3 failed transfers, losing hope, suggestions please

[LosinghopeIVF]

Hi,

I'm in a situation where I recently had my third failed transfer and am currently investigating next steps. We are working with our IVF clinic on this and they are good, but I'd love the hive mind's help.

Our situation:

• Unexplained infertility.


• 2 egg retrievals, 13 eggs both times and 2/3 good quality day 5 blasts respectively.


• 1 fresh, 2 frozen transfers.


• Fresh transfer was a complete fail, on 1st frozen we got some HCG detected on blood test but below 1, on second FET we got a very faint positive HPT and HCG result of 3


• DH has had a comet test which detected a higher than normal level of DNA fragmentation in sperm

Had anyone had a similar situation? If so what have you tried/been recommended, and most importantly what has worked?

I just wanted to make sure I have all the information and options to discuss with our doctors.

@LosinghopeIVF did you have ICSI?

The treatment for high DNA fragmentation is ICSI. Over time, it can be improved with lifestyle adjustments and supplements but there isn't a guarantee. This was what my fertility consultant told us last month because we considered doing a test for high DNA frag but she said as we are doing ICSI anyway, it wouldn't be necessary. She described ICSI as the main treatment. Hope that helps. X

Yes sorry I should have said we did ICSI due to other sperm factors

Have you tried supplements ? Proxeed or Impryl ? Omega 3, pycnogenol, ubiquinol etc?

@LosinghopeIVF the treatment for high dna frag is not ICSI. This is a backward view held by many clinics. You need to see a urologist to ensure there is no infection or issue that is causing the high dna frag - it may need antibiotics or varicoele repair or other issue that can actually fix it. If it can’t be fixed and levels are bad surgical sperm removal can help reduce DNA frag. I would have this as your next step.

We have, he was on proxeed for 3 months before and I was on all of the others you mention. Our clinic is very big on vitamins. Thank you for the suggestion x

Thanks for your suggestions :) He had a varicocele repair near the start of our TTC journey (5 years ago) but the comet test was only 6 months ago or so, so high frag still present. Do you think an infection could last as long as 5 years?

I've asked about surgical sperm removal a few times but been brushed off by the clinic, but have pushed it harder in our meeting today and they are going to review the request.

We haven't had any PGT yet. I pushed for it last time but the clinic didn't think it would be necessary due to my age. However with 3 failed cycles I think they're more open to considering it if we need to do another round of egg collection.

Does anyone have a clinic or specific doctor they'd recommend in London/South East for complex cases?

How old are you OP - 3 transfers is only just on the cusp of what is considered the optimum number for transfers? You are getting a good amount of blastocysts each time - what grade are they?
What about you - lining thickness? What trigger did you do? Took me 4 transfers and 6 blastocysts to have success and that was mid 30s

After 3 rounds, we have dna frag and I get the same no of eggs and blasts as you. However as I am 39 and have had recurrent losses we have been pgta testing from the start. Of 5 good graded embryos, 3 have been abnormal, one normal and 1 mosaic (usable). So pgta might be worth doing if you are having repeat failures.

Otherwise, have you had the ALICE/EMMA/ERA tests done and also immune testing? I will be doing those before we attempt any transfers (embryo banking currently).

We're definitely going to do PGT next time, I wanted to do it this time but our consultant didn't feel it was necessary.

I haven't heard of the other tests you mentioned and will look into them, thank you!

Thanks for sharing your story 💗

I'm 34 and blasts have been good quality. Our fist couple were 4AB and 4BC. The ones we have frozen are slightly worse but still considered "good". Lining quality has been excellent, never any issues here.

I can't remember what our trigger shot was, have you found that made a difference to you?

Have you had your progesterone tested before transfer or on the day? I had a chemical pregnancy after a fresh transfer (5AA). Then our first frozen (6AA) didn’t implant so I began to suspect maybe something wasn’t quite right. I had my progesterone levels tested the day before my second frozen transfer and they were really low, I had to inject Lubion for a few weeks but had a successful pregnancy and our daughter arrived in December.

May just be coincidence but I do wonder if my progesterone levels were too low after the fresh transfer which resulted in the chemical pregnancy. The fact you’re getting numerous day 5 good quality blasts would suggest that it’s not quality related, but more the environment?

Thanks for sharing your story.

This time I had a lot of blood testing around the transfer. I was already taking lubion & cyclogest so progesterone levels were great, but they did find that my oestrogen levels were low and I had to take patches.

At our first clinic they don't do any blood testing, so I do wonder if that could have been a factor in the first two failing.

I've read with dna fragmentation the embryos can look good quality but be more likely to have chromosomal abnormalities. The drop off between fertilised eggs and day 5 blasts also might indicate this. I'm kicking myself for not insisting on PGT, but I did repeatedly bring it up and push for it, so do feel like I tried.

Oops, name change fail

Have you tried immune and clotting disorder testing?

Not yet, but I'll be having those tests next month