TTC no.2 after successful IVF for no.1

[Chocoholic85]

Hi,
I’m just after some advice and to see whether anyone is in the same boat!
Just found out that my 3rd FET failed.
We are very lucky to have DD who came from our first fresh transfer. We were also very fortunate to get 5 frozen embryos from that round so have been trying for a sibling. 1st FET was BFN, 2nd was a chemical pregnancy/early miscarriage and 3rd now is failed. Down to the last two and starting to feel the pressure and also wondering why on earth it isn’t working?!
We have unexplained infertility so nothing was ever found with our initial tests and I was 34 when we had out first IVF round so odds were in our favour. I read somewhere that at 34 around 50% of embryos are abnormal so I guess out our 6 maybe the last 3 were all abnormal. I’m also worried something has changed since I had to have a csection for DD. I did have an ultrasound which showed the scar had healed fine and there no niches, I’m wondering if there are adhesions that might not have been seen on the ultrasound though.
Would love to hear any advice for what to do next or from anyone else in a similar position. Thanks x

@Edf that sounds really good, and great you are reaching those milestones. Wishing you a healthy and happy pregnancy.

Hi @Sofie19 , great you had your follow up and some insight. The holiday sounds lovely: It’s hard to choose about doing another cycle but even 1 good embryo is a good shot at pregnancy. Is there a reason you have to do the potential EC before you try to do a transfer? Because just imagine if it works?

The probiotics recommended are below, they are all oral capsules. I am sure there are many more similar. It’s one a day up to transfer.
Donnaplus Flora íntima.
Vagimed. Lactopia.
Physioflor. IPRAD. Gastroresistant oral capsules.
Lactoflora intimate protection.

Also if your doctor doesn't push for any of them then great, I wouldn’t worry about it. I have decided not to repeat the test and I feel good about it.

@SErunner happy to hear you are on the road to recovery and to trying naturally again.

@Eggling fingers crossed. I had zero symptoms with my first child - just nausea from 6-14 weeks. But nothing during the early days. So it could well be OK.

Thanks, OTD is Thursday so I guess I'll test Wednesday. Keep squeezing my boobs to try and feel something but nada! I think if this one doesn't work we might down reg and do another transfer late July / august time. Not down regged before but the dr mentioned it as something to try.

@Faith2024

I'm glad you're feeling good about not repeating the test. To be honest he didn't seem overly persuasive on any of the tests and almost certain that the reasons for failure have been genetic/chromosomes. I won't do another full cycle but he said it was an option to try and get more euploid embryos whilst I still can make them. I don't think I expected 1/5 to be normal at my age...I should have had at least 3. I think I mentally prepared for just having a few blastocysts and maybe none to transfer but I don't think I realistically thought I would get as many as 5 embryos to test and then most of them abnormal. You are right that just 1 euploid embryos gives a good chance - more chance of a live birth than not. Thank you for all the probiotics you're taking - that's quite a list!

@Eggling I really hope Wednesday brings you good news and these next few days tick along quickly for you.

@Sofie19 I just finished the antibiotics and I am still trying to source the probiotic. You only need to take one of them, once a day, not the whole list. They were just given as options.

BFN tonight

@Eggling I'm really sorry. That's rubbish. I hope I'm wrong but I guess there would be a faint something approx 36 hours before OTD if it was positive. Remind me, what uterine tests have you had done? What on earth is going on? These are all tested embryos aren't they? There has to be a reason why it's failed so many times (the words of my own consultant before we did pgta!).

@Sofie19 I know. I'm completely at a loss. This is transfer 6 trying for baby 2 (transfer 7 total). These last two were pgt a euploid. The one I miscarried in November wasn't tested but the products were and that came back normal as well. I'm on so many additional meds - steroids, blood thinners etc. All I can think isn't that there is a physical problem with my uterus that is causing it, but honestly about a dozen different doctors have poked around in there now and can't find anything.

I'm going to call the clinic tomorrow to try and get the ball rolling though I know they will want to wait for the beta test on Thursday. I'm also going to call the implantation clinic at Warwick and try and book in with dr Brosens privately. I don't think we can bounce straight into another transfer when it keeps going wrong. What I don't understand is that we appear to have both recurrent miscarriage and recurrent implantation failure which is stupid because from what I've read it's different things that can cause them.

I think my plan is to try and get the clinic to prescribe me letrezole so I can at least "try" for the next couple of months and then see if we can get any answers before doing another transfer.

What I really need to do is find a way of managing my emotions and being happy with what I've got. This is the biggest problems for me. These last two years have honestly broken me and I'm hanging on by a thread. I'm thinking of calling the gp tomorrow and seeing if I can get some counselling or maybe a course of anti depressants or something because I'm honestly such a mess. I don't want to waste my life or my husbands life and especially my amazing little girls life like this. But I just always slip back into this awful state of mind.

I don't believe in unexplained infertility, there's definitely a reason this is happening but we don't know what it is. I do wonder if my c section caused damage we can't see on the (many, many) scans.

Does anyone have any suggestions on where I should go from here? Either in ivf terms or in the emotional side of things? I'm honestly at a total loss.

I am so sorry @Eggling. I cannot offer any advice on ivf as I feel like a novice and have yet to have a transfer. I agree with the unexplained part but there are things we may not have answers for yet.

I do think you should prioritise your emotional health. Speak to your clinic, do they offer any counselling? How about the gp? The love of your family can support & sustain you. Clearly you are a good partner and mother as you are self aware. Also, you deserve happiness and peace in your life for yourself first and foremost.

@Eggling I think I read somewhere that the NHS will give specialist counsellors to women who have suffered IVF failures etc. That might just be my local area but I think it comes under perinatal mental health. Maybe worth asking your GP. However, you have only tonight just had a negative test so give yourself a break!! You're hardly going to be bouncing for joy after seeing that.
If so many drs have had a look at your uterus and all are saying it's clear it's unlikely there's anything there but the gold standard is a hysteroscopy if you haven't had that and it could give peace of mind re your scar. In addition I would suggest the EMMA/ALICE but this is basing on what my own consultant said to do if our euploid transfer fails. (But we would have to do another EC which we won't).

@Eggling It's Maternal Mental Health that can do counselling re IVF failures, not perinatal.

@Eggling I'm so so sorry to hear this. I have been so amazed at your resilience after everything you've been through. We don't have as many but our last two euploid transfers have also failed and I'm starting to feel worried about the next transfer coming up with donor eggs.

If you're looking for any more studies or info (and you may not be!) then I find this guy's site to be pretty good: https://www.remembryo.com/category/implantation/

I was actually awake in the middle of the night thinking about all of this and was googling endometrial scratch - I had one in the cycle before our only successful pregnancy and although the HFEA website rates it as amber, I'm thinking about asking about it when we meet with our clinic.

The only other thing I can think of is lining thickness and whether or not you've had any issues there?

From an emotional side of things I can only say how helpful talk therapy has been over the years, for IVF and everything in between. If you can get on the list for some counselling then I would absolutely go for it.

I hope this comes across sensitively, but do you think just taking a little break from it all would do you good? With the plan to go back for another transfer in the future? Just shift your focus maybe and forget about IVF for a couple of months - enjoy family time, hopefully some sunshine, eat and drink what you want!

Sending lots of love xxx

Thank you so much everyone. Very little sleep last night and I'm a bit of a mess today.

I have contacted my gp this morning and they are supposedly ringing me back today. I think I might need a bit of help now, I know anti depressants won't magically fix anything but I'm struggling to do the things I know I need to do to look after myself, I've not slept properly in months and I'm honestly astounded I still have a job because I have no focus at all.

I've also booked into Dr Brosens' implantation clinic at Warwick, there wasn't an appointment until September which is annoying and had to pay £350 but honestly that's a drop in the ocean at this point.

I've spoken to my clinic who said precisely what I thought - have to wait for the blood test results tomorrow then it will go to MDT so the drs can make a plan then book us in for follow up. I think we basically have two options: 1. I beg them for letrezole so we can have a "natural" cycle or two whilst waiting for the next FET or 2. Use a down reg protocol (which my dr has mentioned before) and see if that helps.

I'm considering the possibility of silent endometriosis or similar - nothing has shown on scans but I try ink that can happen. Down reg FET is recommended for that. It's something we haven't tried as well.

@loulamay my lining was 9.4 this time and not really had issues with it so I don't think it's that. It's honestly baffling, my uterus looked perfect on the scan the morning of transfer, my progesterone levels were great, the embryo was decent quality and euploid. It's maddening that it makes no sense.

I really struggle with the idea of a break but I think we will kind of have an enforced one with the down reg. I need to sort my head out a bit and actually do some work at some stage as well. We are away at the start of July for my brothers wedding so I will eat drink and be merry then, I want to start exercising again too and looking after myself. I think I'm going to get my hair Brazilian blow dried (haven't done it as been scared of the chemicals) and try and make myself feel a bit better physically before the holiday. And then we will be moving house etc so perhaps a break over summer will be for the best. It's just I can say that now but I know from previous experience in a few days I'll be hysterically crying that we need to be trying again right now!

Thank you all for being so kind. You are making this horrible path a less lonely one to be walking x

Sorry @loulamay another question - I'm wondering about donor eggs now. What had your dr said about that? I'm just wondering why that would make a difference if the embryos are euploid - sorry to be asking as I know it's not necessarily an easy thing to talk about and don't want to drag up any worries for you.

@Eggling Not sure I understand the question! Sorry. Do you mean why would donor eggs be more successful?

Yes sorry my post was garbage! Yeah why would donor eggs be more successful then euploid embryos with own eggs?

I don't know that there would be a major difference, unless the quality of the embryos were maybe better given younger eggs? Would be interesting actually, to compare a 5AA embryo from a 40 year old to the same grade from a 20 year old. Would one be 'better'? I have no idea!

We'd love to have had more euploid embryos of our own to work with but after three rounds of all abnormal PGT results it obviously just wasn't happening and I put that down to nothing apart from my age. So DE are the next best option for us in my opinion xxx

Sorry ladies, just catching up.

@Eggling I'm so sorry 😢 it is just so hard going through trauma after trauma. Be however you need to be and do whatever works to help the most. I can understand wanting to get next steps moving - that's always what helped me too.

I would second some sort of psychotherapy/counselling if you haven't already accessed and can afford it. I've had a lot of therapy on and off over the years and it really has helped.

I think the difficulty with PGTA testing is using euploid embryos doesn't give you a better chance of pregnancy, it just reduces likelihood of miscarriage should you become pregnant. Ie it doesn't aid implantation, it just means if an embryo does implant you would be less likely to miscarry as it is genetically 'sound'. That is my understanding from the HFEA recommendations anyway. Statistically I understand it on average takes 3 transfers to achieve a pregnancy (not necessarily a live birth), so bearing in mind your awful miscarriage following one transfer, you perhaps aren't that out of line with the stats (unless I've misunderstood this which is entirely possible). Age is still a big factor both in terms of embryo quality and likelihood of implantation, again PGTA testing isn't going to change this as being genetically sound isn't the only factor in embryo quality (I don't think), that being some of the reason why not all euploid embryos a) implant and b) once implanted result in viable pregnancies. I could be entirely wrong, and I'm sorry if this isn't helpful. I think following up with whatever consults/tests you think are best is sensible, and it will be interesting to hear what they say.

I don't really know much about donor eggs but presumably they are sourced from younger women who have better quality eggs and therefore you're more likely to get better quality embryos giving you a better chance at implantation/pregnancy? Genetically sound doesn't necessarily mean good quality perhaps? It is all so complex and so much isn't understood. This is just my understanding from what I've read over the years, but I could be entirely wrong and am happy to be corrected!

Yes statistically any grade embryo from a 20 year old with no fertility issues is far more likely to result in a successful pregnancy than someone in their 40s as far as I understand. Both in terms of embryo quality, likelihood of implantation and carrying to term successfully. I think grading is viewed by some as very subjective and not overly helpful as it only tells you the status of the embryo at that time point - it doesn't tell you what it will do next and therefore some consultants advise not to take too much regard of it. We've all heard those stories of the crap on paper embryos resulting in babies - my daughter was one of them!

"Genetically sound doesn't necessarily mean good quality perhaps?"

I think this is probably true. Our donor is 26 years old so I have to believe that her younger eggs stand a better chance than mine. Sad but true - you can't fight biology at the end of the day.

You're not my age though @Eggling ? I think you're in your 30's? Correct me please!

Thanks @loulamay and @SErunner that all makes sense.

Yeah @loulamay I'm 33, 34 in August. So obviously not early twenties but I don't think age should be a major factor yet. I'm just completely baffled as to why it hasn't worked to be honest.

I've spoken to the gp and been prescribed some antidepressants. She also signed me off work but I'm not sure if that's the right thing to do or not. I'm going to have a chat with my line manager tomorrow. On the one hand I know I'm not functioning at work but on the other time off isn't going to fix the problem so it feels a bit like taking the piss.

I know that I need to adjust my goalposts a bit - I'm still operating as if my big family with a bunch of tiny kids racing around is a possibility and it's just not now. The trouble is I just can't accept that and I think that's making it harder than it needs to be (notwithstanding that this whole process is really bloody hard!).

I've booked in to see my counsellor again and also spoken to a friend who is a therapist and she said some useful things. I just need to actually apply it now. I think a large part of me doesn't want to do the work to come to terms with all of this because I just don't want to accept it, I don't want it to be real. But that's not helping anything.

We're not at the end of the road yet. Think there will be a pause before the next transfer though. Maybe in august?

@Eggling we're similar age then. I haven't had as many transfers as you but had two fail last year and then this miscarriage following the natural conception. I also can't think age is playing too much of a role yet and have just put it all down to bad luck - easier for me with my lower number of attempts though I'm sure.

Glad you've connected with your counsellor and your GP has been supportive. I was resistant to taking some time off work due to the miscarriage as I thought it might be better to soldier on, but in hindsight those 10 days were helpful I think. The repeated failures are exhausting and I think some time off would be totally understandable if that feels right for you.

Thanks @SErunner I have decided to take next week off. I sobbed on the call to my manager today, just haven't been able to hold it in. I'm really really struggling tonight. I think this is the first time I've properly contemplated that this might not work out for us. I'm in a complete state tbh. Spent the afternoon at my mum and dads. Got to get through a wedding this weekend (we have friends arriving to stay with us from abroad tomorrow for it) and I honestly don't know how I'm even going to get out of bed. I've also been awake since 2am so that's probably not helping.

@Eggling I'm so glad your parents are there to help you - it sounds like you need to be in survival mode until this weekend is over, so whatever that looks like - ask for help from whoever can give it to you! Are the friends close enough that you can share what you've been going through?

I think taking some time off work is a great idea and I hope your manager was nice about it all. Sometimes it's a relief just to get it off your chest and let people know what's been going on.

Sending so much sympathy - this is a path none of us wish we were on and it's one of the hardest things I've ever had to go through.

Thanks @loulamay friends know some of the details but not all. Had a rough night so super tired today but feeling glimpses of hope. I just want to get to the bottom of whether it's an embryo issue or a uterus one - if embryo I think I'd be open to using donor eggs but obviously if the problem is my uterus that won't help things. So just wanting follow up asap now.

@Eggling glad you are getting support and have people to talk to as well. A break sounds great as sometimes it’s hard to see anything else when you’re in the mids of it.

I remember my clinic saying that if someone had implantation failure (of euploid embryos) they would recommend a hysteroscopy as that was the gold standard & Emma and Alice test (less evidence around this) but recommended for implantation failure and recurrent loss.

Also down reg with FET is quite common but I would be reluctant to use any more embryos until there was further insight/ testing.

It may not feel like it but a family wedding could be a great distraction. Take care of yourself and take it day by day.