"Perfect Embryos" (x 2) = BFN? Any Advice?

Margritli · May 2014

I haven't been around much lately, though I used to post a lot here. I am going through a bit of a tough time at the moment with IF. Our second FET with frozen embryos just failed and I am having trouble believing that this is ever going to work.

We live abroad and laws here mandate that embryos are transfer back after 2 days, so we have no way of knowing how the embryos would develop. PGD is also forbidden here (Welcome to the Land that makes IF hell). I suspect that this is our problem. In Dec., we transferred two "perfect embryos" (both Grades 1) at Day 2 and got BFN. In March, same thing. In May, again. What is going on? There is not even remotely a sign of implantation (i.e. Beta = <5) and I am looking for advice. The RE also doesn't have an idea and is surprised that it is not working in the least bit.

A little background: DH has a microdeletion and subsequent severe Oligospermia (ca. .1 -.3 Million). We had 10 eggs out of 12 fertilise with ICSI. Everything on my end came back normal.

We are looking at going abroad for treatment now, since we are legally not able to pursue more aggressive treatment here. But before that we have two more rounds, each with two embryos.

My questions: What should I be asking my RE at this point? (We didn't even get a WTF appt. this time around, which really upset me.) Is there anything that we should look for on my side (for example, something that might be keeping the embryos from implanting or killing them off in utero)?

I am so sad and lost at the moment. I didn't expect that with IVF it would be the same story over and over again. To top it all off, my MIL informed me the other day that DH younger cousin is pregnant and that maybe I am just "not meant to have children." I am obviously not talking to her about IVF again.

ETA: Sorry this turned into a novella.

hmz819 · May 2014

I'm sorry you are still fighting IF.

You could look into immune issues to see if there is anything on your end, but honestly with your DH sperm issues I think pgd/ccs testing is your best bet.

Twinkie0612 · May 2014

hmz819 said:

I'm sorry you are still fighting IF. You could look into immune issues to see if there is anything on your end, but honestly with your DH sperm issues I think pgd/ccs testing is your best bet.

I agree with all of this. Also you could look into testing your DH's sperm DNA fragmentation. Sometimes even if they pick a normal looking sperm the DNA is still messed up. There isn't much you can do for this, but sometimes lifestyle changes can help.

hopefulsprout · May 2014

I am so sorry you are having to deal with this. And the MIL on top of it? That's completely uncalled for. I'm not sure I'm any help other than to say I'm sorry and still very hopeful for you.

SKLH · May 2014

I'm sorry you're so frustrated. I will say from experience they need to at LEAST grow to day 5 before transfer. I had a similair experience as you with my previous RE who only transferred on day 3. We always had PEREFECT embryos on day 3 but I always ended with a BFN. We switched clinics. He said that between day 2-5 a lot of embryos will not make it and you want to wait to transfer b/c the "strongest of the fittest" will make it to day 5. We also added PGD testing and that was the lucky trick for us. I think you're making a good decision to to abroad where you have more options. I went through 5 transfers before it worked! Someimtes it just takes more time to find the right embryo. GOod luck to you!

raecheleblue1 · May 2014

I'm so sorry you are dealing with this and a tough MIL too. Our clinic has some research that has led them to move towards the 5 day transfer more and more because of they are stronger, similar to what another poster said earlier too. Good luck with your next steps and I'm sorry it's been so tough!

missmarypoppins · May 2014

I'm so sorry you're going through this. If financially possible I would really seek treatment abroad where you can let the embryos grow to day 5. It's so important to see which ones can make it to blast and still look good. ((( big hugs))) good luck!

airidh80 · May 2014

Absolutely ditto all the previous posters. "Perfect" at Day-2 tells you nothing; find a place that will allow you to transfer at Day 5.

You might consider doing an endometrial biopsy, just to make sure you don't have implantation issues. But honestly, I don't know that I would do it until I'd had a chance to see what Day-5 embryos look like.

Finally, I'm so sorry about what your MIL said to you. That was so completely out of line.

jbasore1123 · May 2014

I took this directly off the internet:https://www.womens-health.co.uk/intralipid-for-pre-implantation-pregnancy-failure-

Since most pre-implantation pregnancy loss is immunological, treatment by appropriate immunotherapies are applied and have been quite successful.

· Intravenous Immunoglobulin (IVIg) treatments have been shown to be quite effective in the treatment of implantation failure. It has been most beneficial to women who have been good embryo producers. Good producers are those who fertilized at least 50% of eggs retrieved and generated at least three embryos for transfer. It is usually administered six to seven days before embryo transfer, and again after a positive pregnancy test. Sometimes it is necessary to administer IVIg every three weeks until the end of the first trimester. The problems with IVIg are that it is a blood product that is obtained from pooled donor blood and each infusion costs between $2,000 and $3,000.

· Intralipid is now being used to help circumvent immunological pre-implantation pregnancy loss in women who have had abnormal natural killer (NK) cell levels or functions. Intralipid has the ability to suppress the NK cytotoxicity and stimulate the immune system to remove faulty signals from cytokines that can lead to pregnancy loss. It is also effective in enhancing live birth rates in women with elevated NK cells and a history of pre-implantation pregnancy loss. The advantages to Intralipid are its track record of being used for decades without side effects, the fact that it is not a blood product and it is relatively inexpensive - costing $450 to $700 per infusion.

Many fertility specialists are now recommending Intralipid infusions for their patients who are plagued with pre-implantation pregnancy loss due to immunological factors.

It stinks that you can't do PGD. It could be a problem with the eggs, which would only be proven with PGD. I had 3 perfectly rated embryos during my first round of IVF and after PGD we found out that all 3 were unhealthy.

Margritli · May 2014

Hi ladies, thank you so much for all the support, insight and advice. Many of you confirmed what I already suspected, which is that we are probably going to have to go abroad for treatment, adding another complicating dimension to this whole IVF thing.

@jbasore1123, thanks for the information about pre-implantation pregnancy loss - do you happen to know how they would test for immunological issues? Is it something long and invasive or a quick blood test?

I am worried about going abroad for treatment, spending the time and resources (both financial and emotional) and then finding out that the problem is something altogether different and being bumped back to square one.

Thanks, again, for all the help and advice. You are amazing.

Margritli · May 2014

@Twinkie0612, do you have any information/websites you could recommend about DNA fragmentation and lifestyle changes?

DH was on FHS injections for three months prior to our Dec. IVF cycle with the idea that this should improve his sperm quality (no idea what the scientific basis is for this, but medicine in Europe is a bit different - feels like voodoo magic sometimes...in a bad way). This did nothing for his numbers but he had a fertilisation rate that was way higher than expected (10 out of 12).

So I guess my question is would the DNA fragmentation show up with a low fertilisation rate or later in the development process of the embryos? With DH's DX, I think that there is a high chance of fragmentation being a problem, but I am just not sure what can be done about that. It seems unlikely that I will truly be able to convince DH to make lifestyle changes without evidence to back it up.

Twinkie0612 · May 2014

Margritli said:

@Twinkie0612, do you have any information/websites you could recommend about DNA fragmentation and lifestyle changes?

DH was on FHS injections for three months prior to our Dec. IVF cycle with the idea that this should improve his sperm quality (no idea what the scientific basis is for this, but medicine in Europe is a bit different - feels like voodoo magic sometimes...in a bad way). This did nothing for his numbers but he had a fertilisation rate that was way higher than expected (10 out of 12).

So I guess my question is would the DNA fragmentation show up with a low fertilisation rate or later in the development process of the embryos? With DH's DX, I think that there is a high chance of fragmentation being a problem, but I am just not sure what can be done about that. It seems unlikely that I will truly be able to convince DH to make lifestyle changes without evidence to back it up.

@Margritli From what I understand the first few days of an embryos development is dependent on the egg, this is why we suspect an egg quality issue for us, our embryos are always very poor quality by day 3. After day 3 the sperm takes over. I have read that embryos that look good on day 3, but arrest between day 3 and 5 can be a sign of a sperm issue. Honestly I haven't done much research into sperm DNA fragmentation or the treatment, but I think most recommended antioxidants, which may or may not have an impact. Sperm DNA fragmentation assay is on our list of tests if DH decides that he wants to try using his sperm if we move on to donor eggs. Here is a study that I found that looked into treating high DNA fragmentation: https://www.ncbi.nlm.nih.gov/pubmed/15867002.

jbasore1123 · May 2014

I imagine in would be blood tests for thrombophilic or blood clotting factors but you can ask your RE what he suggests.

Sunny B · May 2014

I'm so sorry. And your MIL, omg. How horrible!

Margritli · May 2014

Thanks, again, ladies for the advice. I will be looking into all of your suggestions.

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