Ladies W/ Failed IVFs - Testing Question

patchen30 · April 2010

If you've had a failed IVF, what other diagnostic testing did you have done?

I was going to ask my RE about the following:

Anti-nuclear antibodies, Natural killer cells, Integrin 3 biopsy, Kareotyping/chromosome testing, Lap.

I asked my RE about all these tests before my IVF and he thought none of them were indicated. Seems like current thought is that a lot of them are only relevant with RPL. In your experience were any of these tests indicated after a failed IVF?

smilee · April 2010

I have really only had experience with karetyping, but that was only after 2 IVFs, 1 FET and 3 miscarriages. I know my RE would not have done this after one cycle ( not to diminish the awfulness of a IVF BFN which I am so sorry about. )

You could bring these tests up at your WTF and see what he says.

GL.

njdcgirl · April 2010

I didn't have any done (except we added ICSI in the last time). My RE was hesitant to give any dx after the first failed cycle (unfortunately, someone has to fall on the bad side of the odds....) but after the 2nd he suspected poor egg quality. He said he wouldn't have called that after only one failed cycle, but wanted to see a repeat of my embies crapping out by day 5 both times with different protocols.

I can't see it hurting requesting/asking about additional testing. But, based on what you have said so far about your RE thoughts on your cycle, they may not think it is necessary at this point. Good luck!

catery18 · April 2010

hi! I may not be the best help...b/c I have 4 failed IVF's but really never got a BFP (really low betas and bled on beta day every time)...I finally switched to a new RE and what I am doing is repeating my SHG, HSG and doing an edometrial biopsy...he said no on the above tests b/c he thinks its an embryo quality issue (as of right now)

so sorry for you ((HUGS))

lovemymonkey · April 2010

we had karyotyping done, but not until I had failed 3 IVFs and had a couple of losses. With one failed IVF, my RE just felt that I had fallen on the wrong side of the odds, particularly since I had responded so well to my protocol.

As for anti-nuclear antibodies, natural killer cells and integrin 3 biopsy... unfortunately my clinic didn't test for these things. They felt that the combination of the low odds of a patient actually having these issues (based on the fact that 95% of all multiple IVFers at my clinic that move on to donor egg get pregnant) along with the fact that there's no approved treatment for these issues (other than donor egg for the first two or surrogacy for the third), there really wasn't a point in testing for these things unless you wanted to for closure purposes.

GL!

OrangeSmoke · April 2010

I never had any of those testing done - I sort of just accepted fact that I made crappy eggs and needed a lot more to find a good one.

I would actually ask about co-culture at your wtf appointment, it's known to help with implantation issues.

NYC1216 · April 2010

I did not have any of those tests but am meeting with my RE for my WTF appointment at 5 so we'll see what he recs.

Which protocol did you use? What did he say about the eggs at transfer?

c1311 · April 2010

I'm so sorry about your negative. I know how awful it feels.

I had immune testing done before doing IVF (since I have endo and immune problems are associated with endo). I actually sought out a doctor who would test me for these BEFORE having RPL because my local RE didn't "believe" in it. My natural killer cells were normal, but I tested positive for antiphospholipid antibodies, so was treated with intralipids and heparin. Unfortunately I only have a miscarriage to show for it, so obviously there were egg quality issues as well. The fact that you have an immune related thyroid problem makes you more at risk for having elevated natural killer cells and APAs. Do you have endo as well?

There are only a hand full of labs that have tests sensitive enough to pick up certain positives. You should check the SIRM forums if you have any immune related questions (https://forums.haveababy.com/). The doctors there are great and answer questions.

Best wishes.

patchen30 · April 2010

njdcgirl:

I didn't have any done (except we added ICSI in the last time). My RE was hesitant to give any dx after the first failed cycle (unfortunately, someone has to fall on the bad side of the odds....) but after the 2nd he suspected poor egg quality. He said he wouldn't have called that after only one failed cycle, but wanted to see a repeat of my embies crapping out by day 5 both times with different protocols.

I can't see it hurting requesting/asking about additional testing. But, based on what you have said so far about your RE thoughts on your cycle, they may not think it is necessary at this point. Good luck!

I don't mean to pry, but what exactly does it mean to have embryos crap out on day 5 - do you mean they had all stopped growing by then? I'm just trying to figure out how they determine poor egg quality.

patchen30 · April 2010

OrangeSmoke:

I never had any of those testing done - I sort of just accepted fact that I made crappy eggs and needed a lot more to find a good one.

I would actually ask about co-culture at your wtf appointment, it's known to help with implantation issues.

Yep, I plan to ask him that. How did they know you had egg quality issues OrangeSmoke?

Sorry - I'm just trying to find answers here...you know how it is.

patchen30 · April 2010

NYC1216:

I did not have any of those tests but am meeting with my RE for my WTF appointment at 5 so we'll see what he recs.

Which protocol did you use? What did he say about the eggs at transfer?

Antagonist. He said the eggs were fine, that he didn't see any problem with the eggs, sperm or embryos.

gidge · April 2010

We did not do any additional testing after our first failed IVF. However, DH has had karyotyping done because he is azoo.

c1311 · April 2010

I don't mean to pry, but what exactly does it mean to have embryos crap out on day 5 - do you mean they had all stopped growing by then? I'm just trying to figure out how they determine poor egg quality.

Hope you don't mind me jumping in on this. My RE has done a CGH study on day 3 embryos and found that the ones that DON'T make it to blast are almost always genetically abnormal. So if an embryo doesn't make it to blast by day 5 or 6 that would mean that it was most likely abnormal. BUT that doesn't mean that all blasts are genetically normal. He does mostly only day 5/6 transfers to try to cull out more of the abnormal ones.

ccbanana · April 2010

Hi - Just wanted to say I am sorry you had the BFN today.

After our BFN I told my doctor I wanted no stone unturned. He just did a second lap and full blood test on DH and I. I don't have the list here, sorry.

Hang tight. There is a 50% chance the first IVF won't work... so it's entirely possible that you landed on the wrong side of the coin. I hope hope hope the next one works for you.

Hugs.

patchen30 · April 2010

c1311:

I'm so sorry about your negative. I know how awful it feels.

I had immune testing done before doing IVF (since I have endo and immune problems are associated with endo). I actually sought out a doctor who would test me for these BEFORE having RPL because my local RE didn't "believe" in it. My natural killer cells were normal, but I tested positive for antiphospholipid antibodies, so was treated with intralipids and heparin. Unfortunately I only have a miscarriage to show for it, so obviously there were egg quality issues as well. The fact that you have an immune related thyroid problem makes you more at risk for having elevated natural killer cells and APAs. Do you have endo as well?

There are only a hand full of labs that have tests sensitive enough to pick up certain positives. You should check the SIRM forums if you have any immune related questions (https://forums.haveababy.com/). The doctors there are great and answer questions.

Best wishes.

I actually have had APAs tested and they came back negative. As far as I know I don't have endo...I don't have symptoms of it but I've never had a lap.

patchen30 · April 2010

c1311:

I don't mean to pry, but what exactly does it mean to have embryos crap out on day 5 - do you mean they had all stopped growing by then? I'm just trying to figure out how they determine poor egg quality.

Hope you don't mind me jumping in on this. My RE has done a CGH study on day 3 embryos and found that the ones that DON'T make it to blast are almost always genetically abnormal. So if an embryo doesn't make it to blast by day 5 or 6 that would mean that it was most likely abnormal. BUT that doesn't mean that all blasts are genetically normal. He does mostly only day 5/6 transfers to try to cull out more of the abnormal ones.

Intersting. I had a day 5 transfer of 2 blasts...

froggietina · April 2010

I just had my WTF appointment on Monday. No additional testing for round #2. We are going to use donor sperm this time. Deciding if we should do IUI (12 % chance) or IVF (40% chance). We are leaning toward IVF.

njdcgirl · April 2010

patchen30:
njdcgirl:

I didn't have any done (except we added ICSI in the last time). My RE was hesitant to give any dx after the first failed cycle (unfortunately, someone has to fall on the bad side of the odds....) but after the 2nd he suspected poor egg quality. He said he wouldn't have called that after only one failed cycle, but wanted to see a repeat of my embies crapping out by day 5 both times with different protocols.

I can't see it hurting requesting/asking about additional testing. But, based on what you have said so far about your RE thoughts on your cycle, they may not think it is necessary at this point. Good luck!

I don't mean to pry, but what exactly does it mean to have embryos crap out on day 5 - do you mean they had all stopped growing by then? I'm just trying to figure out how they determine poor egg quality.

Not a problem asking questions at all. They didn't all stop growing, they were just poor quality by day 5, w/ fragmentation etc. even though they were always in a good place on day 3 and I had decent numbers. Here are my stats:

IVF#1: 12 retrieved, 7 fert, 3 poor quality blasts day 5, 2 trans; c/p

IVF#2: 20 retrieved, 10 fert, 1 blast day 5 (poor quality), 2 trans, BFN

(new RE) IVF#3: 7 retrieved, 7 fert, 2 blasts day 5, 2 trans, BFP.

I think my RE thought b/c of the low(er) fert, poor quality and low numbers still going on day 5 that I had egg quality issues. I am AMA, so that is somewhat to be expected. My last cycle, my RE changed up lots of things, including my diet, added accupuncture, metformin, and a bunch of other supplements (can't remember what they were off the top of my head). He thought the PCOS was messing with my hormones (even though I had normal insulin #s), which would cause egg problems and he addressed that. Something worked...although sometimes I think it is just a numbers game and I finally found the good egg.

Sorry for the long-winded reply!

OrangeSmoke · April 2010

patchen30:
OrangeSmoke:

I never had any of those testing done - I sort of just accepted fact that I made crappy eggs and needed a lot more to find a good one.

I would actually ask about co-culture at your wtf appointment, it's known to help with implantation issues.

Yep, I plan to ask him that. How did they know you had egg quality issues OrangeSmoke?

Sorry - I'm just trying to find answers here...you know how it is.

There are two reason I suspected my egg quality isn't so super duper. 1- I don't make a crap load of eggs like a normal PCOs patient. 2- I had nothing to freeze from my "fantastic" cycle (IVF3). They all kinda crap out (die) around day 5.

Co -culture helped all of my 4 lone embies make it to day 3 (which usually happens without co-culture too). We transferred the 3 best and I was SHOCKED the lone ranger made it to the freezer. So I really think it helped.

c1311 · April 2010

patchen30:
c1311:

I don't mean to pry, but what exactly does it mean to have embryos crap out on day 5 - do you mean they had all stopped growing by then? I'm just trying to figure out how they determine poor egg quality.

Hope you don't mind me jumping in on this. My RE has done a CGH study on day 3 embryos and found that the ones that DON'T make it to blast are almost always genetically abnormal. So if an embryo doesn't make it to blast by day 5 or 6 that would mean that it was most likely abnormal. BUT that doesn't mean that all blasts are genetically normal. He does mostly only day 5/6 transfers to try to cull out more of the abnormal ones.

Intersting. I had a day 5 transfer of 2 blasts...

Me too. And a hatching blast FET. Huh?

schoolsoutbride · April 2010

I did RPL testing (had a previous chem pg and then a 2nd one the cycle after the IVF failed.) Also did NK test. Am looking into intralipids and have written about it on my blog a bit if you want to see more. Also found out I have compound hetero MTHFR

MrsAMR · April 2010

After my third failed IVF I asked my RE to test me for everything. I don't think he actually tested everythin per se, but I know he tested chromosomes and some clotting disorders. That's when I found out about the MTHFR diagnosis. I'm treating that with extra folic acid. Everything else came back normal.

patchen30 · April 2010

njdcgirl:
patchen30:
njdcgirl:

I didn't have any done (except we added ICSI in the last time). My RE was hesitant to give any dx after the first failed cycle (unfortunately, someone has to fall on the bad side of the odds....) but after the 2nd he suspected poor egg quality. He said he wouldn't have called that after only one failed cycle, but wanted to see a repeat of my embies crapping out by day 5 both times with different protocols.

I can't see it hurting requesting/asking about additional testing. But, based on what you have said so far about your RE thoughts on your cycle, they may not think it is necessary at this point. Good luck!

I don't mean to pry, but what exactly does it mean to have embryos crap out on day 5 - do you mean they had all stopped growing by then? I'm just trying to figure out how they determine poor egg quality.

Not a problem asking questions at all. They didn't all stop growing, they were just poor quality by day 5, w/ fragmentation etc. even though they were always in a good place on day 3 and I had decent numbers. Here are my stats:

IVF#1: 12 retrieved, 7 fert, 3 poor quality blasts day 5, 2 trans; c/p

IVF#2: 20 retrieved, 10 fert, 1 blast day 5 (poor quality), 2 trans, BFN

(new RE) IVF#3: 7 retrieved, 7 fert, 2 blasts day 5, 2 trans, BFP.

I think my RE thought b/c of the low(er) fert, poor quality and low numbers still going on day 5 that I had egg quality issues. I am AMA, so that is somewhat to be expected. My last cycle, my RE changed up lots of things, including my diet, added accupuncture, metformin, and a bunch of other supplements (can't remember what they were off the top of my head). He thought the PCOS was messing with my hormones (even though I had normal insulin #s), which would cause egg problems and he addressed that. Something worked...although sometimes I think it is just a numbers game and I finally found the good egg.

Sorry for the long-winded reply!

Thanks for sharing. Did you have low AMH or high FSH or anything else to indicate egg quality issues? I have PCO too (but not the syndrome) and my RE hasn't wanted to do metformin b/c I'm not IR but that's interesting.

ccbanana · April 2010

Hi -

Since the egg quality discussion is going on I just wanted to tell you how they knew mine were bad. Both IVF cycles they saw half of my eggs being fertilized by more than one sperm. Obviously that does not result in an embryo. My RE said that when the egg is poor quality, they often see them fert this way.

GL

patchen30 · April 2010

OrangeSmoke:
patchen30:
OrangeSmoke:

I never had any of those testing done - I sort of just accepted fact that I made crappy eggs and needed a lot more to find a good one.

I would actually ask about co-culture at your wtf appointment, it's known to help with implantation issues.

Yep, I plan to ask him that. How did they know you had egg quality issues OrangeSmoke?

Sorry - I'm just trying to find answers here...you know how it is.

reason I suspected my egg quality isn't so super duper. 1- I don't make a crap load of eggs like a normal PCOs patient. 2- I had nothing to freeze from my "fantastic" cycle (IVF3). They all kinda crap out (die) around day 5.

Co -culture helped all of my 4 lone embies make it to day 3 (which usually happens without co-culture too). We transferred the 3 best and I was SHOCKED the lone ranger made it to the freezer. So I really think it helped.

Yeah I'm going to ask Spandy about co-culture. Were yours better quality on day 3 than they had been previously, like more cells?

I was concerned that I only had 2 blasts out of 10 embryos (and one was a really early blast) on day 5, but I did have a few more make it to blast by day 6. I thought maybe co-culture could help with that. I'm not sure the Dr. even thinks that was an issue though as he just kept saying my embryos were "good."

AlissaCell701 · April 2010

Hi! I hope you don't mind me responding.

Bur I also had 2 failed IVF's cycles before getting a BFP. We are diagnosed as MFI and I came back healthy. Each time my cycles failed there really weren't any answers why it didn't work. Which is so frustrating...

The only thing my RE could see clearly was that I was a slow responder (first cycle we did Long Lupron, 2nd cycle FET, 3 Antagonist). So when I did number three we made sure to up all meds and I stimmed for longer.

I truly hope you get the answeres you are looking for. I also know that your clinic is one of the best in country so hopefully they will have answeres for you as well..

njdcgirl · April 2010

patchen30:

Thanks for sharing. Did you have low AMH or high FSH or anything else to indicate egg quality issues? I have PCO too (but not the syndrome) and my RE hasn't wanted to do metformin b/c I'm not IR but that's interesting.

All my other numbers have been normal and tested multiple times. I think the whole "taking metformin if you are not IR" is highly debatable among REs. My OB and first RE didn't think it was necessary. I think my new RE puts almost everyone on it that has PCOS - along with major diet changes (I lost almost 20 lbs in the few months prior to my cycle...but was overweight to begin with.) His theory is that it is not so much about being a certain number or weight, but controlling the hormonal issues associated with PCOS with diet/met, and that the changes can impact egg quality fairly quickly.

beachbum1 · April 2010

We are also just coming out of a fail IVF cycle. I asked my RE about testing, but he did not seem to think that any of it would give us any real answers. He thinks it is my egg quality that is the problem and there really isn't a test for that. GL

MarriedaSportsNut · April 2010

...ticker warning...

We had 3 failed IVFs. It didn't take additional testing to determine what my problem was--poor response, crappy eggs. We switched to donor eggs and the only tests I had to re-do were STD blood tests and SHG.

kouiii · April 2010

Our RE didn't suggest any of them to us. She wants us to try again with better quality eggs first.

Ali212 · April 2010

Honestly, we didn't do any. The odds are that IVF won't necessarily work the first time and so after just 1, my RE wouldn't even recommend genetic testing given that the probability is that it may not work with the first cycle. That was their feedback to me -- even though it all looked good, it's not an efficient procedure and IVF doesn't always work 1st (or 2nd or 3rd) time around. After 3 failed IVFs, my RE still didn't reco genetic testing...I have crappy eggs (and not a lot) and we know that....they did have some protocol changes for #4 that involve hysteroscopy (just to see if going in sometimes 'helps' things) and an experimental drug that they've seen success with (in addition to standard IVF meds).

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