pgt-m/a patient with unexplained infertility

[Falafelrovers]

Hi ladies,

First time I have posted but have been on the IVF merry go round for a few years now.

I am 39, had my first child at 35 through IVF (first time) and since then have been trying for 3 years for a sibling. We’ve now had 5 unsuccessful transfers (3 failed attempts, 1 chemical pregnancy, 1 early miscarriage). We are PGT-M / A patients so lose a high proportion of our embryos to testing, and the batching to generate enough embryos has been relentless.

My clinic doesn’t really know why I have had so many failed attempts with euploid, high quality embryos which apparently is statistically unlikely. I suspect some kind of secondary infertility, potentially endometriosis / adenomyosis or related to the c section from my first pregnancy but I have had trouble getting a firm diagnosis. I have been told I ‘probably’ have adenomyosis, I’ve also had a laparoscopy which showed very mild endometriosis though I have recently developed endometriomas on my ovaries.

The clinic have not (I feel) taken this very seriously as they say my treatment approach would be the same anyway; my c section niche is small (1mm) but did contain blood, they advised to leave as is as deemed not to be a factor.

I’ve had unexplained fluid in my uterine cavity a number of times though not on transfer days. Everything else normal.

anybody have any advice? Is it worth pushing further on the diagnosis front?

I am also thinking about changing clinics - I am with CRGH (I am based in London) but they charge a high flat rate for up to 10 embryos rather than on a per embryo basis which basically means I have to opt for 3+ EC batches per round of testing to make it cost effective; we have used of all our savings now (and then some) so keen to explore pay per embryo option as we can’t afford another mega batch testing cycle. If we so move to another clinic, not sure if I would need to pay again for the pgt-m mock up at another clinic (which also takes forever) or whether the clinic would just transfer it. Does anybody know? / have any recommendations?

Thanks in advance for reading and sorry for the mega post.

[DianeArnold Partner Nurse Fertility Network UK]

Hi . Just one little thought. Could the fluid in your womb, when present, could it be from your Fallopian tubes, and preventing developing embryos from implanting? Have you had a firm diagnosis of adenomyosis. If so, someone who is a specialist in this field to have a look. Anyone mentioning clinics by name, please do so by PM please, so there is no potential advertising. Thanks. Diane

[Falafelrovers in reply to DianeArnold]

Thanks, Diane, appreciate your reaponse.

I had a scan on the NHS which they said (in light as well of my painful periods) was ‘suggestive’ of adenomyosis but that was it. There was no follow up and they said given I was TTC there was no treatment options anyway. But I would really also like to have some answers, an indication of whether it is worth us carrying on. I have had the 3D- SIS test which indicated tubes etc. were working okay.

[Aftertherain1]

I would definitely get your niche investigated further. I had one (laparoscopic surgery to fix) as previously I had an early M/C, followed by two failed euploid transfers. I had the surgery and am now 15 weeks pregnant. I know every case is different but mine was causing fluid that I think makes the uterine environment toxic. They don’t always repair a niche if they are really small BUT if it’s the cause of your fluid I would recommend getting a second opinion. Good luck with everything x

[Falafelrovers in reply to Aftertherain1]

that’s lovely to hear (and many congratulations! I think I will get a second opinion. How did you go about finding a specialist? I have been through the NHS route who only operate in the clear cut cases and via my clinic (but they just do IVF and don’t specialise in diagnosis). It feels so stark with how easy I found it with my first child. X

[Aftertherain1 in reply to Falafelrovers]

There was a specialist working alongside our fertility clinic so I just initially had a consultation. I then proceeded to do another FET (my thinking was that I got pregnant with the niche but it sadly ended in miscarriage - untested embryo) but after that FET failed (euploid) I went ahead with surgery. Are all your FET medicated? I think the thing that also helped me was a natural cycle - there was no fluid so maybe also something to consider? I wish you all the very best xxx

[Falafelrovers in reply to Aftertherain1]

Thank you. We did try one natural cycle and it helped in that I got pregnant (just unfortunately misscarried fairly early on). There wasn’t any fluid on that cycle so you’re maybe on to something there. The trouble is I potentially also have adenomyosis/ endometriosis where they recommend a medicated cycle, and I’m not really sure which is driving the issues (or if it’s just really bad luck, but my consultant thinks unlikely at this point). X

[Hanj10]

I was told by clinic they thought I had adenomyosis just through normal Scan. Like you they said no treatment as such other than longer down regulation so my last (successful) transfer I was given zoladex for down reg which was longer than when previously on buseralin. The idea is it reduces the inflammation caused by adenomyosis. I also gave up caffeine a few weeks before cycle and started an anti inflammatory diet. I was already on immunology protocol so steroids, intralipids and inhixa. If it hadn’t worked they suggested a HSG scan just to check nothing in addition. X

[Falafelrovers in reply to Hanj10]

Thanks for the reply, great that you were able to get pregnant with some relatively do-able adjustments (if you can really call giving up caffeine doable!) . What I’ve read has just made it all sound a bit hopeless with adenomyosis so it’s good to hear a success story x

[Axel131]

Hi Falafelrovers, so I moved clinic after I'd had a PGT-M probe (now called an optimization design I was told!) built and a cycle done and there was no additional fee to get it set up again. Once the clinic you change to uses the same genetic lab which is usually Coopers in the UK, it will already be there and there'll be no set up fee. Best of luck with whatever you decide to do.

[Falafelrovers in reply to Axel131]

Oh that’s so good to know thank you Axel131, was worried I would need to pay again and spend several months waiting on the mock ups.