Timing of frozen embryo transfers/ ERA test (not trusting clinics!)

[Catfinkz]

Hi all,

I would be interested to hear your experiences on this as it’s another IVF issue where I’ve lost confidence in the clinic….

I’ve had 3 non-medicated failed frozen transfers at two different clinics and I’m worried that some of them might have been done at the wrong time. I know you never know why a transfer fails, but I’d like to think that after all it's taken to create them, that they had the best chance they could.

All the studies I’ve found say that with a frozen transfer, a 5 day old embryo (that was frozen 5 days after egg collection) should be transferred 5 days after ovulation, which makes sense as surely it would be good to correlate the age of the embryo with when it would naturally arrive in the womb.

My 1st clinic did this, but because my current clinic start counting a day earlier, it schedules them 4 days after ovulation. As a result here was a 38 hour difference in when the clinics did the transfers which seems like quite a big difference.

I’ve spoken to a few different people at my current clinic to query this, but they either just explain the process to me again, or say “oh yeah, that’s weird”. I really hope I’m wrong, and that there’s a rationale as to why they do it this way, but no-ones really understood or explained that yet.

What’s got me thinking about this again is I was looking into an Endometrial Receptivity Array test which measures your optimum window for doing a transfer. I was hoping the day and a half difference between clinic timings wouldn’t matter, but from what I’ve read 24 hours can make all the difference.

If anyone has kept a record of their transfer timings and is willing to share, it would be interesting to know how many days after the LH surge your transfer was done.

Thank you,
R

p.s. I want to be able to trust Doctors/ Clinics, but there’s been so many times when they’ve missed stuff or been really vague, that I just don’t anymore. It’s really hard trying to figure out this stuff without a medical background and then challenging Drs on stuff (they love that!) but I can't bear the thought of the embryos being wasted (I'm 40+ and wont have any more of my own).

p.p.s: please be gentle with me....

FET1 - blastocyst frozen on day 4 post egg collection and transferred 5DPO
BFN

FET2 - same as first one

FET3 - blastocyst frozen day 5 transferred 5DPO BFN

FET4 - blastocyst frozen day 3 and then thawed and cultured to day 5 transferred 5DPO with a day 6 frozen blastocyst thawed and put back 5DPO. BFP and had twins

Ovulation at my clinic was classed as being - if you got a peak in the morning then the next day classed as ovulation day if you got a peak in the afternoon not the next day but the one after that classed as ovulation

I vaguely remember being told that the uterus will wait for an egg to be ready but an egg won't wait for the uterus (or it could be the other way round 🤦‍♀️)

Thanks for this @ivfgottwins. It’s interesting that a day 4 embryo was transferred on day 5. Also that your clinic differentiated between a morning and afternoon LH surge. I got an LH surge at 10pm and they still said that still counted as that day (even though OPK line was stronger the next morning) which seemed a bit vague to me.

@Catfinkz I’m not totally sure but I think I’ve only ever heard of it being done 5 DPO as a FET (even if, for example, a day 6 blastocyst).

For fresh transfers, the day of collection is day 0 and they transfer on day 5 at my clinic (don’t do day 3, but I know there are clinics who do). They don’t transfer a day 6 on day 6 either, they would freeze that and transfer in a different cycle. I’ve never heard of day 4 transfers fresh or frozen at all.

Wishing you lots of luck.

Thanks for your reply @Shamoo

The tricky thing is both clinics call it Day 5, but they start counting on different days. The current clinic starts counting on ovulation day, whereas my old clinic (and most clinics I think) start counting the day after ovulation day.

So my current clinic says it’s Day 5 transfer, but it’s actually 4dpo.

I don’t mind if there’s some rationale behind it…..I’d just like to understand it, because as you say transferring on 4dpo isn’t usual.

At my clinic for FET I was given tablets to 'calm my ovaries down' and taken in for regular scans to monitor that my ovaries hadn't produced an egg and were quiet and that my lining was thick enough. Based on that they then gave me a day for transfer.
I don't think I ever had to look into when I ovulated,but maybe they were doing that when scanning and I didn't know

At my clinic they could ovulation as 2 days post LH surge, regardless of what time of day. They used to do a scan on ovulation day to confirm, but have recently stopped this as apparently it didn't change outcomes.
I've had 4 transfers, one fresh and 3 natural (unmedicated) FET, results as follows:
Fresh transfer - day 5 blastocyst, BFN
FET 1 - Frozen day 5 blastocyst transferred 5dpo, BFP, daughter born 2018
FET 2 - Frozen day 5 blastocyst transferred 4dpo, BFP, MC at 12 weeks
FET 3 - Frozen day 5 blastocyst transferred 4dpo, BFP, currently 6 weeks pregnant

My clinic changed from transferring on day 5 post ovulation (when it would naturally have been) to 4dpo as apparently it led to better results

Thanks @somethingfunny (sorry for the delay in responding) that's really helpful. So if your clinic counts ovulation day as 2 days after the surge, their 4dpo is equivalent to other clinic's Day 5dpo, which seems to be the most usual one to go for, so that makes sense.