Recurrent implantation failure - tests?

[RedPandaFluff]

Right, three IVF cycles with six perfect embryos transferred, only one chemical pregnancy to show for it. Previous early MMC and chemical.

I need to figure this out, so I've booked me/us in for:

Hysteroscopy
Endometrial scratch
Immunology
Karyotype x 2
MTHFR
Sperm DNA fragmentation

We've also had the C4/M2 variant test (which came back normal). Bloods, thyroid etc. all fine.

Am I missing anything? Are there any other tests we should do before we try again?

Following. I've had 2 failed cycles, we think due to thin lining, have you looked into a lining issue?

The lining was fine thickness-wise each time, but hopefully the hysteroscopy will tell me if there is anything else wrong with it.

Have you had any tests yet, @ViolaD77? What thickness were you at? Is it a case of increasing your oestrogen next time?

I'm not sure, having my follow up tomorrow to find out but yes I've had estrogen in the lead up to my ET but for only 5 days and it still failed. I'm going to ask for a hysteroscopy before I start my FET in May. To be honest I feel with my clinic I'm pointing out the obvious, may be time to find somewhere new!

Didn't they do at least one ultrasound prior to embryo transfer to check the thickness and increase your dose of oestrogen if necessary? And then if it still wasn't thick enough, they should have postponed the transfer!

Are you private or NHS? The tests cost a fortune privately 😫

Hi RedPandaFluff, we’re in the same boat - six transfers with a total of seven top quality and two average quality embryos transferred and just a MMC and an ectopic to show for it.

We’ve had a hysteroscopy and endometrial scratch and have done the immunology and thyroid tests (and had a lot of associated treatment!) Just waiting now for karyotyping and sperm DNA fragmentation test results.

I haven’t heard of the MTHFR or C4/M2 tests - what do they test for?

It’s so frustrating trying to find a reason for recurrent implantation failure - I hope your test results are helpful.

Hi @lulahbelle - wow, that's a long haul. It's grim, isn't it?

From memory (I'd need to google it to check my facts!) MTHFR is a gene that can have a mutation which can potentially affect implantation, autoimmunity, how we metabolise folates etc. The C4/M2 variant test looks for a gene anomaly that has something to do with blood clotting I think - if you have it, or your partner, it can increase the chance of miscarriage. That test is only available through Care Fertility and it cost us about £500.

What treatments have you had?

Thanks very much @RedPandaFluff. My clinic prescribes baby aspirin and clexane as a matter of course so it sounds like there’s not much point in me getting the C4/M2 test done as presumably the treatment if you have the gene anomaly is a blood thinner. I’ll look into the MTHFR test though.

Treatment-wise, the Chicago tests showed I had high cytokines which have been treated with steroids, humira, intralipids and IVIG (not all at the same time!) My thyroid function has been all over the place so I’ve been on medication for both thyroid underactivity and overactivity.

When do you expect to get all your test results? The only other test I had that’s not on your list is ureaplasma and mycoplasma - they’re asymptomatic urine infections which some doctors think may affect implantation.

In hindsight I wish I'd not bothered with the C4/M2 rest and just asked them to prescribe clexane empirically 😏

I'm having all the tests next week - my husband is freaking out because I keep saying 'hysterectomy' instead of 'hysteroscopy' by accident 😆

Are you gearing up for another cycle now?

Hi all, I'm in a similar boat, 2 failed ICSI cycles both ending in CP, last one was in October and then in Nov I managed a natural BFP but that ended in CP too after a week. DH's last SA showed a marked improvement of sperm, into the "normal" parameters, just.
Initial excitement led us to think perhaps we could just try naturally but now 3 months on, becoming really depressed about it all.

Had a HSG last month which showed a normal uterus.
I've been referred to the recurrent miscarriage unit for the plethora of other tests required but regardless of the outcome, my consultant said there are still only a few options : icsi cycle with clexane and aspirin.

the thrombophilia tests (blood clotting) do indeed get treated only with clexane. it can still prevent implantation & cause early mc tho even if you are on clexane. I had lots of ivf implantation failure. Then clexane was the only thing we changed and 3 cycles with that I got pg 3 times. But had miscarriages. Embryos were fine as 2 kids successfully through surrogacy.

Hysteroscopy is a waste of money unless your checking for tube blockages

Sometimes I do wonder what the point is of all the science and tests when despite all the tweaking the specialists still can't tell you why the embryo won't implant.

@raindropsinspring what makes you say that? I want to know if I have any fibroids, polyps, adhesions from past D&Cs. All those things can prevent implantation. A hysteroscopy will pick these up.

@RedPandaFluff I've always had those things checked with standard ultrasounds which is much cheaper - has your Ivf clinic recommended the hysteroscopy in particular? As the amount of times they scan you during pre treatment scans would surely have picked those things up already?

I would maybe push for clexane and prednisolone steroids in your next cycle? X

You could also ask about ERA testing? Used a lot in USA but not so much here - I asked my clinic about it and they said they would only offer it if I had multiple implantation failures

Yes, I'm definitely going to ask for both of those, @raindrops.

The clinic didn't push for me to have a hysteroscopy there but they said they would recommend it (and I'm actually going somewhere else as it's substantially cheaper). They're going to do a biopsy of the lining . . . but I'm not sure why. Maybe I need to do a bit more research . . .

I'm think I'm going to have the ERA but it has to be done during a mock cycle, apparently, and it's really expensive so I'm going to see what comes out of these investigations first.

I guess the other thing would be to see if you have hydrosalpinx in either of your tubes but they really should have picked that up by now

And then there is sperm fragmentation testing in case it's male factor?

There is an Implantation Clinic in London but god knows how much they charge 😬

Yeah, the hydrosalpinx thingy, that's been on my mind. Wondering if that's on the list too.

DH is having the sperm fragmentation test next week. We're having the whole shebang done so I've taken a week of annual leave. Worst holiday ever 😄

The HSG is the same as the hysteroscopy as in it checks if the tubes are blocked and the general shape of the uterus by inserting the dye and screening its flow using an x Ray.

I had mine done and all they could tell me was that shape of uterus looked fine and the Fallopian tubes were not blocked.

@RedPandaFluff
I'd be very concerned after 3 cycles if your clinic had not identified hydrosalpinx- I've had it and it's VERY visible on normal ultrasound scans - have you done all your cycles with the same clinic? If so maybe it's time to change?

@redpandafluff sort of.. They looked at it on the ultrasound while they were doing the transfer but didn't comment on the lining...my clinic like to do the ET with a full bladder however I hadn't peed for two hours and drank and drank but mine was empty when they did the transfer... I just can't believe that was the reason it didn't implant I'm going to find out tomorrow what they think is best for next time... It may be time to go elsewhere

I don't think the clinic would have been interested in my tubes as I have to use donor eggs (premature ovarian failure). Maybe they never checked them . . . I've had many ultrasounds but no-one has ever mentioned anything wrong other than my uterus is a bit arcuate-shaped.

Ugh. I don't want to waste money 😣

@ViolaD77 I've always had at least one ultrasound prior to embryo transfer; I think at least one is the norm. I would definitely query this with the clinic.

@redpandafluff - I needed a cervical dilation due to issues with cervix and first failed transfer. At the sent time my consultant referred me for a hysteroscopy. I had both done together and I think the biopsy is standard for hysteroscopies. I was told it’s a good thing to have done as it refreshes the lining of the womb. Had an fet the following month and it was successful. I am currently 22 weeks pregnant. I’ll never know for sure whether the hysteroscopy made a difference (they found no abnormalities) but part of me thinks it did help.

My private consultant was able to make a referral for me to have done on the NHS. I’m not sure if this would possible for you. It was a good few months wait but when I priced going private it was over £3000.