Loosing Hope - 38, 7 failed transfers

[PinkPonyClub]

Hi Everyone,

I'm new here and hoping for a bit of advice/support/knowledge from those who have been through similar.

I'm 38, my husband and I have been TTC for the last 6 years, we have had 4 egg retrievals in that time, and have had 6 transfers, and currently have 5 embryos in the freezer - in Norway, we are UK based but went to Norway for cheaper treatment. We tend to always get around 10-12 eggs, usually around 8 mature, 6 fertilise and usually 3 good enough for transfer/freezer. We've had a mix of fresh and frozen 5 day blastocysts transferred.

The most recent cycle ended in a chemical pregnancy - our first ever positive test, which was devastating. Unfortunately genetic testing isn't available in Norway and we're starting to loose hope and I just can't face another 5 failed transfers with no explanation.

Can anyone suggest any testing we can do in the UK and any clinic/doctor recommendations, we're in Buckinghamshire so anywhere in a surrounding county or London is easy enough to get to, we're looking at DNA Fragmentation tests, I've had all the standard tests and currently we're listed in the ever helpful 'unexplained infertility' group. We've also removed plastic and as many toxins as possible from our home and lives, we don't drink, we don't smoke and both supplement and lead healthy lifestyles.

Not sure how relevant it is but I have a thin lining, and can get it, with help, to around 6.5-7cm before transfer.

Any help/advice welcome, I'd do anything at this point to get some answers.

Thank you!

[Millbanks]

Hello lovely,

I'm sorry you've had such a journey so far - actually not too dissimilar to mine. (have a look at my bio).

We had success on our 6th transfer after doing immune testing and introducing a steroid protocol. It's believed that my natural killer cells were attacking the embryos in my womb and stopping them implanting - as soon as that was suppressed it worked.

We also did PGT-A testing BUT out of 9, 6 came back normal so I don't think that was the issue before....

I did the ERA test which showed I needed a full extra day of progesterone before transfer, but that alone wasn't enough to make them stick. I really think the immune suppression was key.

Have you had any testing done at all? What have your doctors suggested?

xx

[PinkPonyClub in reply to Millbanks]

Hi Millbanks,

Thank you so much for replying!

My clinic have not suggested any testing, they have basically said it's a numbers game and we just need to keep going as we seem to get a good number or good looking blastocysts. Their theory is that testing is so expensive we'd be better spending our money getting more eggs, especially as I'm already 38! I have had so many scans of my uterus, no sign of polyps, fibroids, endometriosis or PCOS, my tubes are clear and although my partners sperm isn't perfect it's considered normal.

I have previously had steroids, prednisolone, for a couple of transfers, I'm also always on blood thinners and have also had additional estrogen tablets and patches and progesterone. I've also had antibiotics before transfers previously.

The most recent chemical pregnancy I did a mini-stim with Menopur for my lining, blood thinner injections and aspirin and then progesterone just after ovulation.

What was the name of the immune testing you did?

Thank you xx

[Millbanks in reply to PinkPonyClub]

Oh wow you really have been through it....

So I had the Chicago bloods done and my NK cells came back quite high - and as a result I was on 20mg prednisolone and had intralipids before transfer.

Which antibiotics did you use? Might also be worth adding some vaginal probiotics.

Have they ever tried adjusting the transfer time? I know a few people who haven't bothered with the ERA test but just tried a few hours later and had success.

xx

[PinkPonyClub in reply to Millbanks]

I'll look into Chicago bloods, not heard of that one! They had me on 10mg of prednisolone, maybe that should have been more?

Antibiotics were doxycycline.

We are talking to a nutritional therapist to see if we're missing something in our diets, she also suggested vaginal probiotics.

When you say adjusting transfer time do you mean allowing the embryo to grow to 6 days rather then 5 before freeze/transfer? Or after it's thawed? The one that was successful, till it wasn't, was the only one that expanded after thaw, the clinic were really positive about it - which makes me think it's an implantation issue, or my body just rejecting it - possibly NK cells?

a minefield! xx

[Millbanks in reply to PinkPonyClub]

Ah so maybe you could do with a higher dose.... 10mg is fairly pedestrian I've been on 20 and 30mgs before.

Doxy is pretty strong so that should have cleared anything out.

I would defo take some vaginal probiotics - especially after something like Doxy that will strip everything out.

So I mean once you've started progesterone - the generic window of implantation is 5 days after the start of progesterone - but mine is 6.5 days (137 hours to be specific) - we did 4 transfers with the "wrong" timing so even if everything else had been perfect it is likely it would never have worked.

Yep it's a god damn minefield for sure. I found it helpful to write a list of everything and do a bit of a flow chart to make it all make sense.... xxx

[PinkPonyClub in reply to Millbanks]

Tempted to just up the does myself next time, I've got loads of the stuff left over!

Ahh ok, that's interesting on the progesterone, maybe we do the ERA test anyway, I'm all for arming myself with as much information and results as possible, begged the GP for another full blood count just so I have some recent data to work with!

Thanks so much for your help and suggestions, loads to think about and consider! xx

[Millbanks in reply to PinkPonyClub]

To be fair, I upped the dose myself to 30mg - the clinic didn't advise it and I was absolutely ravenous the whole time, but we did get a positive test (unfortunately it was an mmc at 8 weeks)

I think it's defo best to have all the info possible and work through it...

You're very welcome - if you have any more questions or want to chat my inbox is always open xx

[Endofitall]

So sorry. Sounds like we have similar situations. I know what you mean about not being able to face more failed transfers. Is it possible to move your embryos to where you can PGTA test them? Have you tried viagra for the thin lining?

Have you done microbiome testing? And how about hysteroscopy? I had these done to check no underlying reason for the thinner lining (though always been trilaminar)

Fertility solutions in beaconsfield is somewhere you can book for sperm dna frag without dr referral. Isn’t too far from you. Claire Mooney does a reduced fee consultation with results and can help give second opinion things to consider. We found her consult one of best we’ve had.

It’s so demoralising but I hope one of those 5 is the one for you!! xx

[Brightflowers in reply to Endofitall]

What did Claire cover in the consultation? The price looks really good

[Endofitall in reply to Brightflowers]

I’ve DMd you xx

[PinkPonyClub in reply to Endofitall]

Hello,

I've not heard of viagra for thin lining, always just been given estrogen and progesterone - what dosage did you take and at what point in your cycle?

We discussed moving embryo's from Norway to the UK, but the issue could be in thawing, apparently not everyone uses the same machines and processes, so we could end up damaging/killing them if they are not thawed in the same way our clinic do, which just isn't a risk I want to take, we're looking at doing a full round here in the UK anyway now for additional tests etc that are offered here.

I'm planning on taking some probiotics now, and looking into the hysteroscopy/EFT test, but wasn't 100% sold on it - Millbank's suggestion above of just taking progesterone earlier could be an option?

Beconsfield is close, and Fertility Solutions have been mentioned several times both here and in other places, so going to give them a call!

Thanks for your reply! xx

[Endofitall in reply to PinkPonyClub]

I was prescribed 25mg vaginally four times a day (what a faff but worth it) from day 5 until day progesterone started I think. Some clinics get pessaries made up for you, others say just to insert the normal tablets vaginally. They both should be effective. I’ll be trying this again with a modified natural/low dose stims when getting to transfer time. I do better with natural/stim lining than medicated with oestrogen. My lining weirdly deteriorated with higher doses/patches/tablets of oestrogen.

I completely get that. We’re banking to PGTA now, and I am so worried to take the risk to thaw and refreeze a remaining blastocyst we have from previous cycle.

Hysteroscopy can be valuable. Things can get missed even on the best scans. I’m even thinking of having another one before we transfer any precious euploid embryos (if we make any). EFT at Coventry research clinic probably limited value for you though obviously helps their research and for me just helped confirm I definitely needed pred as I didn’t like taking things without knowing for sure (especially as I’ve ended up on it for long time cumulatively and with the associated risks to my own health it’s good to know I really do need it . 20-25mg dose at least is needed.

If you’re doing modified natural with stims, I wouldn’t worry too much about ERA or when you start progesterone - just a standard should be fine. The window of implantation is much wider and you have some if your own progesterone naturally in there too. I wouldn’t risk changing timing without knowing how you’d benefit (or not). ERA is a lot more applicable in medicated FETs. Even then the evidence for ERA is looking less robust though clearly there are people who have benefitted.

Fertilysis do microbiome testing that’s cheaper than EMMA/ALICE though I did do EMMA/ALICE too when having lining issues that kept meaning my FETs cancelled in 2022. Before a transfer I will do a DAYE postal test that was recommended by my clinic as a quick check that nothing major changed - it’s only £85ish.

Best of luck xx

[Endofitall in reply to PinkPonyClub]

Oh and I have had some immune testing by GP - basics like Antiphospholipid antibodies, ANA, but then had full Fertilysis panel done while in Athens (you can order kit from UK though I believe) - and then seen reproductive immunologist in UK with results.

[Moosecake]

We had a DNA fragment test done at Acorn Andrology in Endfield. Was £389 I think for fragment test and a semen analysis. Got results same day and was a thorough report

[Endofitall in reply to Moosecake]

Just to add to this that if the dna fragmentation test was reported same day (and cheaper) it is likely to be a Halo test or similar rather than Comet test. The former is done in house usually by the embryologist/andrologist and the latter is sent away to a reference lab. There’s pros and cons to both but Halo test generally only has evidence for reflecting fertilisation potential of sperm. Whereas Comet/Examen has more evidence for other aspects of blastocyst progression, miscarriages etc.

We’ve had both done and the test results were very dissimilar weirdly despite being done almost same time. But it was explained they show different things.

[PinkPonyClub in reply to Endofitall]

thank you - this is helpful info and explains the cost difference a bit more! xx

[Purplecarrot]

Have you had a hysteroscopy? I was in the unexplained camp. Had 2 failed rounds, went for a laparoscopy where it was discovered that not only did I have quite a bit of endometriosis, I also had a unicornuate uterus and a missing fallopian tube on the side where my better performing ovary is. We did have one more failed round after the surgery to remove the endo, (due to an egg collection issue - failed sedation) but after that we switched to Prague had by far our most successful round (currently 35 weeks, with 3 frozen). Best of luck to you, I hope you find answers.

[PinkPonyClub]

Hello,

thanks for your reply, I'm a bit overwhelmed by all these additional tests and things that can be done! I haven't had a hysteroscopy, heading down the EMMA/ALICE route at the moment after speaking to others here, is it worth doing both, struggling to get my head around it all!

What is the name of the clinic in Prague - we've thought about going there over Norway, feel free to DM if you'd prefer?

I'm convinced I have some sort of endo or something wrong in there - although all ultrasounds have come back clear, apart from identifying a heart shaped uterus, which apparently won't make a difference I just don't see how an ultrasound can pick up on everything.

Thank you! xx

[Tinkertinkerbell]

Hi, I had 4 failed transfers then did the EMA, Alice and ERA. That was the thing that helped me and the adjustments from the results meant my 5th transfer worked. I now have a daughter who is 3 months old. Good luck x

[PinkPonyClub in reply to Tinkertinkerbell]

That's great news - did you find a clinic that did all three tests at once? xx

[Tinkertinkerbell in reply to PinkPonyClub]

Care Fertility x

[Spicycurry]

I did IMSI in the end as did not have success with icsi. The numbers you have are good but I went to CRGH.