Implantation failure - final FET

[Rd12]

I have 2 embryos frozen and I have been advised to have a double transfer. This will be my last chance and my 4th try.

The doctor has told me she thinks the reason for failure must be implantation as all of my embryos have been reasonable quality. All of my tests have given good results. I am worried about having a double transfer as I feel I will be even more anxious knowing it is my last chance. Has anyone been in this situation and do you have any advice to improve my chances?

I'm so sorry for everything you've been through - IVF can be such a hard journey.

Can I ask if your Dr is planning to do anything different this time to help you with implantation? I suppose I might be wary to do them both together either way - if she's not changing anything then it seems risky and if she is changing something then you might want to try it first in case it needs tweaking for the second try.

For what it's worth I have twice had multiple embryo transfers but that is because I am older and therefore we expect most of my embryos to be non viable.

X

@Janefx40 thanks, its tough isn't it? I've had enough, time passes so quickly and before you know it you have spent years worrying and stressing.

Yes the Dr has reccomended embryo glue and scratch. I think I will have to go with it. But i've read varying opinions on whether its really making a difference. The dr said a 10% increased chance. Not a lot though is it? I feel like i'll have a better chance with single transfers. But the Dr reccomended double.

@Rd12 sorry to pry but have you had any previous pregnancies or chemicals? And can I also ask how long you've been trying?

I've had 2 scratches. I started with IVF in 2018 and before my first cycle I had a hysteroscopy and scratch. That first cycle was a chemical and the second cycle was my DD. I went back for a FET in June last year and had another scratch. That cycle was a miscarriage. So I have always had some implantation post scratch but again my situation is very different as we have severe male factor as well as my age so we can't get pregnant naturally - so the implantation could be unrelated to the scratch - we'll don't know how I implant without it x

Hi @Rd12 I’m surprised your doctor hasn’t ordered an ERA/EMMA/ALICE if she thinks it’s to do with implantation failure. It could be your window for implantation is completely wrong. If I were you I would at least have an ERA before proceeding.

Have you done PGT-A also as otherwise you embryos may look good morphology wise but be abnormal which would also mean no implantation. On my last round I had x2 4AA and x1 5AA embryos so top quality but all came back as abnormal with Genetic testing

@Rd12 have you taken aspirin with previous transfers? Also ask about prednisolone (steriod to lower the immune system)

Agreed with @MabelG

If you’ve done 3 transfers of good quality embryos with no implantation it could be :

• window of implantation is wrong needing an ERA to figure it out and potential Alice/Emma to check for other lining issues
• embryos are not genetically normal and therefore not implanting even though they’ve good morphology.
• immune system is raised and attacking the embryos also hindering implantation needing testing for immunes/NK cells to see

Honestly I find your consultant very remiss in suggesting you use up your last two embryos and only doing a scratch and embryo glue without even discussing or addressing the above given you’ve had 3 failed transfers.

@Rd12 I agree completely with @FitzsimmonsMarvel and @MabelG.

@FitzsimmonsMarvel has summed it up perfectly. That's where I was going but I was getting there a bit more gradually. I know it's tough to have to start researching again and looking into new stuff but you do want to get it right.

Best of luck x

Also remember you don't have to go with their recommendation of transferring 2. Personally I'd want the potential issues PPs have mentioned thoroughly checked first and then perhaps do one by one. Incidentally, I had some very basic immune testing which didn't show up any issues but was advised to take prednisolone anyway because it wouldn't do any harm (and it's also very cheap)

Sorry to jump in. I am also starting FET cycle. I am very anxious about it. I had two previously failed transfers - one fresh and one FET. Both were blastocysts but grading was not great 2-3BB and 1-2BB. I have two better grading blastocysts frozen and will transfer the best one next. I had progesterone supplementation in both transfers and blooding thinner after one of the previous transfers. I have not done any other additional things except repeating a thyroid test which is good. I had a natural birth previously and always good uterine lining. I don't consider PGS as I don't have many blastocysts. However, is there any benefit to add any additional measures in my case? The doctor did not suggest anything else and tend to think it is egg or embryo quality?

I am doing a natural FET and I wonder if trigger is good or not. In previous FET my dominant follicle got to 26mm on the day of ovulation which took perhaps 1-2 extra days. If I take trigger it is likely to be earlier than natural as doctors looks at size over 16-18mm and they want to give trigger before the follicle is too big. Is it good to just go for the trigger?

I've had multiple implantation failures so I'm having ERA and natural killer cells of the uterus tested before my next transfer.

Thanks guys, theres loads of great advice there for me to look into. Really glad I asked.

@MabelG i've not taken asprin, is it best to take it then? Is that after transfer?
@Janefx40 i've not had any other pregnancies of any sort.
@Jo99999 I had natural FET for my last round. They had to trigger me also due to ovulation not occuring in time, I don't know if that makes a difference though.
@FitzsimmonsMarvel I don't know if there is any point in genetic testing as we can't afford any more rounds after this. The doctor said thats highly unlikely to be the issue. I must say I did think this would be the likely reason as i'm getting on a bit!

I'm feeling a bit of hope now, thanks

@Rd12 embryo glue might have a worker outcome if embryo is already fully hatched. Check the evidence

Meant worser not worker

@Rd12 yes aspirin is meant to help with implantation - certainly mention it to your consultant. I am currently pregnant following FET and they put me on aspirin prior to transfer. Best of luck

@Rd12 We started TTC and then IVF when I was already 40 (our second round was successful aged 41). Age doesn't help but lots of women still succeed at an older age.

My clinic specialise in implantation failure and miscarriage. Everyone takes Clexane and aspirin as standard, everyone has a scratch and they also do a lot of work testing the immune system although I appreciate that can be controversial. They believe that the immune system can prevent implantation or cause miscarriage for some women.

I've not personally had ERA or ALICE but I've heard good things about them too.

Basically if this is your last attempt (and if you can afford it), I'd throw everything at it. Obviously the hope is that you will be successful and get your baby. For me though there is also something about peace of mind - knowing I did all I could will help me let go more easily (we are trying for a second) x

@Janefx40 can I please ask you which clinic is this that gives you everything possible? We are currently with NHS but looking for private clinic for our next trial. Are you happy with your clinic? We have a male factor, so can’t have it naturally. Thanks

I must say I would personally never, ever transfer two at once with repeated implantation failure. The reason being that f it is not embryo quality, it is something environmental, and each of those embryos represents a chance to try something different or figure out what's going wrong. If you do them together, you missed the chance. Multiple embryo transfers only really helpful where the environment is ok but only about 50% of your embryos or less are likely to be viable so it can simply increase odds.

Likely looking an ERA/EMMA/ALICE, immunes, and trying aspirin would be a good idea before any further transfers! Though I think maybe ERA is only accurate for fresh? Someone can correct me?

Hi @Rd12 I wondered how you have since got on? I'm due to have my second transfer in the next couple of months and have so much fear that it won't work and that ill just be wasting away my embryos. I know I'm catastrophising at this stage but I just need to know that if this one fails too then we're not game over xx

Bumping as I also want to know

@Sherr33 what stage are you at if you don't mind me asking? X

@Eagerlywaiting1990 failed fresh and failed frozen. And now they want to transfer two and well I don't know how the hell I feel about that to be honest especially with no further investigation or changes to meds

@Sherr33 really sorry to hear that 😔. Have you many more embryos frozen? Have they spoken about doing an Endometrial scratch or having lubion injections or anything? They aren't changing anything for me this time round either but I guess I haven't had a frozen cycle yet. I live in Scotland and as of the last few weeks its not permitted to transfer more than one embryo here. I have 2 day 6 embryos that I definitely would have transferred together if given the choice but 3 more day 5s before I get to that point xx

I had six embryos. Got 3 frozen. 1 didn't thaw well so they discarded it :-(
I'm on lubion and I really wanted to do the scratch this time but I got put off again. They keep saying no evidence etc and it's like they telling me no point so I feel like oh okay and don't go ahead with it.