Seeking Advice After Unsuccessful Transfer with ABC IVF - Considering Next Steps

[amandamary]

Hello All,
I hope this message finds you all in good health. I recently underwent an IVF cycle with ABC IVF, and unfortunately, the urine pregnancy test on the 10th day post-transfer turned out negative, leaving me quite devastated.
To provide a bit more context, 7 eggs were inseminated on the day of egg collection, resulting in 5 embryos that fertilized normally. On day 3, the embryos were classified as follows:

• 8 cells-grade 1
• 8 cells-grade 1
• 6 cells-grade 1
• 12+ cells (grade not specified)
• 2 cells-grade 1

One embryo, classified as 4Aa, was transferred into the uterus, while 2 others were cryopreserved for future use (3Cc and 4Ab). 4 eggs and embryos deemed unsuitable for cryopreservation or transfer were discarded. Given the unsuccessful outcome of 4Aa transfer, I am now contemplating the next steps. I am particularly interested in your insights on whether I should consider PGTA (Pre-implantation Genetic Testing for Aneuploidy) for the remaining two frozen embryos. Additionally, considering the 4Aa embryo resulted in a negative pregnancy test, I'm leaning towards transferring both frozen embryos next time. Has anyone faced a similar situation or have suggestions on the best course of action? I would greatly appreciate any advice or shared experiences that might help guide me through this challenging time. Thank you all for your support.

For the sake of clarity, I am completely satisfied with the kind of treatment and care I received at ABC IVF. Just to avoid any confusion related to the title of the post.

I'm sorry for your outcome. Have you had a follow up with your clinic yet? Unfortunately it is perfectly normal for some high grade embryos to not work. It doesn't mean future cycles with your remaining embryos won't be. Grading is viewed by many as a false reassurance anyway, so try not to get too hung up on it. There are plenty of examples where people have been unsuccessful with high grades and lower grades then work. On average it takes 3 transfers for a successful outcome so having at least 1 fail is sadly normal and doesn't necessarily mean anything, it's just bad luck.

At this point there isn't really a reason to go mad with additional testing. You can waste a lot of money and time unnecessarily. I'd be inclined to just go ahead with a frozen transfer when you feel ready. Unless you are older (39/40+) the clinic are highly unlikely to agree to a double transfer at this point either, and even then after only one transfer it's unlikely they would agree. PGTA testing is only recommended by the HFEA in the event of recurrent miscarriages and there are risks of viable embryos being discarded through over use/reliance on it. I am sorry it hasn't worked this time, but if you can, I would just view it as bad luck and prepare yourself to have another go whenever you're ready. Wishing you luck with your next steps.

@SErunner Thank you for your support and insights. I appreciate your advise that high-grade embryos not working is not uncommon. Your advice on not rushing into additional testing and viewing this as a stroke of bad luck resonates with me. I am 35 in March and have had the history of 2 ectopics with one fallopian tube removed and one is retained, but underwent surgery during second ectopic pregnancy removal. That is the reason why I opted IVF after naturally trying for almost a year after the second ectopic. I might go for the frozen cycle very soon, without much delays. I am having consultation with the clinic the coming week.

@amandamary - sorry for your outcome. But 1 failed transfer is not a reason to worry just yet. I had two failed ones with well graded embryos. Did extra tests and changing protocol for the 3rd one. I think it is certainly bit too early for PGTA testing

@SErunner very interesting insights regarding PGTA. Are you basing this on your own research? I did read up about it but haven't yet decided how to proceed with it.

I'm due to have natural FET any time soon and another collection under access package afterwards. I know my consultant will be advising PGTA (had miscarriage on natural conception in the past and chemical with 2nd FET). However, I think if I only have 2 viable embryos will just go with transfers without testing them. Might consider testing if there are 3 embryos.

@CoCoaButter85 the HFEA website has a section on PGTA testing and only recommends it to reduce the risk of miscarriage, not to improve the chances of success (which I suppose could make it appropriate for anyone to use but perhaps more so for those who have experienced recurrent losses). It specifically cautions against use to generally improve fertility due to the reduction in perceptively viable embryos. Robert Winston talks about the risk of overuse as well.

@SErunner - I will have a look into it myself. Thank you

@CoCoaButter85 I'm sorry for your loss. Worth discussing with them but I can understand your thought process around not testing. I suppose there is some nuance as to what a chemical is classed as when it comes to your history of miscarriage (I don't mean that insensitively).

I think age comes into play quite a lot with these considerations. I am 34 (with a daughter from IVF age 31), trying to conceive a sibling. We've had a failed fresh and FET so far as no embryos left from our successful round with our daughter. I don't have any intention to test our embryos (we only get low numbers as it is!) but can understand the draw for women age 40+ who have a much lower chance of creating a genetically normal embryo. However, as we know, that gives no guarantee with the outcome and so much of this is poorly understood. I highly recommend Robert Winston's 'the essential fertility guide'. It is very pragmatic.

@amandamary I'm so sorry for your experiences to date, how awful for you. There is no evidence to suggest going straight into an FET has a negative impact on outcome as far as I am aware. The only caution is if you want to do a natural modified transfer (which has a fractionally higher success rate compared to medicated, but honestly really tiny), hormones from your fresh round can mess your cycles up for a few months so it might be harder to get everything to do what it needs to at the right time. I had this happen after our fresh round failed last summer and ended up doing a medicated FET after 2 attempts at natural modified where my body didn't play game.