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2 Failed FETs & unexplained fertility. What to ask next?

9 replies

hopefulhel · 22/09/2021 01:45

Ladies

I could do with some help or advice. We started our fertility journey in Sept 2020 with egg collection in Feb which resulted in six high grade embryos. I've no underlying fertility issues but do have an autoimmune disease which my consultant tells me shouldn't impact fertility. Had to do a frozen transfer on my first transfer as was all risk of ohss. Two frozen transfers later which both failed and am at a loss of what to do next or what to ask my consultant at my follow up next week. The second cycle my protocol was changed and progesterone was increased and lining was over 9mm but no implantation.

OP posts:
Gardenlady543 · 22/09/2021 08:57

Hi @hopefulhel I'm sorry about the unsuccessful transfers. How old are you? Have you ever been pregnant before and how long were you trying to conceive before IVF?

hopefulhel · 22/09/2021 09:02

I'm 38 I had a miscarriage two and a half years ago and we've been trying for four years so one pregnancy in four years

OP posts:
Gardenlady543 · 22/09/2021 09:28

@hopefulhel so at age 35 the chance of an aneuploid embryo is 50%, at 38 it would expect it to be higher. Overall clinics usually advise the chance of a cycle being successful with an untested embryo to be 1 in 3. So at this point statistics are on your side.

However I was in a similar position, at age 35 I had never had a BFP and my fresh cycle yielded 9 high quality blasts. After the 2nd transfer I insisted on further investigations because the situation made no sense. The first thing we did was Pgt-A tested the embryos, 83% of the embryos came back euploid, so on every objective test I had high rates of high quality embryos, but they never implant.

So we went into recurrent implantation failure test, I’ve had:

Recurrent implantation blood tests, this is a thrombophilia screen and autoantibodies - I had no autoantibodies, I had a PA1 mutation (prone to clot so I'm now on aspirin and heparin), MTHFR mutation (I take methylfolate now).

Era Emma Alice - pre receptive and microflora issues. I would highly recommend this as this seems to be the most abnormal thing I’ve had and microflora is really important.

Hsg - normal, I would recommend some form of imaging, either a saline scan or hsg.

Hysteroscopy - cervical stenosis found and treated, but wouldn't explain the lack of success. This should only be done if there is a reason to do it.

Nk biopsy - this is quite controversial but after you’ve done everything else it might be worth exploring if things still don't work.

Essentially it’s up to you whether you chose to do further investigations at this point or try more transfers. You could start with Pgt-A and if you wanted to, then to explore further I would go for some form of imaging (hsg and saline scan) and the ERA EMMA ALICE (we have a thread on here about this test).

hopefulhel · 28/09/2021 20:42

Hoping for some advice @gardenlady543 and any one else that could help. I had my post failed fet consultation today. The doctor said that as I've had two failed fet with two high quality embryos I would be better doing a whole new cycle than use the remaining four embryos. He was of the opinion that what I triggered with didn't produce good quality embryos and said a new cycle might yield better results. I could go ahead and transfer some of the remaining embryos but he doesn't think it would be successful given that two high quality embryos didn't implant. I was at risk of ohss in my first cycle and was told not to trigger with ovitrelle. He reckons if I used ovitrelle this time it would yield better results. I don't know anyone who has done ivf before so have no one to ask for advice

OP posts:
Gardenlady543 · 28/09/2021 20:59

Hi @hopefulhel the professor I'm under at the implantation clinic made a comment about all my embryos being from the same batch. But I don't really know about that being an issue, 83% of my embryos came back euploid.

With 2 transfers if your embryos were untested then you could have been unlucky. How are you feeling? to be honest I wish I could bank more, so going through another fresh cycle is fine to do, it would be better to do it now as the quality reduces with age.

hopefulhel · 28/09/2021 23:21

I thinks it's more a finance issue. If we do another fresh cycle it would put us under serious financial pressure. We could afford to go ahead with a fet transfer immediately. It's €4800 for a fresh cycle vs. €1300 for a fet. He said the remaining four embryos are a lesser quality than the two transferred but still good quality.

OP posts:
Gardenlady543 · 29/09/2021 07:24

@hopefulhel I would transfer them then. I don't see a problem with them being from the same batch, if they're good enough to freeze, they are good enough to transfer.

Rubyrebel · 29/09/2021 09:07

Hi I would transfer them but with an auto immune disease you may have an immune issue. I had 4 mcs in a row, I’m now in third trimester after seeing dr Gorgy and doing immune treatment. At least get tested to see if you have raised killer cells etc . Many of the treatments aren’t mainstream but i will do them all again for my FET. My killer cells were high, my antibodies to protect pregnancy really low. I believe my body was attacking the 50% DNA of my dh as a foreign body like a cancer.
Dr Shehata said it was statistically impossible at 38/39 to have 4 mcs in a row and all be chromosome issues

AsItWas22 · 08/10/2022 16:11

What is the name of the antibody and killer cell tests please @Rubyrebel and @Gardenlady543 ?

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