Failed transfers, miscarriages, IVF

[Sunny56]

Hello everyone

This will be long. About us - diagnosed unexplained infertility, ttc since august 2017, normal uterus, ovaries, tubes tested, partner's sperm 4% morphology, but otherwise all normal, we have been supplementing for years now. One natural pregnancy, missed miscarriage, ivf pregnancy, grade 5AA, miscarriage, possible chemical pregnancy following grade 5AB fet, second ivf cycle, grade 5AB failed fresh transfer, now have 4 embryos in the freezer, 2 of them good quality (5BB, 4BB), 2 borderline for freezing. I just don't know what else can we do. Now waiting to officially advise clinic of my failed transfer, so I will be moving on the fet again in July probably. They have put me on progesterone for 12 weeks if pregnant, 5mg folic acid. Had bloods taken by recurrent miscarriage clinic, all came back normal. I'm just sad for us, all we want is a baby to take home.. any advise, any success stories to similar situation?

This has taken such a big toll on us, I have become this antisocial monster, everyone around us are having babies easily, and these endless questions of when are we having one, what are we waiting for. Just makes me so sad. I don't want to be negative, avoiding people, but it's just so haaaard...

Would it be worth checking tubes again? Fell pregnant naturally on the cycle I had them checked, since then I had surgical management of miscarriages - one of them it was needed twice.

Firstly I'm so sorry you're experiencing this, have been there and it is truly rubbish.
Couple of things - have you had a lap? This can sometimes diagnose asymptomatic endometriosis, which can affect implantation.
Have you had a hysteroscopy following your d+c? This could rule out any scarring of your uterus lining which is a rare complication of this procedure and which can affect implantation.
Has your partner had a DNA fragmentation test? Sperm within normal parameters can still be quite fragmented, so you could also rule this out.
Have you done any testing on your embryos? Our best quality embryos turned out to be abnormal, the slightly lower quality one was the normal one. Grading of embryos is a really inexact science it seems. So perhaps a few routes for you to explore if you haven't already (I also had all the recurrent miscarriage tests which came back normal) but the tests I've mentioned above revealed some issues for us, which we were very lucky to overcome. Wishing you lots of luck for your next transfer.

Hi @Sunny56 in addition to the great advice @Labradormama1 has given, have you considered an ERA EMMA ALICE. You seem to be getting embryos fine which would suggest that the issue is with implantation/maintaining pregnancy.

The microflora is really important in this process. I've just had every test under the sun to look into recurrent implantation failure, as I produce high rates of high quality embryos but I've never had a BFP. I was found to have 0.00% lactobacillus (good bacteria) in my uterus.

This study https://doi.org/10.1016/j.ajog.2016.09.075 separated women with more than 90% lactobacillus vs those with less than 90% lactobacillus, the outcomes were statistically significant:
Implantation 60.7% vs 23.1%
Pregnancy 70.6% vs 33.3%
Ongoing pregnancy 58.8% vs 13.3%
Live birth 58.8% vs 6.7%

@Gardenlady543 what is the fix for this issue? Thanks

@Moonstarsun 7 days of antibiotics, which antibiotic depends on the bacteria found. And then 10 days of vaginal probiotics.

I've attached the recommended list of vaginally probiotics. I've also decided to take femdophilus, which are oral probiotics that have clinical trials showing they improve the microflora in the reproductive system.

@Labradormama1 @Gardenlady543 Thank you for your messages. Do any of you know if these tests are also available on NHS? Or am I not entitled to any NHS help since I have paid for my IVF cycle?

[quote Gardenlady543]@Moonstarsun 7 days of antibiotics, which antibiotic depends on the bacteria found. And then 10 days of vaginal probiotics.

I've attached the recommended list of vaginally probiotics. I've also decided to take femdophilus, which are oral probiotics that have clinical trials showing they improve the microflora in the reproductive system. [/quote]
Hi @Gardenlady543 do know if it would do any harm to use these probiotics without having the test first? Thank you for this info, really interesting!

@Sunny56 I think if the NHS do the ERA EMMA ALICE then you'd have to be under them having fertility treatment. I paid privately, it was £1000 for the ERA and an extra £500 for the EMMA ALICE, so £1500 all together plus the medications which I got from Asda at cost price.

Hi @OhPeanuts how are you? I don't see how taking probiotics would be harmful. A fertility dietician recommends people take probiotics, she recommends symprove. I think the femdophilus is a good one as well, peopleWith recurrent bacterial vaginosis swear by it. I've put my husband on viridian lactobacillus rhamnosus GG. I'm planning on taking the course of vaginal probiotics for 10 days and then using one every few weeks alongside femodophilus orally ever day.

Hi OP, sorry it’s been so tough for you. I have had similar results (2 MMC, 2 CP, 3 no implantation). All results in terms of bloods etc look fine. We decided to genetically test our embryos so we could tell if the issue was embryo or me. I now know that I have 6 genetically good embryos, which whilst not great quality, has given me some peace of mind.

I now know I need to look at my body more thoroughly. Before that - due to my age - doctors kept telling me it would be my egg age, but we now know that isn’t the issue.

Wishing you lots of luck. I know how awful it is, how it weighs on you. Big hugs. X

@Gardenlady543 I have been taking Garden of Life Dr Formulated Probiotics Once Daily Women's, did the fertility dietician mention these ones? Do you take Symprove? They seem really expensive! :(

Hi @Shamoo I'm sorry to hear about your experience, in IVF they always try to pin the issue on the embryo. In my case I have recurrent implantation failure, I ended up with 9 high quality blastocytes and it was only after 2 unsuccessful transfers when my PGT-A results came back to say 83% were euploid that my specialist agreed that we should look into implantation failure. I've known the whole time that something was wrong.

@Moonstarsun I'm not sure, if there is an issue in the microflora like I have then the evidence suggests that a person would need vaginal probiotics. I understand that symprove is recommended as the bacteria don't get killed off by the gut, but it is expensive and also I hear it doesn't taste nice!

This study looks at femodophilus, the oral one I suggested
doi.org/10.1139/W08-102

It's fairly small study, they separate 64 women with bacterial vaginosis into 2 groups, both get 1 dose of antibiotic and then either placebo or the oral probiotic.

You can see from the attached image that most of the people in the probiotic group ended up with normal vaginal flora, and most ended up with their bacterial vaginosis resolving. They didn't analyze the microflora like an EMMA does though.

I haven’t seen the IVF dietician myself, but this is her https://melaniebrownnutrition.com
You could arrange a consultation and see what she recommends for you if you're nit sure what the best thing for you to take is?