Has anyone had more success with FET than fresh transfers

[LuckyPineapple]

My partner and I have been going through fertility treatment for over a year now, and unfortunately, we are still in the throws of it. We recently found out that our fresh transfer failed.

In total I have had 3 transfers,
1st was a good quality day 3 embryo fresh transfer that failed, 2nd was a frozen day 5 embryo (graded 4AB) that took but unfortunately ended in miscarriage at 7 weeks
3rd was a fresh day 5 embryo (graded 4BB).

Just for a bit of background:
We have male factor infertilty and have completed 2 rounds of ICSI and 1 round of IMSI.
1st round resulted in 1 day 3 embryo.
2nd round resulted in 2 day 5 blastocysts
3rd round resulted in 2 day 5 blastocysts
We have 2 blastocysts frozen (1 from 2nd cycle and 1 from 3rd cycle)

I guess I'm starting to wonder whether I'm not a great candidate for fresh transfers. I've always responded really well and quickly to the stims with my 2nd cycle being a freeze all. In my most recent cycle I had 14 eggs. Ovaries were touching at the point of collection but a fresh transfer was proceeded with. I can't help but think that all the fertility drugs and higher estrogen levels are affecting implantation.

Has anyone ever had experience with FET being more successful than fresh after your body has had time to recover?

Apologies for the long winded comment. This journey is really starting to take its toll.

Thanks x

I'm sorry for your struggles and loss. From recollection I think there are slightly higher success rates from frozen transfers than fresh, but I think it's marginal.

It takes on average 3 transfers for success and whilst you sadly had a miscarriage it's positive one of your transfers implanted. Unfortunately IVF is mostly a numbers game. I'd be inclined to transfer your last 2 embryos before going down the route of any additional investigations. Best of luck.

@SErunner thank you for your reply. We had considered transferring 2 in this most recent one but in hinsight, I'm glad we didn't incase it was something to do with the amount of fertility drugs and receptivity. Further testing such as Era/Alice/Emma was discussed after the miscarriage but I would be of the same opinion as you. I'm considering transferring the 2 in the next FET. Maybe my lack of knowledge, but I don't feel ERA testing is necessary when 1 previously did implant.

It's such a rollercoaster of emotions. Good luck with your journey!

Robert Winston's 'the essential fertility guide' and the HFEA website are great reputable sources of advice in terms of evidence based treatment. I'd highly recommend. ERA/EMMA/ALICE aren't recommended due to lack of evidence but are commonly used by some clinics. The ERA in particular I would certainly give a miss, I think it's been fairly robustly discredited. I agree that 1 miscarriage doesn't warrant additional testing, unfortunately they are a natural process in most cases. The NHS usually does additional investigations after 3. You could discuss a double transfer with your clinic - their openness to it is likely to depend on your age. I don't know much about success rates for single vs double transfers but I'm sure someone else on here will!

@SErunner Thank you for this. I didn't know about Robert Winston. I will certainly have a look at this!

It is so difficult to know what to do sometimes. My gut instinct is saying to go with a double transfer next. I think my Dr will be willing to. He let us decide last time, but I think the risks associated with multiple pregnancies scared us. Although at this point I don't see that as a high possibility.

It's great to be able to chat with others who understand it. This is the first time I've been back on here since before the miscarriage. Thank you!

No problem. Happy to help. I've spent a lot of time on and off here over the years! RW also has a website - the genesis research trust. He was one of the pioneers of IVF and is definitely an opinion you can trust. He is very to the point and pragmatic which some people struggle with, but I personally found clarity helpful.

I had 1 fresh transfer, and I started bleeding / my period 5dp5dt, so something obviously wasn't quite right with my hormone levels. My second egg collection we did a freeze-all.

I've always got on better with FET. I find them way less stressful and do believe your body is in a better state for transfer. My first FET was a chemical. 2nd FET is my DD and 3rd FET is my current pregnancy.

I'm personally really against double transfers, as I think it puts you and your pregnancy at so much of an unnecessary risk if both take, so its never been worth it to me. I very much focussed on the goal of being a single healthy baby. A double transfer might get you there quicker, but I felt I would feel so guilty if my own impatience resulted in a multiple pregnancy that but myself and my children at risk. Its very much an individual choice though, and need to consider your own personal circumstances and feelings around it.

Best of luck with your next transfer

I had a great icsi round for male factor, 7 eggs and all fertilised and all made ut to day 5 to our utter astonishment. One slowed down so wasn't frozen, one was fresh transfer and 5 were frozen. They were all good or excellent grade but fresh didn't take, bled before the OTD.

For frozen 2 months later my body felt so much more my own, I had progesterone upped to lubion injections as I bled early on fresh, and I took high dose vit d. First frozen one worked , got a positive 4dp5dt and he's now 8 months old.

Best of luck with your journey, what was your rate of fertilisation like or did you see a drop off at day 3 if you don't mind me asking?

Echoing some of the others here. I did my first fresh transfer with a good looking day 5 blastocyst. It completely failed (0.6 hcg) and I was bleeding by day 4. I also suspect my hormones weren’t right, but they did a ‘catch-all’ approach to the first round, sadly.

My first FET in March I got my first BPF! Still a long way to go, but I at least know a FET can get me pregnant.

@SErunner Thank you. I've starting reading Robert Winston - Q&A totally see what you mean about his way. I'd prefer this sort of honesty. The money involved in all the testing is unbelievable, so his opinion is certainly something to take on board.

@2mumlife - the double transfer is something I've always been wary of. Just before our last transfer, we were given literally 5 minutes to decide 1 or 2! The statistics scared the life out of me. I think my hope of it working with even 1 has lessened when everything has failed so far. I'm also approaching 39 and worried whether our embryos are genetically normal as our clinic don't offer PGT testing. We have our follow up appointment this week so hopefully I'll feel a bit clearer on a plan.

@Imisscoffee2021 that's an amazing round of ICSI! Unfortunately our issue is fertilization. I usually get between 11 - 14 eggs on each cycle but last 2 only 3 fertilised in each. 1st cycle only 1 fertilised. Its been put down to sperm quality which we've really worked on over the last year. In fact it was re tested and its went to normal parameters! Only we found out there are anti sperm antibodies too. They've noticed my eggs are 'sticky' whatever that means 🙄 but weren't in the first round. Not sure why, but I feel this has something to do with stim medication. Im always on a high dose yet have good AMH or really it could just be my age.

@Copenhagener great to hear you got you BFP! Congrats! I found the down regulation on Buserelin difficult with my last FET (migraine central!) but totally agree our bodies are in a better place. In fact, I did down regulation for just over 3 weeks, and my body still decided to do its own thing and produce a follicle, so I had to have my protocol changed to a natural cycle. It did work but sadly ended in miscarriage at 7 weeks.

For all you ladies - Do any of your clinics test progesterone once you start taking it, whether fresh or frozen? I find it odd that my clinic has never tested this to know that it is enough following transfer. For my failed transfers I started bleeding at 11dp5dt so assume this is a normal time?

It's lovely to hear all your success stories! Thank you for that. It has given me so much hope 🙏🏻

I didn't have my progesterone levels tested in any of my fresh cycles but did in my FET (it was fine on the same dose). A common misconception is that progesterone should stop you bleeding, and if you bleed levels are too low. This isn't true and there is some evidence progesterone levels that are too high may have a small negative impact on success. I'm sure you could ask for it to be checked if you'd like, you may just have to pay for the extra blood test. It was quite nice to have the reassurance. I have bled on a successful and unsuccessful cycle, and haven't bled on an unsuccessful too so it also varies cycle to cycle!

@LuckyPineapple I've never had progesterone tested or embryo testing either. It may be with your age that a double transfer is looking not as risky. Have you ever had a BFP? Its very hard to know if you just need more transfers (numbers game) or if there is any other reason other than sperm issues that is impacting you TTC. Hope you get the chance to ask lots of questions with consultant so you can feel comfortable with whatever decisions you make next x

Hi all just jumping to query those who have had gone to have positive FET after a failed fresh transfer. Is there anything you changed fir your FET and tips or advice you would give and what were you eating or taking during the FET?

@Sherr33 there is nothing you can eat or take that will have any impact on outcome. Hopefully in some ways that is reassuring in the sense that it is out of your control. Wishing you luck with your FET.

@22mumlife I had a BFP with my previous FET which was sadly a miscarriage at 7 weeks. A heartbeat had been seen, but growth was slowing down. It could be a numbers game. I think IVF is a lot of trial and error. I'll write my questions down for the upcoming appointment and hopefully feel better to start a FET.

@SErunner I think I'll ask for progesterone to be checked to give me some reassurance. I found with the FET that resulted in implantation that I had more because my body was producing and I had pessaries. Its the only transfer I had with more Progesterone.

All these little things make you wondering.

Along with what you are already doing, I would also look in to the reason behind male factor infertility.

We also had MFI, and my partner was referred to urologist. After karyotyping, we found a genetic issue, which showed that our chances of having a healthy embryo was 25%. After that we decided to perform PGT on embryos.

Before karyotyping, we have had 2 failed IVFs (one frozen and one fresh), miscarrying at 6 weeks, 10 weeks.
We miscarried after PGT as well, as PGT cannot check for all issues.

@Imisscoffee2021 your story is literally my own. I've just had a failed fresh transfer (devastated) and have 5 in the freezer (from 7 collected). I pray our stories carry on with the same similarities xx

So similar @Eagerlywaiting1990 ! So sorry about the fresh, I know the pain of that too well, and the disappointment. I found the FET such a better experience meds wise and in my body too, wasn't bloated and sore from egg collection. I spent the two months between doing things I wouldn't be able to do when pregnant or with a baby "just in case" like running in the sunny early autumn and drinking cider at the pub with pals etc, just little luxuries that you don't realise are luxury til after :) try and enjoy the next few months for your first FET if you can, and finger crossed that snow baby sticks.

Just realised my fresh transfer was also in August and my FET in October so really similar timeliness too!

Thanks @Imisscoffee2021, hopefully that's a little omen :). Yeah I think we'll need to embrace life a little again, it's been on hold for a really long time. Can I ask if you did anything differently before your frozen transfer? I'm considering taking a probiotic for good bacteria and maybe starting acupuncture. I also have a blocked tube and don't know if it's a hydrosalpinx- perhaps that impacted too. Just overthinking everything today xx

@Eagerlywaiting1990 I took a high dose vit d and then just before transfer began lubion as I have borderline progesterone and wasn't absorbing much from pessaries. nothing else different except the protocol is easier on the body so didn't feel as wrung out.

Hi all,

@Eagerlywaiting1990 and @Imisscoffee2021 I've just had a failed fresh transfer too 😢, I'm so sorry for you both too 🙁. I started spotting at 9dp5dt, light period at ODT then really heavy bleeding after that. All whilst still on progesterone pessaries. I was also wondering whether a FET might have been better. Even though they didn't get many eggs (they grew asynchronously) 9 follicles were recruited which I didn't think was bad (I also have low AMH). I know my oestrogen levels were sky high from my symptoms. I got a migraine at 7dp5dt which was identical to the ones I get before each period due to rapidly falling oestrogen levels and all my symptoms disappeared so I was kinda worried it might not have worked from that point. Maybe they dropped because my body knew implantation had failed or could it be they were so high my body freaked out and told my ovaries to stop producing it? I'm not sure that's even a thing but it feels like that's what my body does every month! I know you need more oestrogen in pregnancy but I'm not sure you need as much at the start as most ladies probably produce after ER.

We will go again and I'm really hoping we get more than one embryo this time so I can see how a FET compares to a fresh for myself.

So sorry @JenRi , especially as you have to do another round. So many possibilities for why but your story of a migraine ans then bleeding before odt is exactly like my own fresh transfer and why I got lubion injections for my FET as I just wasn't absorbing the progesterone well in the pessarkes, it was 35 when they tested and although that's a bit over their threshold it's still the lower end considering. Maybe something to ask about foe your next round?

If you get one embryo you can always request a freeze all and do a FET if you'd rather try that, there's added risk as some em reps don't survive the process of the thaw but they'd not freeze a low quality one probably and people have gotten pregnant from.those embryos before :) all the best foe your next round x

@Imisscoffee2021 not only do we have similar usernames, but your experience with the progesterone pessaries sounds the same as what I’ve just experienced after a fresh transfer… I started bleeding on 6dp5dt, I called the emergency line for my clinic and they told me to double up my pessary dose… when they tested my progesterone the next day it was at 35! And this was AFTER doubling the dose, so my progesterone must have really been low. And similarly, I believe I wasn’t metabolizing the pessaries well… I stopped feeling sore boobs 3 days before the bleeding started despite being on the pessaries. My transfer ended up as a biochemical pregnancy which has been pretty traumatizing. The current plan is to do a mock cycle where we do all the hormones injections/tablets for FET and just test my blood to see what the levels are at… I wonder if I should also just push for lubion injections from the get go… I’ve got only one euploid blastocyst left…

@coffeelover2023 that's awful, so sorry that was your experience :( definitely look into lubion if you aren't absorbing pessaries, not sure why some don't but I didn't and I was better on lubion. It was expensive (we went private due to waiting times) but worth it, was about £100 a week and I took til 12 weeks but at 12 weeks my progesterone was off the scale high due to the placenta making it too by thennso probably could have come off earlier. Good idea about a mock cycle before trying a FET with your embryo, hope that one goes better, the dismay at bleeding early is just so heartbreaking

@Imisscoffee2021 thank you so much for your insight. I ended up taking the lubion injections after the bleeding started with my fresh transfer and continued up until it was confirmed as a biochemical pregnancy, but I agree… worth it to possibly not have to go through that again. Did you end up taking any other medication besides the lubion for your FET? My doctor is recommending 3 chorimion (hcg) injections (spaced out) ahead of the transfer (it’s supposed to encourage your body to produce its own progesterone) and then pessaries to supplement… I’m still a bit weary of the pessaries, but I guess the mock cycle will give us a better idea of whether or not they’re working for me. Did they test your progesterone levels before and after your transfer?

sorry for all the questions, it’s just nice to talk to someone who has had a similar experience and is on the other side of it

@coffeelover2023 My first fresh transfer I started bleeding 5dp5dt and kept bleeding until OTD. My clinic weren't as good as yours - didn't suggest increasing progesterone or testing my levels. All my subsequent transfers were FETs, with Lubion (but only for 5 days before transfer and day of transfer) and all worked out much better (CP, 1 live birth, 1 current pregnancy) so I think it being frozen rather than fresh helps as your body is much less of a mess than after an egg collection! Wishing you the best of luck x