Implantation Failure - What more can we do?

katie35

Hello,

We just had our 4th failed round of IVF and I am at a complete loss as to what to do next.  I am hoping that someone may have suggestions or thoughts on what we might be missing or what we could do differently.

To give you a little background....long story short, we found out a few years ago that due to my husband being diagnosed with CBVAD that we would have to go the route of IVF with ICSI if we wanted to get pregnant.  Our fresh cycle started off great.  They retrieved 25 eggs and we ended up with 12 embryos.  That first cycle they transferred two high quality embryos but unfortunately we ended up with a chemical pregnancy.  Our next round we did an FET with a suppression cycle.  The embryos this time around were not as good of quality and my lining was a little thin so I wasn't surprised when it ended with a BFN.  The next round we did another FET suppression cycle.   This time around the embryos looked great and my lining was spectacular.  I think the fact that I changed my diet and started acupuncture really helped my lining.  Unfortunately, this once again ended in a BFN.  After this cycle we decided to do some further testing.  We did a sonohistogram which looked fine.  I had several labs drawn: T4, TSH, Thyroid Peroxidase Antibody, Rubella Antibody, Prolactin, Factor V Leiden DNA, Beta-2 Glycoprotein Antibody, Lupus Anticoagulant, Cardiolipin Screen.  All of them came back normal except for the Thyroid Peroxidase.  For this they put me on Synthroid.  Since there is not really a clear reason as to why it hasn't been working we tried a few different things this last round.  Rather than doing a suppression cycle we switch to a stimulation cycle.  They put me on a resistant uterus protocol which included Ibuprofen, Xanax, and prednisone from the time of transfer until the pregnancy test.  They also did intrauterine HCG this round with an endometrial scratch.  Everything seemed to go really well.  Again my lining was great (thank you acupuncture) and the embryos were beautiful.  However, we still received a BFN. 

We still have 4 embryos left which I am very thankful for, but I am so scared of losing them if we don't figure this out. 

Has anyone had any testing done which was not mentioned above?  Or is there anything we can do differently during our cycle/transfer?

Thank you all and I appreciate any insight you might be able to share!

mtpbadger

I'm so sorry you've been through all this! I had threee IUIs with one BFN and two chemical and then two FETs, one BFN and a chemical and my third FET was cancelled due to lining issues. I just had an ERA (endometrial receptivity array) done to see if the lining is recepetive at the time of transfer. Some ppl need one less day or one extra day of progesterone to be "ideal" for implantation. 

My RE also wondered if there was any inflammation of the uterus and had me try a cycle with a steroid as well as a blood thinner (lovenox) which is the FET cycle of my chemical pregnancy. 

I also just sent an email to my RE asking about testing for natural killer cells and the MTHFR gene defect to see if those could be underlying issues. I'm waiting to discuss those further tomorrow but will share if I move forward with those or anything else. 

oxinfree

Have you had a full immune panel done? It's somewhat controversial but generally speaking treatment would be IVIG and/or neupogen. Otherwise you could always have a laproscopy for silent endo...  the only additional thing I could think of that you maybe haven't done is increasing bloodflow to the uterus by using lovenox like @mtpbadger mentions. If you have MTHFR the only thing is to switch from folic acid to methofolate so that's easy enough to do as a precaution. 

I'm so very sorry. I'm coming up to my 4th transfer now and also running out of ideas. If we're unsuccessful we plan on having a laproscopy to see if I have endo, and then if so clean up and try again. If not, go the route of surrogacy.

kangastein

I have I have a similar situation but we are blaming the embryos. Without PGD testing we have no idea if they've been good or not. I suggest you try another cycle of IVF and PGD the embryos. That said, we are trying steroids and Lovenox this cycle also

adirat

@katie35 I'm so sorry for what you are going through. The abnormal thyroid antibody bloodwork is a red flag for me -- have you seen a regular (not reproductive) endocrinologist to treat your thyroid?

Just adding synthroid often isn't enough. Synthroid may not be the right medication for you (I did not do any better on synthroid but when I got on levoxyl, which is the same active ingredient in a different formulation, my whole life changed). Also, the antibodies may indicate a larger autoimmune problem that an endocrinologist could help you figure out. Good luck!

2MomsHoping

Have all of your transfers been from the same retrieval?  After our second chemical in a row my RE said that sometimes my eggs can be compromised by the stimulation protocol or might just might be bad as an underlying issues not detected before in testing.  Like @kangastein mentioned, if I were to try a second stimulation I would do a different protocol and would opt for the PGD to prevent transferring ones that are unlikely to make it. 

katie35

I am sorry for what everyone is going through:(   Thank you all so much for being willing to share some of your story and experiences with me.  It is very appreciated!

@mtpbadger, thank you for all of the information!  I am interested in speaking to my RE about the ERA testing as well as learning more about the mthfr gene and natural killer cells.  I had done a little reading on the natural killer cells before but my RE hasn't sounded very interested in going down that road previously.  Maybe something to bring up again.  The ERA testing and mthfr testing are both new concepts to me and I am looking forward to speaking with my provider about them!  I did some research on the ERA testing and it sounds like it could have the potential to be promising.  If you don't mind me asking, have you received any information back on your ERA results yet? 

@oxinfree we have not done a full immune panel.  I did bring up immunity issues previously to my RE but she kind of brushed that off.  She basically said that there isn't a lot of good evidence out there around it.  However, I think I want to bring it up to her again.  And I have never heard of silent endometriosis.  Definitely something else I want to look into/ask about!  Good luck with your upcoming transfer!!

@kangastein I have heard of PGD testing before but this is also something that is a fairly new concept to me.  Is this something you have done previously or are you planning to try in the future?  I am just curious as to the process around it.  For example, how long does it take for the test results to come back?  I am assuming they would wait for the results before they transfer?  Or do they not do the testing during an IVF cycle?  Good luck with your cycle!

@adirat I have not seen an Endocrinologist, just my RE.  I did ask the office if I should be referred to an Endocrinologist and they told me it wasn't necessary.  However, I still kind of feel like it would be a good idea (for the reasons you listed above and for long term management).  Something else I should bring up to them again!

@2momshoping Thank you for the information!  Yes, all of the embryos were from the same retrieval.  That is good to know!  I never thought of the fact that the eggs themselves could have been compromised from the stimulation/retrieval itself.  If needed and we decide to go down the road of another retrieval, this will definitely be something that I keep in mind!  And as for the embryos we have left, I think I do want to talk with my RE about the PGD testing.

Thank you all for your help!!

mtpbadger

I haven't gotten my results back yet but hopefully soon! There is a thread somewhere on here specifically about ERA testing as there were quite a few of us who recently had it done. 

I agree with others, definitely go see a medical endocrinologist as they deal with the whole endocrine system which can impact fertility whereas REs just deal with the reproductive portion. 

I didnt do PGD testing but it seems to take about 2 weeks for the results so you end up doing a frozen transfer. If I have to do another retrieval this is something that I will most likely do as I'm thinking my issues might be a combo of my lining and egg quality. 

Unfortunately there is still so much that is unknown about why things aren't always successful. I have 6 frozen embryos left but don't know if I have the stamina and strength to do that many more transfers, especially if there's no real explanation as to what is going on or other options.  My doctor has mentioned looking into surrogacy but said she's not ready to have a serious discussion yet with me but wanted me to have it in the back of my mind, just in case. 

NolaBeachBride

@adirat I have been fighting my thyroid for 2 years. My RE left me on Synthroid and my thyroid kept increasing. I found a naturopath who was the one who finally got my thyroid under control after 2 years. I'm on Nature-Throid. After only being on a month I felt so much better. My TSH had come down and my free T3 & free T4 were still
out of whack. TSH number really doesn't matter to doctors who know how to treat thyroid disease. My doc focuses on the free's. I know this may not be your predominant issue, but I guess my point in telling you this is you have to educate yourself on thyroid disease. I found a select few really know how to treat. Good luck to you!

katie35

@mtpbadgerthank you for pointing me to the other thread about the ERA testing.  It was really helpful!  Sorry you have to wait the whole weekend. But fingers crossed you get helpful results!