Third transfer failed

[PurpleLake]

Hi everyone

I've just had my third transfer fail. It was my last one from my first cycle. Feeling gutted and so deflated right now. After 2 MMC, followed by a year of infertility and now 3 embryos failing to implant I'm losing hope and feel like I've wasted so much time.

All tests have come back normal (we've had a lot), the only thing is that my AMH/AFC is on the lower end of normal range for my age. I also had hysteroscopy in the cycle before my last transfer.

Our consultant suspects chromosome abnormalities and I think will now suggest PGTa. I was hoping to start a fresh cycle in January but have been told they can't do the genetic counselling until end of Jan which means waiting two cycles!! This has really thrown me and although I think it's going to be the right thing to do, the wait seems unbearable.

Are there any other tests I should push for? Is PGTa worth the added wait?

Anyone in the same boat? I'm feeling more and more lonely on this journey.

Hello @PurpleLake I just wanted to say that I understand- we have now had 3 failed transfers now and it’s utter rubbish. We have also had PGTA testing suggested but have chosen not to yet as we have used access fertility, so each transfer doesn’t cost us much. However, if we do another egg collection will consider it. Hopefully someone else will come along to tell you something more useful about testing your embryos.

So in summary, I don’t have any useful information but I would like to say that you aren’t alone and you aren’t in any way wrong for feeling so deflated. I read something recently that I liked and so I will share it in case it helps you in any way:

wendymartin.org/2023/04/06/the-jellyfish-swarm-an-analogy-for-the-invisible-pain-of-infertility-and-miscarriage/

I'm so sorry, its brutal.

I did PGTA test my embryos, I'd had a known chromosomal issue in a previous pregnancy that ended in TFMR so when I wasn't getting pregnant again after ages, we did IVF with the testing at the forefront of the reasons why we thought it would be a good idea (I was also by that time 38 and aware risks increase). It is expensive, but the peace of mind to know we'd only be transferring genetically normal embryos was very important for me and thought it would save time in the long run and spending on potentially unnecessary transfers, as well as the emotional toil of course!

My first euploid embryo transfer didn't work, the stat I was given was 60-65% chance of it sticking and then if it does, miscarriage rate goes down to 11% (this might not apply to everyone's clinical picture, but what I was told) and then chance of it sticking in 2 transfers is 85%, so pretty good odds!

My 2nd transfer did work but if it hadn't I was going to do additional uterine environment testing. Great you've already had a hysteroscopy, if you've not done a microbiome test, that might be worth doing while you're waiting. There's emma/alice/era, but they're expensive and Invasive and I wasn't super convinced it would help (my Dr also didn't seem that convinced) so I did a vaginal.swab test to see if that threw up any issues, and did a one off session with a nutritionist to get advice on probiotics etc

@YourTipsyDog sorry you're going through this too. What are your next steps now?

We are also with Access and I think you have to pay a freeze all fee to do PGTa, unless you want to transfer one and then thaw, test and refreeze the remaining embryos. We technically could do this and still go ahead with the cycle in January but I think a freeze all approach is probably best if you're going to do it.

It's so hard to know what to do! It's a massive cost to do it and after paying out for so many other tests we are starting to feel the strain financially. Feeling frustrated that I'm being set back by my clinics appointment availability.

Thanks for sharing the link - mother nature is definitely out in full force! It really cuts deep and I feel like I can relate to fewer and fewer people as this journey drags on. It's like I'm desperate and in such a rush to do anything I can to get pregnant.

@Orangewillow it really is brutal! Great to hear you got a sticky one, it feels so impossible to me right now!

What were the timelines like for PGTA? If I'm not going to be able to start my fresh cycle until Feb, I expect it's going to be a while until PGTA is done and ready for FET. All the waiting and no answers is so painful. Maybe I just need to see this as a marathon not a sprint, but I'm worried my fertility is declining.

Hi @PurpleLake so sorry to hear what a rough time you’ve had.
We had our embryos PGT-A tested as I’m 39 and it was highly recommended by the clinic. I’m so glad we did because only 1 out of 7 good grade blastos (I think worst of the 7 was a 4BB) came back ok, which means we could’ve gone through 6 miscarriages or failed transfers before we got to the one that has a chance of sticking. In my clinic it took 2.5 weeks from the biopsy to the results. It is pricey but with the number of failed attempts I think it’s definitely worth considering. The delay, for me, would be worth saving myself from another failed transfer and the heartbreak that comes with it. Bear in mind your embryos are frozen in time and their quality won’t change, your age has little impact on it now, especially if you transfer an euploid! Wishing you all the luck!

At my clinic, they biopsied blastocysts on day 5 and we got the results in about 10 days, theyd said 2 weeks but was a bit quicker. We then could have gone ahead with transfer in next cycle, we had a break as it was Christmas and clinic closed

@zirafica thanks, I think it will be the right route for us now as we need answers. I'm just totally thrown by not starting in January and feeling frustrated that the clinic can't accommodate. It means I won't have a transfer until April!

I’ve also had 3 failed transfers - 2 euploid and 1 untested. PGT A is pretty quickly, I’ve had results back in under 2 weeks twice. The first one I transferred a fresh and tested the rest. How old are you? I tested 8 and 3 were abnormal - given transfers are £2.5k at my clinic (double if medicated) it was well worth it for me. It’s been pretty soul destroying!

Could you change clinic? Why can’t you start in January? X

Sending love ❤️❤️ I’m in the same boat with 5 failed rounds now.. seriously considering donor eggs now xx

@NiftyAmberLion sorry to hear that, great that you've got some in the freezer. I'm 34 but my AMH is 8 and AFC can range from 8-20 but usually on the lower end. I got 8 eggs from the first round and 3 made it to blastocyst. All untested and all failed to implant. Transfers are included in my package cost so it's just the time and meds costs.

I can't start in January as they can't do the genetic counselling appointment until end of January and I need to have that done before my cycle starts.

@Mrsblobby88 sorry to hear that, it's such a tough journey.

Interesting you need to have a genetic counselling appointment at your clinic, mine did not require this and it was a bit of a tick box to say we'd freeze all and test, I thought it was pgt-m where they're looking for a specific, known genetic issue (rather than chromosomal with pgt-a) where you needed genetic counselling, but I guess clinics differ, and it's very frustrating to have it hold you up

Yeah we had to have genetic counselling. I suppose you could still go ahead with a transfer but test the remaining embryos in the meantime not to lose time? Again, I’d definitely not want to transfer an untested embryo after so many attempts, but if you’re so worried about the timeline it’s an option!

Why do you need genetic counselling? I’ve done PGT A at 2 clinics now and neither required that! X

@Orangewillow @NiftyAmberLion I think it's to understand the implications of testing before we go ahead. It's really frustrating that this is the hold up as I've mentally prepared myself for January start.

@zirafica if we did this, we would have to test them after freezing as the genetic counselling appointment is too late. So this would cost more and means thawing and freezing twice. So frustrating..!

@PurpleLake not necessarily - you could thaw only the one you wanted transferred, and then thaw the rest for biopsy after you've had the genetic counselling

@zirafica yes that's true, although will cost us more to thaw and refreeze for biopsy. It also then has to survive the freeze and thaw process twice. I wish it was more straightforward 😂

@PurpleLake that’s true but there have been comments about how if an embryo can’t survive a thaw it probably wouldn’t have survived a transfer and led to a live birth. Again, for me totally worth the risk of avoiding further miscarriages.

Its such a difficult situation to be, I've had 6 failed transfers and when we do our next round I will definitely want to PGT test them as this has not been a possibility with the NHS.

I suppose the only thing to make you feel slightly better about waiting is its another month to prepare your body/eat healthy and work on egg/sperm quality before you have your next round. That's always what I think and makes me feel a little better with a wait. I have my fingers crossed for your next round.

@zirafica yes good point, I think either way we need to go ahead with PGTA otherwise we will never know

@Cesas sorry to hear that, can't imagine how tough that's been! Do you feel any further with knowing why it's not worked or are you still in the dark? Yes I guess you have to see the positives, there's just so much waiting involved!!

I definitely understand the panic about the additional time. It's so hard when you feel like you're stood still in life and time is slipping away but in the grand scheme of things, a few months really won't make any difference (I know it doesn't feel like that though). I used to try and reframe the enforced breaks as a time to get as healthy as I possibly could and preparing my body -following a high protein diet and exercising etc. I often found the break did my mental health the world of good too.

In terms of PGTA testing, we went for it after four failed transfers (two miscarriages and two BFNs). We felt like it would give us answers one way or the other as if euploid embryos kept failing then probably something else at play or if we couldnt create euploid embryos then we could move on to consider donor egg or sperm. We also moved clinics and rhe pgta testing took about 2/3 weeks to get results back. I had my egg collection 28 April and the transfer 10 July (was longer than expected as my period decided to go missing for about 6 weeks!). It worked and I am now 25 weeks pregnant and feel so incredibly lucky. It has helped ease the anxiety slightly with the pregnancy as well, knowing that the baby is chromosomally normal.

Best of luck with whatever you decide - its an awful journey and I do genuinely think everyone going through it is an absolute hero. Xx

@PurpleLake I don't know, I have stage 4 endometriosis so unsure if this is causing further immune issues or issues with implantation. Or it could be causing issues with the embryos. My clinic aren't really willing to do much else which is why I'm considering moving and going private and PGT testing the embryos to see if that makes a difference. To them they won't do further testing til ive had more failed transfer and then its just a hysteroscopy x

@FancyGoose that's amazing news. Did it explain why the first 4 failed? I'm hoping it gives us some answers or at least a clearer direction to look in. You're right, it is painful waiting when everyone else seems to be getting pregnant. It's been so long since we started trying and I'm desperate to resolve it. I think I'm not going to have a choice but to have a break so might try and get away for a bit but it's hard with the financial strain of it all.

@Cesas I hope you get some answers soon, it's such a long journey!

You mentioned having had lots of tests, but not which ones, so I'll write out what worked for me just in case it might help.

Our clinic had us check our DNA before we even started ICSI as at that point we had been trying for 2.5 years with no positive whatsoever. I think they checked if me or DH had translocations that could explain it.
After 3 failed transfers of high quality day 5 embryos the clinic recommended 3 more tests: check me for blood clotting disorders (there are several), and take a sample of my uterine lining to check for inflammation and natural uterine killer cells.
Turns out I had quite a few more killer cells that was considered normal and the hypothesis was that any embryo is seen as a potential foreign health threat and overwhelmed by the killer cells.
For my 4th transfer I got an intralipid transfusion and I also had to find a doctor to do more of those every 2 weeks after until the pregnancy reached week 12. That transfer was successful and I'm currently in week 25 and everything is developing fine, healthy pregnancy and healthy baby.

(We also tried embryo glue for the 4th transfer but the jury is still out on whether it actually does any good, but it was only 200€ and we didnt want to worry about what ifs should the transfer not work)

@PurpleLake my theory is that we probably didn't have any euploid embryos from any of the other rounds. I had had 3 egg collection prior and got 2 embryos from the first, 2 embryos from the second and 0 from the third. None of the embryos were amazing quality and I think we just weren't making good ones, although I will obviously never know as we didn't test. We got 6 euploid ones with our fourth egg collection and the first one worked.

Things we did differently were - my partner had an embolism on a varicocele vein (I think this was the biggest factor although we had previously tried a surgical sperm retrieval and that was when we got 0 embryos so who knows!), a different clinic that used a much more aggressive protocol drug wise - e.g. injected progesterone as well as pessaries whereas my other cycles were only pessaries and higher doses of everything, they also had me on clexane and baby aspirin and 5mg methylfolate supplements as I have mthfr homozygous Mutation (but previous clinic didnt think that was important), a different sperm selection technique for ICSI, embryo glue (new clinic did it as standard) and obviously testing the embryos. I also followed a fairly strict diet making sure my protein was over 30% and my carbs below 25%, although I had also been following it for the egg collection which resulted in 0 embryos. I will never know whether one of those things made a difference or whether it was all of them combined or just luck was on our side this time round but I do think testing helps give answers. If a euploid embryo failed or miscarried, we were going to move onto testing my uterine environment (emma/alice/era and NK tests but via biopsy rather than blood which is supposed to be more accurate) and if we didnt make any euploid we were going to move onto sperm donor.

Best of luck and do look after yourself. Try and enjoy the break and just focus on feeling like yourself and doing things you enjoy. I know it's hard and a hard time of year in particular though. A holiday would be lovely if you can swing it but yes, the cost of IVF can be crippling can't it.