Hi allFirst of all just wanted to say thanks so much to all the support that this place provides. Don't know what I would do without it.
We have unfortunately just had our second BFN with a PGT-A tested embryo. I know that this is a numbers game but really would appreciate some advice on next steps.
For background, my clinic includes 5mg prednisolone, clexane and Aspirin as part of the protocol. I've had a blood test for NK cells and came back normal.
My clinic gives antibiotics and I had oral and vaginal probiotics before this round.
Wondering if we just go for another round or we consider some testing. I'm not sure if Alice/emma are worth it because we already have antibiotics and probiotics. So that just leaves ERA but I know that this isn't recommended my many.
With immune I'm not really sure where to start having had nk blood test done already.
As testing is so expensive my husband wants to just go again but I don't want to put another one in if we can find something wrong and correct it.
I'm also considering a modified natural cycle next time instead of medicated as my lining really struggles to grow and I have got pregnant naturally before and gave birth to my son on 2022 so I feel like my body knows what to do.
I'm feeling really lost as to what to do next and would appreciate any advice you have. Thank you xxx
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Dietcoke2025
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Hi. I would check with the HFEA to see if you really need all these tests . Make sure your Fallopian tubes are ok and not leaking toxic fluid because of blockage. Perhaps a look round with a hysteroscopy and biopsy the lining. Low dose of prednisolone and try again. My thoughts of course. I wish you well. Diane
Thanks Diane, much appreciated. That's why I'm hesitant to have an ERA but think you are right a hysteroscopy might be the best place to start. Thanks x
Depending on how many embryos you have left, it could be with trying a natural transfer. Natural transfers always gave me better lining and higher progesterone levels then medicated did.
Thanks so much for replying. I'm wondering if a natural transfer would give me a better lining so good to know it did for you. My clinic seems to prescribe a really high dose of progesterone so my levels were really high the day of transfer. Thanks again x
That cant be that good. Progesterone needs to be around 20 on et day for optimal results. Too high may be an issue, theres an article somewhere i will try and find it for you
I had the same situation than you and my second PGT-a embryo stuck. It could just be a numbers game.
I used a modified natural with letrozole and it worked really well for my lining. My lining didn’t respond well to medicated before.
A natural or modified natural also gives a larger window of implantation so you don’t have to worry about an era test.
For progesterone, my doctor gave me Lubion on top of producing my own and my levels were really high at 100-200 nmol and he was happy with that. There no such thing as too much progesterone according to him.
Thank you. I think we will try again with the natural modified with letrozole like you and see if my lining responds better and hope it did like yours did. So happy for you that your second stuck xx
I had uterine microbiome which was very similar to the EMMA and ALICE tests, anti nuclear antibodies and a histology sample to check for any inflammation, malignancy and any abnormality within the cells xx
I was going to have a biopsy for NK cells but I thought it was a waste of money because uterine NK cells are never in contact with the embryo so makes no difference if they’re high or low. I had them checked peripherally instead xx
Thanks so much for this. I've ordered the fertilysis tests so will see what this brings up. Ah that's interesting on thr NK cells. I didnt know that. Thanks again xx
Sorry to hear about your second round not working .. I would 100% consider having a microbiom test with Fertilysis, even though your clinic put you on antibiotics it doesn't mean they were the right ones, for certain bacteria found you need a specific antibiotic for that strain, I had testing with them and now 12 weeks pregnant xx
Thanks so much for responding. Yeah I have taken a look at fertilysis and looks good. So hard when you are so desperate to get started again but all these tests take time. Congrats on your pregnancy, hat is amazing news xx
Just wondering if you’ve had your thyroid tested? I needed some medication to bring this within the normal range. I also had an unusually thin lining which was unresponsive to oestrogen but I managed to conceive. I wish you the best of luck. X
Hi, yes thyroid all looks normal. Yes my lining is always thin but I managed to get pregnant naturally so it must work for me... did you use a natural cycle? Thanks so much for replying xx
Sorry, it’s so frustrating to have a negative result especially with tested embryos.
I took 20 mg of prednisone on my Successful transfer (currently 22.5 weeks with a healthy pregnancy)
(I’ve had numerous transfers and one twin pregnancy loss previously)
If it was an FET did you have progesterone tested?
My successful FET round included
-lubion injections (extra progesterone)
-75 mg aspirin
- 20mg prednisone
-clexane injections (blood thinner)
I know everyone’s different but these extras do seem to help some people. Without needing expensive testing.
Another thing to think about is perhaps having an Aqua scan, this would rule out any polyps etc - which I did have on one of the rounds but they can be removed easily with a hysteroscopy. Alternatively you can go straight to a hysteroscopy if you prefer which can check your uterus. A normal scan can’t see everything.
Is your husbands sperm all ok? How many embryos do you have frozen?
Hey thanks so much for your response. My protocol looks very similar to yours apart from my clinic prescribes 5mg of predisolone rather than 20mg so maybe it would be worth increasing this. Im so sorry for your loss but congratulations on your pregnancy that is amazing news!
I haven't heard of an aqua scan so will take a look.
We had a lot of failures with getting embryos at the beginning but worked so hard to improve egg and sperm quality and hope that now that we have some 5aa euploids that the embryos aren't the problem...but it isn't a guarantee. Everything just feels like guess work at the moment! Thanks again for replying xx
Hello! Sorry about the failed FETs. I'm in the exact same position. 2 PGT-A tested embryos, both BFN. Going for another transfer at the beginning of April, and this is what I've done for the next one.
25mg of prednisolone
Aspirinx1
Claxanex1
Estrogen 3mgx3
Probiotics
Folic Acid
Vit D
Omega 3
Prolutex x2
Cyclogestx1
I also had a hysteroscopy and D&C at the end of February with an endometrial scratch.
Ive no idea if any of this will work and I still feel mostly hopeless to be honest but it's worth a shot.
So sorry to hear you have had BFNs too. It feels so baffling doesnt it. Thanks so much for sharing your protocol, it looks exactly the same as mine apart from my dose of prednisolone was 5 so much lower and everyone that seems to have had success with this seems to have had the dose that you've had. Ah interesting about the scratch, my friend just had one and it worked for her. Wishing you all the best for April. Message me if you feel like chatting xx
I’m sorry you’ve faced these BFNs. So many useful replies here! I just wanted to add that 5mg pred is pretty useless - it’s bascially a physiological dose (ie matching our body’s cortisol production levels) but wouldn’t have any benefit on this. Most use 20-25mg to help with implantation and avoiding pregnancy loss. Wishing you luck 🍀
To be fair it could be an early or late window so the ERA is really helpful. I had a bfn with an off timed window, which was conoletely me having followed the directions wrong and the month after was succesful with the same conditions apart from the timing of the transfer. Maybe worth investigating xox
Hey thanks for your message. Yes I'm beginning to think an era may be the answer. I think we are going to try and modified natural next time which gives you a wider implantation window but if this doesn't work an era is the next step! Thanks again and so glad it worked for you xx
Hi. I would first ask why you need steroids and aspirin if nk blood tests came back normal. Steroids could be lowering your nk cells in endometrium as well. A natural modified transfer is good only if the clinic provide extra progesterone. If you’re on clexane, you don’t need aspirin as well.
Emma, era, Alice are good. I found out I had slightly low nk cells in endometrium which affects implantation. I had to have neupogen infusion on confirmed day of ovulation. I also had hcg infusion on transfer day. My progesterone was checked on transfer day and it was over 100. Too many antibiotics messed with my gut health and vaginal microbiome. My consultant told me to avoid taking antibiotics for transfer.
Hi, so i have an overactive nervous system (diagnosed way before fertility problems) so even without the NK cells it seemed like the logical step but I definitely think this is something we need to look into more. Noted on the progesterone for the modified natural, thanks.I've ordered the fertilysis tests so hopefully this should tell me more. Unfortunately for both my transfers I've had infections that have needed antibiotics and I do wonder if this has affected success as my body has been busy fighting these and as you say the antibiotics are destroying your microbiome even with the addition of the probiotics. So hoping I can stay well for the next one and no antibiotics needed! Xx
Hi thanks for this. I know i definitely have high levels of inflammation. What did you do to treat the inflammation?Had a look at that test and looks really interesting but seems they only do it in a Ireland! Xx
Hello, I got pregnant without medication just progesterone, tracking just my ovulation. I did endometrial scratch month before the third transfer and like you I had healthy embryo .Maybe some of the information will help you. Well done for baby aspirin and Clexane I would keep going with them definitely one more time.
Hi thanks so much for replying and I've just read your story and I'm so sorry for your loss, I can't imagine the pain that must have caused Yes I think we will try with a natural modified and see if my body can do this on its own as it has done it before. Xx
Here are the stats: the chance of the first PGT-a tested embryo not taking is 30%, the chance of the second not taking if the first does is 12%. So you are now in the 12% of people that 2 in a row don’t take (as I was).
At this point you could just be really unlucky and it would likely work the third time if so. (Only 5% 3rd PGT-a transfers fail to implant after the first two haven’t) But I think a lot of factors can help decide your decision going forward:
How many PGT-A tested embryos do you have left? If you have over 2-3 more then you could do another transfer and see (like your husband is saying).
It also depends on whether you want the chance at a sibling or not down the line? We wanted enough embryos that we would be able to try for a sibling down the line (that is if we were lucky enough to even have one) and that meant making the embryos then as I was already almost 37 at that point.
So if you have only 1-2 embryos left and you want a chance at a sibling down the line and you’re over 35 say, then you may want to do another egg collection first. We did this as we only had mosaic embryos left from the first round. That said for us our second egg collection was not as successful and didn’t yield any euploid embryos.
Then you have to think that you guys are now on the wrong side of the statistics- the 12% that the second PGT transfer didn’t work for. Which means the studies that say ‘for most people…’ don’t necessarily apply to you. So for example if ERA has been shown to not make a difference in 85% of cases (I don’t know the statistics on this I’m using as an example) then you’ve a higher chance now of being in that 15% that it could work for.
What we did was this:
We did the era/emma/alice - they were all fine and I actually feel they were a waste of time and money but I know some people have sworn by them but at least we didn’t have that as a ‘what if’.
I had an hysteroscopy- I would say if you’ve not had one of these it’s probably a good idea. This can tell a lot of things, they found that my uterus was a bit narrow due to extra fibrous tissue and they could widen it during the procedure. They weren’t sure this was why it wasn’t working but it could have been a factor.
We had some immune testing done, the one that flagged up for me was KIR/HLA-C2 compatibility testing. My clinic felt this was the immune testing with the most evidence behind it (they didn’t agree with NK cell testing etc). I was found to have an incompatible KIR to my husband’s HLA-C and so was seen by a reproductive immunologist and prescribed a specific drug to help that from transfer up till 9 weeks. (I was also then given steroids, clexane, aspirin but it sounds like you’re already on that)
Lastly, having done two medicated FETs I wanted to do a more natural FET the next time, I couldn’t do fully natural due to v irregular cycles, so I did a stimulated FET, prepared for it as if for an egg collection (though milder drugs so as only to create one leading follicle) and then had a trigger injection and progesterone. I found my body did better working alongside my natural cycle.
All this to say our third transfer worked, and it was a mosaic embryo as we had no PGT-A ones left. I will never know exactly what caused it to work that time and not the others- could have been a mix of a few things etc.
Anyway I really hope this helps give some hope as I know how awful it feels to have those two unsuccessful PGT transfers.
Sending lots of luck! Happy to help with anything!
Thank you so much for responding and putting this into writing, that is so helpful. I was trying to explain these stats to my husband so it's helpful to have them written down.
So we have another 3 good quality ones left and we already have my son this is all for a sibling for him and have already decided no more egg collections.
It's so lovely to know I'm not alone, even if I fall into the wrong side of the statistics and even more amazing to know it worked for you on the third attempt, I'm sp happy for you.
So we've decided to go with the natural modified for the next one so this should mean that the implantation window is wider and hopefully era is not as relevant but if the next one doesn't work then era is next step.
I've ordered fertilysis which is similar to emma and alice just to rule this out.
Hysteroscopy is definitely something we've discussed. I know I have a retroverted uterus but not that much else about it.
Thanks for your information about your immune testing. Could I ask what was the drug you were prescribed and also what was your dose of steroids?
Thank you so much for giving me so help, it has really helped and so happy for you that the third worked! Amazing news xx
Thank you- yes sometimes I find it really helpful to look at statistics etc. and yes there are always people on the wrong side of statistics- we just don’t think about it like that. That’s why I wrote it like that as so often it’s written as ‘it works first time for 70% of people’, but that minimises the 30% it doesn’t work for. I found those stats the most helpful thing my doctor explained to us so I committed them to memory!
ok great - well that sounds like you’re in a really good position with your embryos. And the fact that you’ve had a child previously is also a really good sign. Was he from ivf?
One thing a hysteroscopy can rule out or address is any scar tissue from first birth especially if you had a c section as that can sometimes affect implantations and is often a cause of secondary infertility.
Fertylisis testing is meant to be good so hopefully again that can rule stuff out.
The drug I was prescribed for the KIR/HLA incompatibility was Neupogen. Though if you have a previous child it’s unlikely, but not impossible, that you have that.
I was prescribed 15mg prednisolone which increased to 20mg when I had some bleeding. I think I was also on dexamethasone from 1st day of period until transfer then it was switched to prednisolone.
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