Failure to achieve a single BFP after years of trying - anyone else?

[SamTTC]

Hi everyone,
I thought it would be nice to have a thread for those of us who've been trying for a while and never had a BFP - maybe compare symptoms/treatments and see if we can help advise each other how to move forward?

I would have titled this thread "Recurrent Implantation Failure" but as far as I know, that label also cover those who've had chemicals or miscarriages, which seems to me like a separate (and in many ways obviously much worse) issue.

In this thread I'd like to specifically talk to other people whose issue is specifically that they've never seen a BFP. Heck, I've never even been able to get a BFP from an HCG trigger. (And never a positive Covid test either! That second line eludes me everywhere 😶)

My background: I'm 34, ttc as a solo mum. I've had two previous partners where we dropped contraception and casually began trying, nothing came of it (probably for the best really, since I'm now single). I decided to pursue fertility treatments when I turned 33 because I felt the clock ticking and like the idea of following in my own solo mother's footsteps. Had all the usual tests and they found no issues other than a low-average AMH of 17. Over the past year and a half I've had 4 IUIs (all BFN), a long wait for IVF, one retrieval in Feb with an AFC of 16 that yielded 5 eggs > 3 blasts > 3 transfers (all BFN). I'm headed into my second retrieval, hopefully this month if timing works out.

My clinic doesn't do much testing so I haven't had any 'extras' like ERA, EMMA/ALICE or immunology. I've only had an HSG and been checked for STDs and bacterial vaginosis. If I get enough blasts next time, they've suggested PGT testing to evaluate egg quality, which would be great - but frankly I'm more concerned with looking into implantation issues at this stage. If egg quality is the issue, and I need to consider moving on to an egg donor, then at least age would no longer be a pressing factor and I would have time to think about it/save up. But if egg quality is not the issue right now, it will be soon, so I really would like to optimise the time I have left to (potentially) get pregnant with my own eggs while age is still sort of on my side.
I also do wonder whether egg quality is actually likely to be the cause, because chromosomally abnormal embryos do implant sometimes, right? Implantation is the thing that doesn't happen for me.

Would love to hear your stories and connect with anyone who is on the same step of the fertility ladder, as it were. If there is anyone else... I've struggled to find anyone in the same position as me. 🙂

@SamTTC
Have you have your progesterone tested that could be a reason for implementation failure. Sorry your going through this its tough. I have had 4 bfp all ending in miscarriages I'm now pregnant again meant to be 9+3 weeks but I have the same feeling this time as I did the last times that its going to end, all in a pattern to 1st 10 weeks second 6 weeks 3rd ten weeks 4th 6 weeks so on time for a ten week one this time around.

My advice would be to push for tests. My story is a bit different as I have a naturally conceived dc and secondary infertility. Early in ttc I did have an early natural miscarriage, then nothing. Had surgery to unblock a Fallopian tube (turned out not the be blocked) and was then told I had a midline septum (not a big issue). Lots of rounds of ovulation induction (no positives). 5 rounds of ivf (no pregnancies), one after ERA/Alice/Emma adjustments/treatments then someone on here suggested I go for a saline sonogram. Turns out I didn't have a septum but actually had a big adhesion acting like a natural coil device. Had surgery. Fell pregnancy naturally twice after, but both early MC. Saw immune specialist and turns out I have immune issues. Going for another ivf transfer soon with immune protocol. My point is, if you've had three failures it's really worth getting all the tests done. It's taken me 4 1/2 years of solid trying to get to this stage - I regret not testing sooner and for not trying to get multiple things tested in conjunction. Good luck.

Hey. Me and my husband have been trying 3 years come July. Never had a BFP in that time.

we’ve been referred for IVF (just waiting to hear from clinic). Unexplained infertility diagnosis. I do have sub clinical hypothyroid which I am finally getting medication for and high prolactin which is finally being investigated! (It’s taken 10 months for a DR to do something about both of these!).

Hi @Lauralozzle

If they found prolactin issues I think you have big chances of being successful. Prolactin affects fertility a lot and once they treat it your fertility will go back to normal/ being good.

@SamTTC

Hi Sam,

My respects to you. This is already an extremely hard journey and solo must be harder. I've been TTC for 4 years now doing all, OI, IUI and IVF.

In the last 12 months I got 2 BFP but both ended in early MC.

Have you considered going to a different doctor for the immunological tests? NK cell tests (where your body attacks the embryos)? ERA test? I went to an endocrinologist to run tests before starting to TTC and found I have PCOS.

In my experience, until you reach IVF is when you get to know more details and probably find the root cause of your fertility problem.

IVF rarely works in the first stim, so don't loose hope, many say is a numbers game. I had better eggs with a different clinic which used stronger / higher dose medicines and double trigger.

It's good that you use PGD, that will help you sort out and find out more info on the eggs.

If your PGD passed embryos don't implant you definitely need all immunological tests before continuing.

My doctor approves I take 100 mg aspirin daily after ET which helps implantation, perhaps you can give it a try.

I'll join you if I may. Been trying since September 2019, no BFPs. Had a pretty disastrous round of IVF last year which ended with a uterine infection and no blasts. We went for a round of tests for DH which ended with him being diagnosed with testicular cancer early this year. His latest semen results have come back improved, but still not great, particularly with DNA fragmentation. We're trying to work out whether it's worth us holding off for another few months in the hope the sperm quality might improve further or whether we should just go for it now.

I would echo other posters and say if you're not sure what is going wrong, then getting tests done is the right way to go.

Hi @SamTTC I think we’ve chatted in forums before, not quiet in the same boat I’m afraid- I had 4yrs of ttc with only BFN. I did get a positive last month after a fresh transfer, same time as getting a positive on my Covid test but both came up negative a week later.
do you know what is causing your infertility? I know I have blocked Fallopian tubes so in my mind, the 2yrs of ttc naturally I’ve put down to the eggs not coming through to my womb rather than not implanting. I’ve then had 2failed FET. Might ask my consultant about pgt testing, and about getting onto the next round ASAP (another negative this morning).

Hi OP, i had never had a BFP until I started IVF. Was trying for years with my partner, at least 5 Started IVF we were diagnosed with unexplained infertility. On our successful cycle I was told to take baby aspirin after the last cycle was a chemical.
Good luck

I started TTC in 2017. Started IVF in March 2019. Got a BFP in November 2021. So a long time with not even a hint of a BFP. I never had a chemical or miscarriage - like you I just never got two lines.

I ended up doing 6 rounds of IVF. The egg that formed the embryo that got me pregnant was when I was 35. My first egg collection I was 31 so my younger egg embryos never worked. So I don’t think I would jump straight to needing egg donor. Like you said it can be an implantation issue.

With additional testing we found I had:

• low testosterone


• progesterone far too low at transfer


• incorrect implantation window


• bacterial infection in lining


• raised natural killer cells


• no good bacteria in lining

the transfer after addressing all these worked despite embryo being a lower grade.

I would put a pause on doing more egg collections/transfers until you do more testing - unless you freeze all embryos.

good luck.

Hi @DaykinD can I ask, what tests did you have to establish the above? I’m concerned were missing something with me so want to chat to our consultant about additional tests.

@SantoPalo can I ask, what does the baby aspirin do to help improve chances? I’ve heard of lots of people taking them but I’m just unclear what they’re for? Assuming it’s something your dr prescribed / told you to take?

@Agapanthus13 check out this article www.webmd.com/baby/news/20170209/daily-aspirin-may-help-prevent-some-recurrent-miscarriages

@Agapanthus13 yes the doctor advised that I take it, had to buy over the counter at Boots as the dosage is different to the aspirin that was on shop floor

I also asked for my progesterone levels to be checked day before transfer. If they were too low I would have been asking to increase dosage. I remember doing lots of reading on here for advice. I also remember reading something about increased estradiol levels so also checked my results.

@Agapanthus13 I did

• blood test for testosterone then took DHEA for 3 months to get it up to a normal level. Needed monthly blood tests to monitor. Mine was 0.1 normal is 1.5-2. If it goes too high it can damage egg quality same as Joe levels too low can lead to poor quality
• era/Emma/Alice endometrio- biopsy while following FET protocol. Found my implantation window was day 6 not day 5. Found the infection in lining and no good bacteria and they did a progesterone blood test the day of biopsy which showed abnormally low progesterone despite being on progesterone pessaries x2.
• Chicago bloods found the raised natural killer cells

@SantoPalo thank you very much. I’ll have A read of the article. I did ask my consultant about my progesterone levels but he said so long as I didn’t start bleeding before 9dp5dt then it shows the levels are ok. Perhaps I’ll ask again, I like to have everything tested so we know for sure it’s not an issue. The whole process is a bit of a mind play!!

@DaykinD thank you very much. I’ll have a chat to our consultant re all of these

Hi,

I have also never had a BFP naturally or after 3 transfers so far !

I'm 33 trying to conceive since August 2019 with my partner. After investigations we found I may not ovulate every month as I have irregular cycles, all other tests clear apart from low AMH and partner sperm has Low mortality so our protocol is Long protocol with ICSI. Since November 2021 I have had 1 egg collection where I had 12 follicles, 9 mature eggs, 6 fertilised, 2 made it to day 5, 1 day 6. 1 fresh transfer, 2 FET's, all failed :( So the next step is to wait for a follow up appointment and start another full cycle. I'm hoping they change something or do some investigations before my next cycle but I have read that they may not change anything. I'd even just be happy with another hormone check as a lot can change in 2 year ?! 2020 was the last time they checked things like progesterone, oestrogen, AMH, LH FSH.

Anyway let me know when you start your next cycle as I'm hoping mine is July time !

I am also going to try my best to read into what I can change to get the best out of the next cycle! I feel like I kind of just relaxed with this one so I want to put a little more effort into my body, even if it helps just a little ! So any reading recommendations would be great from anyone or any tips !

@IVFGotThis05

I'm doing IVF and my husband has motility and morphology issues. Which one is the bad one on your partner? It says mortality on your message. How would a long protocol help?

We are doing IMSI along with ICSI? Has he done genetic testing? DNA fragmentation test?

My next cycle is in July as well, for us is like the 7th stim. We took a break for taking supplements.

Thanks

@DaykinD can I ask, what was the treatment for these issues?

@SamTTC hi, you definitely aren’t alone. I’ve also never had a BFP. It’s very hard to imagine an outcome where we will eventually see one. We started ttc in October 2019, a similar time to @Lauralozzle actually.

We’ve done one round of ivf with icsi in Feb because dh has motility issues. We got 15 eggs and 4 embryos from that round. First transfer was April, that transfer failed, I’m finding it hard to imagine any of them will work tbh. We have 3 more frozen embryos to try from this round, next transfer will be in July but I can’t say I have high hopes right now, time will tell I guess.

@thislittlebird DHEA supplements to get testosterone levels up pre egg collection, transfer of embryo on day 6 not day 5. Progesterone in oil injections alongside Crinone (has to be intra muscular in oil- the ones in stomach didn’t raise levels) and regular blood tests to monitor during TWW, antibiotics and probiotics and repeat test re bacteria in lining and steroids for natural killer cells.

I wouldn’t give up yet! It took us 5 years and 6 rounds of IVF but we did get pregnant. It’s great you’ve 3 embryos to transfer as stats say it can take up to 3 transfers for it to work. 1 failing is quite normal (although hard to take I know). Good luck.

@DaykinD thank you for the info! I’m going to ask them to do blood tests this time, as my consultant mentioned they could, because I worry about my progesterone levels.

The microbiome is something else I worry about and I’m not sure at which stage I should be looking into it.

When you say 6 rounds, do you mean transfers or full cycles? I’m 39 already so time is not on my side!

I saw this thread yesterday before bed and wanted to respond. My husband and I have been trying since early 2020 and not a single BFP. We are I think still unexplained although DH has a lower sperm count and lower morphology but within the "normal" range (which in my opinion is not normal at all but I digress).

We had 1 failed fresh and 1 failed frozen of top grade embryos. Since then we have done DNA fragmentation and his is elevated but he did have covid a month before. We then dod 5 months of supplements before our recent fresh cycle in May. I have had a lap, die test, 3DSIS, hysteroscopy for poly removal that popped up during my fresh cycle. And now I am walking into an unmedicated FET (with luteal support).

With the new consultant we discovered I have a blood clotting issue so I will be on blood thinning injections. I also asked about vaginal probiotics and she said that at first she didn't think they would have much of an effect but she has seen improvements with her RPL patients so said to take them as they can't hurt. I have been taking oral for a month now and after my bleed at the beginning of the cycle I'll be taking oral and vaginal for 6 days and then just oral with 1 vaginal once every 4 weeks. This clinic gives doxycyline during cycles which is the same antibiotic some have used to treat micro biome issues so my thinking is that IF that is an issue I have we are potentially treating it as we go through the treatment. I'll stay on the probiotics (at least oral) until I achieve pregnancy.

My two considerations for testing were the ERA, EMMA and ALICE but my consultant is not convinced we need them. I've had two hysteroscopies now and they haven't noted any inflammation etc not sure how much of a guarantee that is though. As for micro biome we are doing the above which may or may not be enough but is sificantly cheaper than the ERA, EMMA and Alice test. Then for ERA not much we can do but apparently for unmedicated the results aren't that applicable and it is most useful for medicated FETs as the window of implantation is more strict. So based on all of that we have decided to proceed as it.

There is also a £200 test from fertylisis that your consultant (if willing) can order that tests your micro biome and bacteria from menstrual blood. If we don't have success after 2 transfers I'll be pushing for that. I've had enough of invasive procedures and so would like to avoid an endometrial biopsy if I can.

As sad as I am that we are all here I'm glad I'm not the only one. But just because there is no implantation please know that sperm can also impact that and so it isn't all down to us women and potential issues with our uterus. My consultant seems confident that between blood clotting and sperm we may have cracked the code. We shall see.

I’ve been pregnant twice in nine years. The first time was a natural conception and the second time was with IVF.

It is almost certainly total implantation failure as I’ve no gynae problems, and my first IVF cycle (at 39) had 7 mature eggs, 7 blastocysts, 6 suitable for freezing and 1 PGS-tested chromosomal normal… I conceived my DS2 using the PGS normal with a natural FET.

The only thing that changed between the times I’ve conceived, and not, was that I have an immune disorder that is so rare I’ve been unable to get it diagnosed (or treated on the NHS). We got it treated by accident at a IVF clinic that did immunes and I fell pregnant naturally while waiting to start my first cycle.

I obviously did immunes with the IVF cycle, as well and, of course, I had immediate success.