Another chemical pregnancy after IVF - advice please

[Cariad82]

I have just had my third cycle of IVF. First cycle I didn't get any eggs, second I had 2eggs and a good blast transferred at day 5 but it ended in a chemical and the other embryo wasn't good enough to freeze, and third I had 1 egg and so a day 2 transfer and it has just ended in another chemical.

The same thing happened each time - I got a good clear BFP about 4 days before OTD but started lightly spotting (brown and pink, not red). The spotting gets slightly worse each day and the line on the test fades each day until it's gone by OTD. I know it's not a case of any HCG being left from the trigger because I tested out the trigger each time.

I just wanted some advice about what to do next. I'm well aware IVF is a numbers game, but unfortunately we have only retrieved 3 eggs over 3 cycles so we don't have numbers to play with. I want to make sure we have looked in to all reasons for the chemicals in case there is something that can be done.

My lining always looks good. I take progesterone pessaries as well as injections (I take so much because I spot for a week before every period and so the consultant suspects my natural levels are low anyway) and I take baby aspirin. I have acupuncture and do all the old wives tales things like socks to bed, Brazil nuts etc.

I don't really know where to start with research now. Should I be thinking about things like genetic testing, sperm dna fragmentation testing, immunology testing? Other things? I'm at a bit of a loss and any advice would be appreciated. I want to go in to my review appointment with as much information as possible. Last time my consultant didn't suggest any changes to the protocol - it was me who pushed for baby aspirin and even higher doses of progesterone. His attitude was they probably won't make any difference but if I want to try them they won't do any harm. I feel like if I don't go in to the appointment fully informed they'll just tell me to keep doing the same thing and that doesn't make sense to me.

Thanks xx

[Teddybear45]

Level 1 and Level 2 testing.

[jemimafuddleduck]

@Cariad82 I'm so sorry to hear this. I have some experience so can really sympathise.

I take it you have had your FSH and AMH tested - how are they looking? It sounds like you could possibly have low ovarian reserve??

That's what I have, and we moved straight to donor eggs. Is this something you'd consider?

[Cariad82]

I've had all of the standard tests. My hormone levels are fine for my age (36). Our infertility is unexplained. They have no idea why I respond so poorly to the drugs. My consultant said he was as shocked as I was the first time it happened. I thought the poor response and low egg collection numbers was our biggest hurdle but it looks like holding on to an embryo might actually be the main problem. I don't know if it's better or worse that they keep telling me all tests are fine and I have no obvious problem - that makes me want to persevere with my own eggs. Maybe if they just said it was never going to work I could start accepting it and think about donor eggs, but I don't feel like I'm ready for that yet. And also if the reason I can't hold on to an embryo isn't related to egg quality I wouldn't be able to hold on to a donor egg embryo either. I feel like I would need to fully explore possible reasons for not being able to keep hold of them before we wasted donor eggs on me x

[Cariad82]

@Teddybear45 - do you mean the Chicago tests? Have you had these yourself or do you know anyone that has? I get the impression they cost around £6k, is that right?

[INeedNewShoes]

I would ask for your clotting factors to be tested. Blood tests for Antiphospholipid syndrome. I have this (discovered after 3 cycles of fertility treatment led to 3 BFPs in a row which ended in early losses so I understand your situation). I asked my GP to do blood tests to check clotting things and it showed up this.

For my next cycle I took 7mg aspirin from the day I got a faint line (so test early with a good quality test) and then once I got my BFP I phoned my local early pregnancy unit and persuaded them to see me at the clinic with a view to starting heparin which they did. This all led to a successful pregnancy.

[Cariad82]

Thanks @INeedNewShoes - I will do this. I was on asprin this last cycle and it didn't help but I will ask for the tests. Especially if I can have them done on the NHS. I just feel like the only thing that is stopping me having a melt down at this point is doing something proactive. I need all the information I can get.

[Teddybear45]

Not just chicago tests, most clinics combine them with others. But yes I have had them (without karyotyping). They cost 2k but actually as I got my bfp straight after the protocol change, it would have worked out cheaper if I did this at the start (instead of failing cycles with great embryos). I had 3 failed transfers but the consultant wanted me to wait until 3 failed cycles to test which would have meant spending even more money. But problems were found in my tests; I suppose I might have felt differently if they were all clear!

[Cariad82]

I did mention immune testing to my clinic on my last review and the consultant was a bit dismissive I thought. I am going to research it more this time and push more. £2k seems a small price to pay to me to get some answers. I feel strongly that we're missing something - some problem that even if it couldn't be fixed I would at least know if it wasn't worth carrying on.

[Teddybear45]

I agree it’s so much cheaper than a failed cycle. And if you aren’t producing many useable embryos it feels like such a waste when a good one fails if there’s something you can do about it

[ChocolateGateaux84]

Cariad82 im so sorry for your hard journey so far.
Ive been there too. 3 IUI, 3 IVF, one was a chemical the rest BFNs
Nothing more soul destroying.

Im not sure my experience will help u but ill put it out there so u can make your own mind up.
After 2nd failed IVF i did the immune rounds. Firstly seeing professor Brosens at the Coventry implantation clinic.
Nothing showed up there.
Off i went to dr Gorgy one of the most renown/expensive/contraversial private immune specialists in London.
A few things came up. Slightly high NK cells, and raised tnfa (which basically means inflammation).
Onto 3rd IVF with the recommended steroids, humira, clexane and intralipids.
Once again i got a bfn

Eventually, all out of answers, i decided to try donor eggs. Im 34 so not exactly old but i felt it was time to make serious changes.

I also changed clinics to Reprofit in Czech Republic. I chucked in the steroids, aspirin, clexane, and intralipids just for the hell of it.
Finally i got my BFP

I really don't kno what made the difference here, sadly i can only suspect my eggs were scrambled (not sure why). Or maybe it was the immune meds that made the difference. Who knows

Id certainly try an immune specialist 1st and c how u get on.
Dr Gorgy or the Epsom miscarriage clinic are probably your best bets.
Best of luck 2 u xx

[Cariad82]

Thank you @ChocolateGateaux84. Sorry to hear about what you went through. I'm glad you got your happy ending. This information is really helpful and I am going to make an action plan and refuse to be fobbed off by doctors. I really want to give this everything we've got so I don't regret not doing my best x

[Helix1244]

Hows thyroid?
As that can cause miscarriage and cycle issues.

[Cariad82]

Thyroid is fine. Slightly under active but within normal range apparently.

[Loopytiles]

Sorry you’re going through this.

The most likely explanation seems that stats for a baby after a round of IVF treatment are low (23% for your age on the NHS site), so IMO given the stats it wasn’t really on of your doctor to express surprise.

The “standard” recurrent miscarriage tests could cost £2k. You’d need to pay privately. The most pricey one would probably be the genetic karyotyping for you and your partner. If you’re near London would recommend St Mary’s.

A lot of mc / fertility specialists disagree with the immunology ideas: not proven. another dr doing research on that a while back was Prof Siobhan Quenby.

[Loopytiles]

US doctors intervene on underactive thyroid much more, the “normal” range there is much narrower, might be worth seeking a private opinion on that.

[Helix1244]

Ideal is around tsh 1 for getting pg.
I git treated by ivf clinic for being about 3.

[Jenbot78]

Cariad 82, I would recommend Dr Ndukwe at Zita West. He will do a consultation over Skype and is an immune specialist. It costs £250 I think for a consultation. I am pregnant with my second child after following his protocol. He really knows his stuff and IMO acts with integrity.

When I read about ‘slightly under active thyroid’ alarm bells rang for me. What was the actual result? Often docs will dismiss thyroid test results as within normal range when in fact they are not within the optimum range for pregnancy. Also if it is slightly under active you could still have autoimmune thyroid disease. You need to get your antithyroid antibodies tested as these are a good marker as to whether there is anything dodgy going on with your immune system. I had this test done after IVF1 resulted in a chemical pregnancy. Mine were through the roof and my next cycle (got pregnant with DD1) was treated with steroids.

Good luck with it all. I was always told that a chemical pregnancy is a good sign, which was not much comfort at the time, but I think it’s true!