Hi everyone. Hope those who had positives are doing great and feeling ok!
Curious if those with failed transfers have spoken to their clinics about the outcome at all? I emailed my Dr in Cape Town and thought I would share his responses in case they were helpful. I think we are planning our third and final (argh) transfer in July. I may go out by myself though because we just can't afford the flights and accommodation for all three of us. I found this loss especially hard but the passage of time has helped a little. Thinking of everyone who may also be going through a rough time still. x
I realise it's a very difficult question, but if you had to speculate, what do you think might be the most likely cause of the transfer failing? I know that this embryo was graded as a 4BB and Amelie was a 4AB I think. Does this make much difference?
There is a statistical difference in implantation rates of euploid embryos between a ‘good’ embryo (4AB) and an ‘average’ embryo (4BB). Both have a significant chance of not implanting. (he also shared a graph here which I have attached)
I recall that the timing of our transfer of A was based on the biopsy that was conducted during the endometrial scratch in the cycle prior. I wonder if you have notes that you could look back on to refresh my memory on this. I believe that we transferred her on day 6, despite her being a day 5 embryo. If this was the case, do you think that the receptivity window for the recent embryo was off by a day and we should have transferred on day 7, or again, does this not make much difference?
Current evidence suggests a 3 day margin of error in histological dating and the guideline remains to match the freezing day to the progesterone day. You are correct that I suggested doing the transfer on Day 6 rather than Day 5 allowing a bit more of a progesterone effect. The difference in an artificial cycle between Day 5 and Day 6 is small enough to depend more on the area of endometrium the embryo encounters rather than the day and it is not possible to say whether it made a difference. Because there is also a 3 day implantation window, many would say Day 5 would probably have worked too. Nevertheless, we can work out the timing to coincide with closer to 6 days of progesterone.
Two days after the transfer I felt quite intense cramping, similar in feeling to past miscarriages I have had. Is it simply a case of the embryo not implanting, or is there anything about the cramps that suggest that the embryo was 'rejected'? (if that is even a thing!!)
I can’t interpret the cramping. It is not a symptom of the embryo being ‘rejected’ – implantation takes place at a microscopic level – there are no associated symptoms. Many women have cramping, bleeding and other symptoms in the luteal phase and still get pregnant so one cannot know what it means.
For our next transfer, would the protocol be the same?
I would like you to use an injectable progesterone with the Duphaston which can be changed to a vaginal form once pregnant. This is to make ‘extra-sure’ that your progesterone levels are good. I will also decrease the Estrofem dose for a few days when adding the progesterone (this is what would happen in a natural cycle).
So that's where we are. I've never done the progesterone in oil and not looking forward to it because I think that will have to involve my husband and he's scared of needles haha.
Feeling pretty apprehensive about going through it all again with what just seems like a roll of the dice each time. Would love to know if any of you took any supplements pre-transfer or do anything else to help?