Implantation issues - treatments, causes?

[Anonymous]

Talk to me about implantation issues. We're finishing up our 3rd fresh IVF cycle after 4 natural IUIs and 3 clomid IUIs. All BFN. I'm fairly young - 29 (started trying when I was 25) - and both Shady Grove and CFA have been able to find nothing wrong with me. All numbers look good, regular cycles, regular ovulation, one blocked tube/hydrosalpinx removed years ago so that's no longer a problem. I'm healthy overall, this time had 9 good-looking embryos make it to blast and then to freeze, in addition to the 1 we transferred. The CFA doc recommended not to do PGS testing because of expense and my age and no known genetic issues at this time. I know I shouldn't test before my beta but I have and everything's coming up negative, so I'm pretty close to writing this cycle off as a wash.

But what comes next? We'll be moving on to FETs since we now have embryos frozen, but I worry that my issue is not with egg quality, etc, but with implantation. I've tried to do some research into what causes this/how you can treat it, but it's confusing, with some sources saying 90% of issues are egg quality, not sperm (we're using a donor with proven pregnancies) or implantation, and others saying endometrial scratches or supplements can help here.

I just worry that in three different fresh IVF cycles (never mind the 7 IUIs) we've gotten all the way to implantation with beautiful blasts and overall health and that's where it seems to have failed. I'm not a doctor, obviously, and I always defer to my doc's recs, but this is just what I'm observing. At this time, of course, I have no way of knowing if there are egg quality issues because we aren't PGS testing right now, but if it was implantation - can they do anything about that? What should I press for moving forward? I will of course have a WTF consult with my doc but I want to come armed with information. Any links or resources or personal experience you can offer would be much appreciated!

[Anonymous]

Are you with sacks? He told me not to PGS test for the same reason and all failed cycles. I liked him a lot but not the office. moved to SG and they worked with me and did PGS and I have a happy healthy baby now.

[Anonymous]

OP here. I am with Sacks, that's funny that that was your experience too. We had a REALLY bad experience with Shady Grove for two years so wouldn't be returning there, but I guess we could look elsewhere. We do like CFA a lot, though, but Sacks hasn't been too aggressive because everything "looks good." But I'm sure he would be comfortable with us doing PGS if we chose too. I just don't know if we have the additional money at this point, but it's worth considering. Did your problem end up being something that was PGS discoverable? Sounds like it worked for you regardless, congratulations! That's great.

[Anonymous]

You need to pgs test those embryos. At this point you don't know if it's an implantation issue if you haven't tested the embryos. Yes, it's expensive but not more so than additional failed cycles or even the first year of daycare.

[Anonymous]

Thanks for the recommendation. I definitely agree we don't know if it's implantation. I've been kicking around whether we should test and it's making more and more sense...we'll have to have that conversation, I think. Especially now having 9 (we didn't think we'd get any to freeze) - I don't want to go through 9 experimental transfers just to find the one that works. After almost 4 years of trying I don't know if I have the stamina for that. PGS seems like it's the way to go.

[Anonymous]

Anonymous wrote:Thanks for the recommendation. I definitely agree we don't know if it's implantation. I've been kicking around whether we should test and it's making more and more sense...we'll have to have that conversation, I think. Especially now having 9 (we didn't think we'd get any to freeze) - I don't want to go through 9 experimental transfers just to find the one that works. After almost 4 years of trying I don't know if I have the stamina for that. PGS seems like it's the way to go.

It does. I'm unaware of anyone who regrets pgs testing.

[Anonymous]

Wow I'm in the same boat. I'm going to CFA for a consultation. I have the same issue- implantation. My embryos never got tested because my RE didn't see the need to do so.

[Anonymous]

Anonymous wrote:Wow I'm in the same boat. I'm going to CFA for a consultation. I have the same issue- implantation. My embryos never got tested because my RE didn't see the need to do so.

I'd test. I had a lot of embryos and around 20-30 percent were abnormal. Had I had one of those abnormal ones transfered I wouldn't be pregnant now. I would have had to try another time and maybe another abnormal one would have been transfered.

I think they are doing you a disservice by not explaining this. Pgs can end up saving you a lot of time and money. For me, I just wanted to know if I had a problem related to implantation or staying pregnant. I figured pgs would rule out embryo quality.

[Anonymous]

may also want to try Dr Kwak Kim for immune issues.

[Anonymous]

Also was a patient of Dr. Sacks and he also did not recommend PGS testing. I was in my early 40s. Always had plenty of eggs, but usually ended up with out 3-4 embyros at the and, and never any embryos to freeze. So each cycle was starting a fresh.

I have become a convert to PGS testing. Also a former Sacks patient, and I liked him a lot, but I should have started with PGS testing. I would have at least been working with embryos of known quantity and we likely would have a baby by now.

My interpretation of how Sacks works is from the point of view that if nothing is else is wrong, if you keep transferring embryos, eventually one will work.
That's fine if you have 1) unlimited financial resources or excellent insurance, 2) unlimited capacity for the uncertainty each month, and 3) and are okay with transferring 2+ embryos at a time and multiples. Oh, and high possibility of miscarriage, because, I my case I was transferring untested embryos at 40+ (And did miscarry, the time we transferred three embryos. I still can't believe I transferred three!)

I so so so wish more than anything that I had done PGS testing from the start. I ended up going to an out-of-state clinic with aggressive PGS testing and single embryos transfer policies for a fourth and final IVF cycle, where I ended up with three Day 5 embryos (from 10 eggs retrieved) and only one tested normal. It did not work, alas. No knowing why.

I guess there could be implantation issues, but it's probably just luck, getting the right egg at the right time. (Which is how Dr. Sacks approaches it.) If I'd had the insurance coverage to do another cycle out of state, I would have. I just couldn't justify spending $15-17,000 out of pocket on something that only had 20 percent odds of success, even with PGS testing.

On to DE now, where odds are higher and results are guaranteed by SG...

[Anonymous]

Anonymous wrote:Also was a patient of Dr. Sacks and he also did not recommend PGS testing. I was in my early 40s. Always had plenty of eggs, but usually ended up with out 3-4 embyros at the and, and never any embryos to freeze. So each cycle was starting a fresh.

I have become a convert to PGS testing. Also a former Sacks patient, and I liked him a lot, but I should have started with PGS testing. I would have at least been working with embryos of known quantity and we likely would have a baby by now.

My interpretation of how Sacks works is from the point of view that if nothing is else is wrong, if you keep transferring embryos, eventually one will work.
That's fine if you have 1) unlimited financial resources or excellent insurance, 2) unlimited capacity for the uncertainty each month, and 3) and are okay with transferring 2+ embryos at a time and multiples. Oh, and high possibility of miscarriage, because, I my case I was transferring untested embryos at 40+ (And did miscarry, the time we transferred three embryos. I still can't believe I transferred three!)

I so so so wish more than anything that I had done PGS testing from the start. I ended up going to an out-of-state clinic with aggressive PGS testing and single embryos transfer policies for a fourth and final IVF cycle, where I ended up with three Day 5 embryos (from 10 eggs retrieved) and only one tested normal. It did not work, alas. No knowing why.

I guess there could be implantation issues, but it's probably just luck, getting the right egg at the right time. (Which is how Dr. Sacks approaches it.) If I'd had the insurance coverage to do another cycle out of state, I would have. I just couldn't justify spending $15-17,000 out of pocket on something that only had 20 percent odds of success, even with PGS testing.

On to DE now, where odds are higher and results are guaranteed by SG...

OP here. Thank you for sharing your story. I didn't realize this was a recommendation Sacks made across the board - I know one couple who also worked with him and did PGS testing, but now I'm thinking they must have pushed for it. I wish you the best of luck with DE.

I think I would feel better if we conducted PGS testing on our frozen embryos before moving on to FETs, and this is a conversation my partner and I have been actively having - but that opens up a whole new round of questions. Can they do testing "after the fact," since we didn't choose to do it initially when they were fresh/first frozen? Would we run the risk of losing some just to the process itself, not just discarding them because of abnormal results? I'll admit I don't know anything about PGS because we've put it aside for the last year at the doctor's recommendation. Any information you guys could provide would be helpful, and I'll start researching on my own this afternoon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Also was a patient of Dr. Sacks and he also did not recommend PGS testing. I was in my early 40s. Always had plenty of eggs, but usually ended up with out 3-4 embyros at the and, and never any embryos to freeze. So each cycle was starting a fresh.

I have become a convert to PGS testing. Also a former Sacks patient, and I liked him a lot, but I should have started with PGS testing. I would have at least been working with embryos of known quantity and we likely would have a baby by now.

My interpretation of how Sacks works is from the point of view that if nothing is else is wrong, if you keep transferring embryos, eventually one will work.
That's fine if you have 1) unlimited financial resources or excellent insurance, 2) unlimited capacity for the uncertainty each month, and 3) and are okay with transferring 2+ embryos at a time and multiples. Oh, and high possibility of miscarriage, because, I my case I was transferring untested embryos at 40+ (And did miscarry, the time we transferred three embryos. I still can't believe I transferred three!)

I so so so wish more than anything that I had done PGS testing from the start. I ended up going to an out-of-state clinic with aggressive PGS testing and single embryos transfer policies for a fourth and final IVF cycle, where I ended up with three Day 5 embryos (from 10 eggs retrieved) and only one tested normal. It did not work, alas. No knowing why.

I guess there could be implantation issues, but it's probably just luck, getting the right egg at the right time. (Which is how Dr. Sacks approaches it.) If I'd had the insurance coverage to do another cycle out of state, I would have. I just couldn't justify spending $15-17,000 out of pocket on something that only had 20 percent odds of success, even with PGS testing.

On to DE now, where odds are higher and results are guaranteed by SG...

OP here. Thank you for sharing your story. I didn't realize this was a recommendation Sacks made across the board - I know one couple who also worked with him and did PGS testing, but now I'm thinking they must have pushed for it. I wish you the best of luck with DE.

I think I would feel better if we conducted PGS testing on our frozen embryos before moving on to FETs, and this is a conversation my partner and I have been actively having - but that opens up a whole new round of questions. Can they do testing "after the fact," since we didn't choose to do it initially when they were fresh/first frozen? Would we run the risk of losing some just to the process itself, not just discarding them because of abnormal results? I'll admit I don't know anything about PGS because we've put it aside for the last year at the doctor's recommendation. Any information you guys could provide would be helpful, and I'll start researching on my own this afternoon.

Yes, you should be able to test now.

No, you shouldn't worry about damage to the embryo. There is always a risk but I think the risk is very very low. The risk you'll transfer an abnormal embryo if you choose to not do pgs testing is much higher.

Fwiw, I've read some Fet success rates are higher than the fresh cycle success rates.

[Anonymous]

There is a big risk with thawing testing freezing and thawing. It's very traumatic for the embryos. But if you have a lot it may be worth Itz

[Anonymous]

It's no longer a "big risk" to thaw and PGS test and refereeze. Happens all the time -- search for it in this board. With her IUIs and IVF, OP has been through what, eight cycles? That's a lot. You've been through the wringer with the ups and downs of all those IUI cycles. It takes a toll.

PGS testing may not solve everything, but it could also cut down on additional unnecessary cycles because you'll have more certainty about the embryos you are transferring.

Good luck!!!

[Anonymous]

Anonymous wrote:OP here. I am with Sacks, that's funny that that was your experience too. We had a REALLY bad experience with Shady Grove for two years so wouldn't be returning there, but I guess we could look elsewhere. We do like CFA a lot, though, but Sacks hasn't been too aggressive because everything "looks good." But I'm sure he would be comfortable with us doing PGS if we chose too. I just don't know if we have the additional money at this point, but it's worth considering. Did your problem end up being something that was PGS discoverable? Sounds like it worked for you regardless, congratulations! That's great.

Pp here. I was "unexplained" and my issue was never figured out but what worked was doing the FET on day 7. PGS was just extra precaution I suppose. Before all this I had multiple chemical pregnancies and bfn's. If you are interested in staying at CFA just push for PGS with Sacks. Good luck to you!