What testing to do ahead of transfer of euploid embryos

[sotif]

I’m thinking of doing some testing ahead of doing a transfer of euploid embryos as I have unexplained infertility, and if I can, I’d like to find a reason for the infertility before transfer so we can max the chances of success. Anyone done this or have any thoughts on doing this?

My doctor thinks it’s overkill and I should just try a transfer because "95% of euploid transfers work by the 3rd try" but I don’t want to waste precious embryos if there’s something we can fix beforehand.

It'll be my first transfer of a euploid but I did transfer an untested embryo in summer, ended in a miscarriage. This is why I'm doing PGTA testing despite being only 30 - I don't want to risk the heartbreak and wasted time by another miscarriage.

By testing I mean things like Fertilysis or ScreenMe for vaginal or uterine microbiome , or any blood test (should I do NK cells?).

I have a child, conceived naturally, 3yo. I am 30yo.

@sotif I'm in a somewhat similar position, I've got euploid embryos banked and preparing for a transfer now.

I've done LOADS of tests, including vagunal microbiome and NK cells. Microbiome tests are fairly simple to do and I've read a lot about how presence of bad bacteria can be a problem and can be treated, so that might be worth a go.

I've also been tested for thrombophyllia (blood clotting) an MTHFR gene test, various hormone panels... the big one for me was thyroid, never knew I had a thyroid problem until we did fertility testing but here it is, and because my thyroid antibodies were so raised i then got referred for NK Cell testing and found I have those too. If it wasn't for my thyroid results I wouldn't have done the NK Cell testing - unless there's a reason, like recurrent miscarriage or implantation failure, its not usually seem as needed (also its over £1000 so not one to do lightly!)

I think there's loads you could do, but a good clinic/consultant won't advise you to without a reason.. my doctor has spoken to me about EMMA/ALICE tests but as they're long and Invasive, that woukd be an option maybe if a pgta tested FET doesn't work out.

Another one I've done is hysteroscopy and saline imaging scans, but those have been to identify/remedy/check on scarring from D&C surgery so again, not relevant for everyone!

@Orangewillow thanks so much for this, super helpful!!

Firstly, which microbiome tests did you do? Vaginal or uterine? Which company (ScreenMe / Fertilysis / other) or was it through your doctor? If my doctor is reluctant , because he says it's a waste of money and time to do it unless there's failed euploid transfers , can I do it independently? (I'd rather waste money and time now , than euploid embryos and time later)

Also, blood clotting - how would I test that?

Thyroid I've checked and it's normal, thank you.

NK cells - how common are issues? Would you recommend to do it if I have no symptoms or indications? I don't mind spending more £ on it if it saves the precious euploids.

And most importantly, good luck in your transfer coming up!!! ❤️

Hi @sotif I had NK cells testing before my FET with a euploid embryo, it wasn't suggested to me by my consultant but I wanted to have it done bc I'd had a few chemical pregnancies and had wondered if it was an immune problem for me, I'm asthmatic and I get bad allergies, the idea of my immune system over reacting made sense to me. My Nk cells did come back elevated and I had steroids as part of my treatment. I'd say that if you don't have any immune related conditions you might not need to get tested, also if you've had a successful pregnancy and birth that shows your body's immune response is well modulated during pregnancy. Just my thoughts x

@sotif you're so welcome, happy to share any info that might help someone through this hard hard process!

I've done vaginal microbiome test through Invivo, it was about £200. I did get a Referral from an acupuncturist but you might be able to just buy one. Daye sell them online too. My clinic did say vaginal microbiome results might not be the same as uterine, but to do that involves a biopsy and they don't think that's needed based on my current picture, might be worth a discussion with your clinic to see if they think it's worth it. Mine said as we have several embryos and I don't have recurrent implantation issues, they don't feel its necessary. A vaginal one is easy and not too expensive and at least that would give you an indication of whether you have a microbiome issue or not.

Blood clotting test was done through my clinic, it's just a blood test.

No idea about how common NK cells are I'm afraid. Reproductive immunology seems a bit of a grey area, I know the HFEA are a bit funny about ir and and don't generally recommend routine testing for it without some kind if indication its needed (such as other blood results or recurrant implantation failure/recurrent miscarriage). I honestly wouldn't have even thought about it if my thyroid antibodies hadn't been picked up and indicated there might be something else going on. Speak to your clinic and see if they know much about it and have a view!

Thank you! Have had a FET cycle abandoned a couple of weeks ago, hopefully gearing up for another attempt soon, hopefully this one goes better and my lining plays ball this time

No asthma or allergies for me... I've had a chemical pregnancy (? Or would it be a miscarriage if it's 6w?)
So maybe that's something I leave until I've had at least 1 transfer fail.

@Orangewillow thanks so much for all the info.

So if you're interested in uterine microbiome there's a company called Fertilysis who (claim to) test it to the same extent that a biopsy would, except they just do a swab, but I just can't get my head around how they could test the same thing with a swab as others do with a biopsy, and if the swab is just as reliable as a biopsy... why haven't all the fertility clinics swapped to swabs? Surely that's easier and less invasive. Not sure whether i can trust it but maybe it sounds a little too good to be true.

Ive done the Daye vaginal one actually, just waiting for results.

Ah ok, if HFEA aren't keen on reproductive immunology maybe I hold off for now and see how one transfer goes. Just don't want to waste the euploids I've worked so hard to get!

Fingers crossed for your lining 🤞

I didn’t do any and I’m now 19 weeks pregnant with the first euploid transfer. I’m a bit older than you though (37 at time of collection so prob age related). Unexplained secondary infertility and was trying for 3 years before doing the ivf. I had a 4 yr old conceived naturally at time of ivf plus one miscarriage 2 years before.
i strongly considered getting tests beforehand as i kept imagining all sorts of reasons why I couldn’t get pregnant and like you, I didn’t want to waste precious embryos , I still wonder why I couldn’t get pregnant naturally as I think I had an average amount of euploids and embryos for my age. I decided to go for it as my clinic didn’t recommend any further tests and I was lucky. I would consider going ahead with a transfer and then review after that.

@Cornflakes123 thank you!! This gives me some hope! I think part of the issue is that if you read fertility forums, by their very nature, these have a lot of women with fertility struggles / failed transfers of euploids (because those who had one easy transfer, followed by an uneventful pregnancy often leave) , so although the statistics suggest that 95% of women will find success within their first 3 euploid transfers, the fertility forums give a different picture.

I feel the same, in that my euploids statistics are pretty good (72% of embryos sent for testing were euploids) so I can't help but think it's my body not "welcoming" the embryos, something wrong with my uterus or lining or something else.

I have had 3 full cycles of ivf, transferred 2 untested embryos that didn't work then 3 euploid embryos...the first one didn't work. The second one I had really low progesterone so they added lubion injections and then because there was a history in my family of clotting they added in clexane. This resulted in our little boy. Had the 3rd euploid put in to go for a sibling, exactly the same medication and it was graded better than our little boy but it didn't work! So that completely threw us as we almost had an expectation that it was going to.

I did also have the Alice/emma/era tests which came through fine but I was also taking women's probiotic tablets everyday, which I still take.

Now going through 3 full cycles again in the hope of having a sibling for our boy.

Hi OP @sotif how did you get on? I’ve just had my first failed FET with an euploid and quite upset. I have more banked but wondering what tests I maybe need.

I’m in the same place- clinic suggested do another collection, then while waiting for my PGTA results do a blood test for NK and clotting. Happy they are willing to test something. But I might do a screenme uterine test myself too just to be more informed before a potential transfer of a euploid

Hey @sotif. Good idea. If you are doing ivf with a male partner have they had any tests? I recommend they get checked for a varicocele and if one is found get a sperm dna frag test and consider embolisation. My husband has just been found to have this despite a normal semen analysis. Male factor infertility accounts for half of all infertility cases. I do not have enough positive words to say about Professor Jonathan Ramsay if you or anyone else reading this does want to see a urologist.

Professor Ramsay also recommended I do the Screenme vaginal microbiome test btw and I have mine here ready to do. Just need to wait till I come off my progesterone pessaries to do it and send it off. Looks easy though - just a swab you can do at home.