IVF - 2 failed rounds

[skot]

Hi. apologies in advance for such a long post :(

just underwent my 2nd round of IVF. Got a BFP last week but with a really low HCG. And lots of cramping. Initially, HCG was doubling slowly but this Wednesday it dropped by almost half. The EPU said it's a failing pregnancy, hoping for a natural miscarriage. Have to go for a repeat blood test next Wednesday

While I am waiting for AF / MC, also thinking about next steps. As am not ready to give up yet.

We were with ABC; I can't flaw them at all. However, I am wondering should we go with them again or find another clinic or try abroad.

Most importantly, what are the questions that we should be asking this time?

They transferred an 8 cell grade 1 embryo on day 3. According to them it was top quality. We were hoping for a better result this time.
I have thyroid problem as well, but just before treatment started it was under control.

Is there anything more that can be done after embryo transfer?

Should we be getting any tests done before next round?

There must be something that we are missing i.e. something wrong somewhere due to which i am not able to conceive. But I am not sure how to find the right answer or what questions should i be asking now.

I am sorry this has happened. Similar happened to me and I was recommended the following blood tests: lupus anticoagulant, mini thrombophilia screen, full blood count and thyroid (although you have already had thyroid).

Despite being top grade, it may just be that the embryo wasn't viable. Whilst grading can give a guide which ones are more likely to implant, it is only very superficial and can't tell whether it was actually genetically viable xx

@skot sorry forgot to tag you

@Weswoo - thank you for your message. Also, very sorry you had to go through this too. Did your GP or IVF clinic recommended these tests?

@skot it was my IVF clinic so I had them done there

Thank you @Weswoo - may I ask which clinic was it?

@skot I'm at Create. My tests mostly came back ok apart from thyroid and also that I should take aspirin if I get a BFP next time

@Weswoo - thank you so much for your replies. I wish you all the best for future .. lots of love

I am in a very similar position to you. But my transfers were both day 5 and poor quality. Both my rounds have also left me with nothing to freeze. In my case it looks likely to be an egg quality issue and possibly an issue with progesterone absorption. I've done everything I can to work on both. Remember NICE actually recommend nhs funding for 3 rounds for a good reason, even in a couple with zero fertility issues it quite often takes 3-6 months to make an embryo that sticks. My advice would be to research specifics to your situation so you are armed with knowledge and hopefully we will get 1 to stick next time. We've decided to try to more rounds and then reevaluate. X

@SpyroC - Thank you for your message. Actually from NHS we had funding for 1 fresh cycle and 2 frozen cycles. our 1st fresh cycle with NHS failed with nothing to freeze. So we had no funding left and our 2nd cycle was self paid

Ho do you conclude egg quality issue or progesterone absorption issue? I don't know how to conclude what is going wrong with our cycles.
The one with NHS resulted in 2 poor quality embryos and BFN
The private one was 1 top quality embryo , BFP but then early miscarriage. So not sure what's the common factor here. Perhaps egg quality too.

We've also had two failed rounds - my second was a BFP but I had a miscarriage at 6 weeks a few weeks ago.

There was definitely a progesterone issue for us, my body didn't absorb Cyclogest and we were given the IM injections way too late. My lining also didnt thicken very well under the medication (no issues with that naturally). However, they have also now recommended a hysteroscopy to check for any uterus issues - my consultant said he thinks 2 failed cycles is the right time for that.

We are also now moving to ARGC who will be doing full blood and hormone profile and have recommended a natural cycle instead.

Good luck 😊

my body didn't absorb Cyclogest and we were given the IM injections way too late

So many ladies on these boards have this issue (me included) - WHY are IMs not prescribed as standard or at least offered as standard?! I know they aren't the most pleasant of things but it's better than another round of IVF!

@pineappleC - so sorry to hear about your news :( I totally know how that feels

@PineappleC @Weswoo - What is IMs? Sorry I have no idea.

Did you do any tests or scans where it was concluded that the body is not absorbing progesterone?

@PineappleC - may I ask which clinic you were with? Have you already had a consultation with ARGC?

@skot thank you 😊 In the first round o started bleeding after 8 days so I pushed for a progesterone test on the second round. The result was 7 (needs to be at least 30) and due to a cockup the IM injections took until 5 days post-transfer to get. Was actually gobsmacked I got a BFP after that. Fairly sure that played a part in the miscarriage, but of course will never know for sure.

IM = intramuscular progesterone injections. Painful but did the trick for me - progesterone level shot up to 119.

I've had the initial consultation with ARGC and will move my embryos there shortly, but they want me to wait another month post-miscarriage before we start.

@Weswoo my thoughts exactly! Our first 2 were NHS (hence why we're now moving clinics as no more funding) and they kept stressing that they were doing me a favour by allowing me to do a progesterone test. There was all this stuff about me having to pay for it and pay for the injections like it was a big deal. I didn't care about the money - the test was £30 and the IMs were about £50 per week- a small price if it could've saved my baby! Meanwhile, the NHS are happy to do a hysteroscopy which would've cost £1,400 privately 🤷‍♀️

@PineappleC I know it's ridiculous and surely would save them money on further rounds of IVF!

@PineappleC - Thank you. that's very helpful.
All the best to you for your treatment :) :)

@skot thank you and you too 😊🤞

@Weswoo there seems to be very little logic involved in all of this!! Good luck to you too 😊🤞

@skot it's impossible to say for sure. Almost all eggs fertilise normally but the quality isn't great and they are slow but 2-3 have always made it to say 5. ( I only get 6-7 eggs and I was 31 😔)I have endo and my typical endo symptoms have kicked in at the "right time" on both cycles and the cycle I had my bfp I actually had a full period (this is why I suspected an ectopic straight away). The hospital tested my progesterone when monitoring for the ectopic and at that point I was still on cyclogest and lubion (the lubion was added for cycle 2). My consultant was not happy with the progesterone levels and so I will be on more lubion this time around and have a prescription for some pills I can add in if I start to bleed. As I say I'll never know for sure but I think the lubion may have helped with my bfp last time. I think my embryos may be too slow for my lining so perhaps the two problems are linked.

@PineappleC and @Weswoo tell me about it. Cyclogest absorption is clearly an issue for some women but they just don't seem that interested in the uk. I will be on lubion again this time but daily instead of every 3 days. Hopefully, that'll do the trick. My progesterone was low 40s at 5 1/2 weeks pregnant, not awful but not ideal.

@PineappleC how long have you had to wait for the hysteroscopy? My plan after cycle 1 was to have one but I was worried the wait would be too long thanks to covid.

Hey @SpyroC, only about 3 weeks. The consultant suggested it in our follow up to our failed cycle, and he booked us in straight away. In my hospital it actually seems like things are quieter and less waiting than before Covid but not sure if it's the case everywhere. 🤷‍♀️

And yeah I was on Prontogest daily, and after 5 days it had risen to 119, do hopefully daily will do the trick!

I really hope next time is the one for both of us! 🤞

@PineappleC that's good! Did they put you under for it? My consultant said they would and that put me off too to be honest. I've since read some people have just the "look and see version" with no GA. if this fails I think I'll take plunge. 🤞🏻🤞🏻 We have been on these boards since Feb! 2020 still has the potential to be amazing for us...just about 🤞🏻 x

@SpyroC thank you very much. I will call the epu tomorrow, see if they checked progesterone levels in blood test.
Hope next time is good news for us all

@Weswoo @PineappleC @SpyroC
It's very difficult waiting for periods. When you were in similar situation, when did it start for you?

@SpyroC I know! And it feels like way longer than February! Surely it's our turn now!! I haven't had it yet, it's next week but yes they said it'll be a GA. It's a bit of a pain but I figure I've been through sedation for EC, jabbing myself with needles every day and all the pain of an MC, so I will just grin and bear it! I am trying not to look into it too much - when I looked into Hycosy, it scared the shit out of me because everyone had a horror story, but that turned out fine. Don't want to jinx anything but hopefully this will be "okay" too 🤞

@skot my period came back really quickly after MC. I started bleeding a few days after I stopped IMs, and my next period (which im currently on) was within normal timeframes. I think this will really depend on your body and what meds you were on, so just give your body the time it needs to do it's thing 😊