUIs and 2 years of trying naturally.... could these all caused by this single polyp?

I am not convinced as I read here(pubmed.ncbi.nlm.nih.gov/104... "Small endometrial polyps, less than 2 cm, do not decrease the pregnancy rate, but there is a trend toward increased pregnancy loss". That says I should at least get a positive test.

Did you had repeated implantation failure and fixed by simply removing a polyp?

2) My consultant thinks it could also be the fold of the lining (so potentially no polyp!). What else can I try in this case?

Please share your experience and thoughts! 🙏

[Orangeflowers]

Hello, I'm afraid that it's impossible to know whether a polyp is the cause of the failures or not, but I would do a hysteroscopy and polypectomy to rule it out.

I had a 'tiny polyp' identified in my initial checks and waited months during COVID to have it removed. By the time I got my booked my procedure it had vanished and they said they can get washed out with your period.

Another few months down the line, it shows up again. The consultant said with it being so small it may or may not affect implantation. I had a fresh round and BFN. I then had it removed and a frozen transfer months later and BFP! (Now 20 months old)

It's impossible to know if the polyp was the cause of my first failure or not, but as you've had a few BFNs, I'd say go ahead and get it investigated further/ removed.

Good luck!🤞xx

[neverdance in reply to Orangeflowers]

Thanks! I am planning to go ahead to try again removing it. Just hoping that is the issue for all these BFNs.

The second time when you got it removed - was it with a different surgeon or maybe a different timing? My first Hysteroscopy was done between day 14 - 28 of the cycle. But my consultant said I should book my next one between day 7 - 14 because small polyps are flattened when flushed with saline. It is difficult to see when lining is thick. I am wondering what is the ideal thickness of lining to perform the procedure. My lining could be thick around day 12... Really don't want the same thing to happen again.

Congratulation on your BFP! I read you are trying for a sibling - finger crossed for you!

[Orangeflowers in reply to neverdance]

Yes - was different timings and different consultant. My polyp was described as 'tiny' but could still be identified on scan - if I got into the crab position 😂Hopefully you'll have it removed and that is the answer for you 🤞x

[Savvy_teapot]

I had a similar thing happen 1st time hysteroscopy didn't see anything but then had it taken out the second hysteroscopy. I am now due in a couple of weeks! However I would say we had multiple other issues with egg quality and sperm morphology. I also had a scratch but mainly as there wasn't a lot to change for my 3rd round. Please do message if you have any other questions!

[neverdance in reply to Savvy_teapot]

It sounds like hysteroscopy did the magic to you. Congratulations!! All the best in two weeks!

Any chance if you remember if the second hysteroscopy was done at a different timing? My first one was done between day 14 - 28 of the cycle but apparently it is better to do it between day 7 - day 14 instead (so surgeon can see the cavity more clearly).

[Savvy_teapot in reply to neverdance]

Well perhaps it was one part of it! So many different factors involved as also have 1% morphology. And not great egg quality either. Sorry I can't remember the timing being discussed. I did have another procedure before the 2nd hysteroscopy with water which showes the lining. I had that at the clinic.

[Katkan]

My mom said she had 3 or 4 surgeries to remove polyps, because they were coming back before second ivf when she got pregnant with my brother after 13 years of secondary infertility. She does not know if the polyps were the problem or because they put her on progesteron. In any case better get rid of the polyp.

[neverdance in reply to Katkan]

Thanks - will certainly get it removed!