Three failed rounds of IVF and time to talk to the doctor

[Anonymous]

We recently had our third failed IVF (one fresh, two frozen) and are planning to meet with our Shady Grove RE to discuss next steps. Our diagnosis is male factor, we used ICSI and assisted hatching, I responded well to ovarian stimulation in the fresh round, hormones always look great, lining looks great, embryos look great, and then no implantation. I'm 34, husband is 41. I'm planning to ask the doctor if I should get another HSG (it's been more than a year) to see if anything wonky is going on in my uterus. Then I think we should probably be doing some more genetic testing of me and my husband. As I understand it, the Counsyl test doesn't go very in-depth. I'm not sure if PGD would be recommended at this time. It seems like we are either very unlucky or something has to be going on with those embryos that can't be deduced visually.

Anyone have thoughts? Want to commiserate?

[Anonymous]

I am sorry for what you are going through.
I would get PGS testing of the embryos done in your subsequent cycles: the test that screens all chromosomes.

[Anonymous]

Anonymous wrote:I am sorry for what you are going through.
I would get PGS testing of the embryos done in your subsequent cycles: the test that screens all chromosomes.

Posted too soon: visual inspection of the embryos is not enough to distinguish the chromosomally normal ones. You are still young, which is why they probably did not bring up PGS earlier. But it may be a good idea to make sure that you are implanting known normals.

[Anonymous]

What's your TSH? Have you been tested for thyroid antibodies and blood clotting factor?

[Anonymous]

OP here: TSH is normal, everything is normal on my end. Is there some extra thyroid testing I should be asking for? The only things we know are wrong are motility/morphology issues, but since IVF with ICSI addresses that, I have no idea what is going wrong. I assume we can have additional genetic testing done on us first, before we decide about PGS/PGD. Naturally, insurance will only pay for it if one of us has a known genetic issue. Husband doesn't want to pay out of pocket for it. It feels like such a gamble to try IVF again without it, but the whole thing is such a gamble to begin with.

My beta was only a few days ago, so I'm still feeling miserable. I know what you mean about being "young," but it certainly feels like time just keeps getting away from me.

[Anonymous]

I am a lot older reproductive age-wise than you (both of us were 41 at the time of IVF), so not exactly the same situation. However our Counsyl tests did not reveal any problems. We needed PICSI and assisted hatching due to male factor. Out of 6-7 blasts in each of 3 cycles (all graded as 'good' visually) only 1-2 were normal by PGS testing each time.
PGS is expensive but so are repeated cycles and FETs.
If you have nt done so already, it may be helpful to take Coq10 for egg quality. Make sure your vitamin D levels are fine.My RE also suggested DHEA, but since that is a hormone check with your doctor first.

[Anonymous]

First, get tested for blood clotting factors!

[Anonymous]

Definitely do PGS testing. I was 33/34 years old and did 2 cycles of IVF and both failed. I was a great responder and always produced "beautiful" day 5 embryos. On my 3rd IVF cycle, I had 11 day 5 embryos PGS tested and only one was normal. My first FET was successful after transferring a normal embryo. Good luck!

[Anonymous]

I'm sorry you are so miserable. I will say that I don't actually consider that three rounds of IVF, because it was only one stim cycle, and all the eggs were from the same batch. I would ask about changing your protocol to get highare quality eggs.

[Anonymous]

I would definitely do PGS on your embryos. I would also push for another saline sonogram (probably had it done during your mock embryo transfer) or a hysteroscopy.you don't need an HSG. fwiw I'm at SG as well and my RE was open to testing my embryos after 2 failed transfer, 2/10 came back normal and I'm 31.

[Anonymous]

I would be very surprised if your RE did not suggest PGS testing at this stage. That will be a simple, albeit expensive step to make sure that you are putting in good embryos.
If this is all it takes, it can save you a ton of money and time pursuing other causes like immune issues.

[Anonymous]

Ask for a recurrent pregnancy loss panel to be done. It will identify many of the things others are suggesting you test for. Do not be discouraged. In actuality you did one IVF cycle and two frozen transfers. This is not the same as three IVF cycles since all of your eggs/embryos came from the same cycle. Ask your RE to run additional tests for genetic mutations, clotting, and immune issues and see what they would change for a second IVF cycle. You may also want to request your records and schedule consults with other practices. Good luck.

[Anonymous]

OP here: Yes, I should have said three transfers not three rounds, sorry. Although the way data is presented on success rates, it seems that number of transfers is the defining metric, not number of fresh cycles. (Am I misreading them?) Just feeling like a big failure over here, although I know I was lucky to have embryos to freeze and all that...

What would be a stim cycle protocol to produce higher quality eggs? I get the impression everything I've done so far is very "standard starting point" because I didn't have any trouble responding to it.

[Anonymous]

I agree with the previous posters who stressed the fact that all the eggs came from the same stim cycle. I would not rush to Pgd yet. Rather take some ubiquinol, add in some acu and then do another ivf fresh cycle. Perhaps add sgfc to add an endometrial biopsy in there as well.

[Anonymous]

I would do PGS testing. In fact, I think everyone should do it, regardless of age. Shady Grove has the package with RMA of NJ, and everyone should take advantage of it.

It reduces your chances of miscarriage, for one. And it allows you to transfer one embryo at a time, reducing the chance of twins. It boggles my mind that insurance companies that cover infertility don't insist on it, considering that the cost of twins is far, far more expensive birth and pregnancy, etc., than a single baby. Not to mention the lifetime expenses.

Transferring a tested embyro is no guarantee of success, but it's more of a sure thing than blindly flinging two or three embryos into your uterus.