Next steps after 3 failed PGS normal FETs?

[Anonymous]

Got the call today after my beta that our third FET with a PGS normal 6 day blast is most likely a chemical pregnancy. (Beta is only 28 at 9dp6dt). Our first FET in June with our only PGS normal from our first fresh IVF cycle resulted in a beta of 46 at 9d6dpt, and was a chemical. Did a second fresh cycle in August, and got two PGS normals out of five that made it to 6 day blasts. Complete BFN on the second FET with one of those. Now this third FET is a bust, too.

I am so devastated. And also pissed, since we're now upwards of $55K out of pocket. We are doing IVF because DH has cancer and the meds he has to be on, plus the chemo from his bone marrow transplant, makes natural pregnancy impossible. We banked sperm before the treatments started, and have to do ICSI. We have done ERA biopsy (receptive for 6 days progesterone, so - okay) and a hysteroscopy last month after the second failed FET (removed two tiny polyps, nothing major). I have been on Crinone 2x day and Estradiol 2x day for each FET, plus baby aspirin. Not sure what else to do at this point or even what questions to ask next week at the WTF appointment. My RE was very optimistic when we started that this would be a pretty easy process, with likely success with our first FET, as all my tests and levels are normal/good for my age.

I was able to conceive naturally five years ago and carry to term, but that took two years of trying and three failed IUIs at SG before a spontaneous pregnancy right before we were scheduled to start IVF. (We have since moved out of the DC area). Now I am 38 1/2. That experience, combined with my age and these current difficulties, leads me to believe there is some kind of underlying issues. But I don't know what. Dealing with the cancer, which is not in remission, plus this, is just like... can we catch a f-ing break?? Anyway, any thoughts or questions I should ask are very appreciated!

[Anonymous]

Age related egg quality? Try the egg quality supplements for 3 months (see It Starts with the Egg book)? Try a new clinic with better numbers (check SART data and compare the one you are using to one of the top clinics to make sure you are in a good spot)? Late 30s are hard for a lot of people as fertility rates drop... I'm sorry and good luck!

[Anonymous]

Anonymous wrote:Age related egg quality? Try the egg quality supplements for 3 months (see It Starts with the Egg book)? Try a new clinic with better numbers (check SART data and compare the one you are using to one of the top clinics to make sure you are in a good spot)? Late 30s are hard for a lot of people as fertility rates drop... I'm sorry and good luck!

She doesn't have egg quality issue. She had FET with PGS tested embryos.

OP - Have you had a full thyroid panel? Find an endocrinologist and get tested for TSH, T4, T3 and Hashimoto's markers.
Have you also been checked for STDs that cause low grade inflammation - chlamydia, gonhorrea, high risk HPV, mycoplasma/ureaplasma, BV?
There is also recurrent pregnancy loss panel that you should get done, that would screen for things like blood clotting disorders and folate absorption deficiency.
Do you eat and drink from plastic? If yes, eliminate those.

God bless you and your family.

[Anonymous]

Also think about doing an endometrial biopsy to determine when the best time to transfer is- some women need longer on progesterone and estrogen than the standard FET protocol

[Anonymous]

I'm so sorry OP! I don't have any suggestions but I hope you hang in there.

[Anonymous]

Thank you, everyone! I will definitely look into seeing an endocrinologist and having those tests done. We did have to do STD testing with our clinic, but I don't know how extensive it was. I will also ask my RE about the RPL panel. Is that just a blood test (or series of them?) I don't eat out of plastic much at all but I do drink a ton of water from mostly BPA-free plastic (guiltily puts down Camelbak bottle.) I will switch to stainless steel.

To the 07:51 PP: we did do the ERA biopsy right before the first FET and it came back receptive, so luckily that's ONE thing ruled out. : /

22:39 PP: I had ignored all the talk about It Starts with the Egg because I foolishly thought I would be fine given all my levels/tests were good. However, I definitely would like to be getting more than 1 or 2 normal blasts from the four or five blasts that make it to day 6 if at all possible; so we have more to work with. I'll look into adding the supplements and other changes that could help. I was already on DHEA last retrieval cycle.

Our clinic is in the top 5 in TX per SART data, so I don't have many better options locally, unfortunately. I am considering switching even though I love my RE; he's widely published, very active at conferences and in clinical trials, and the office is convenient DH is super frustrated at this point and basically does not want to do any more cycles unless we can do a shared risk program, which our clinic doesn't offer in any way; he's stressed about the costs and I don't want to add more stress to his plate. Today I am going to call around both in-state and out of state to see what shared risk programs (if any) I could still get under the wire for at age 38 1/2. I don't know if my two CPs or the three failed FETs would disqualify me from most of them. We're already traveling so much for DH's cancer treatments and appointments that I'm reluctant to throw more scheduling and cost issues into the mix... but, maybe there's a program that makes sense. We are in TX, so Denver wouldn't be too bad - and I see that CCRM actually has a new clinic in Dallas now. Friends have also recommend other clinics in Houston, Dallas and San Antonio - I need to look up their SART reports.

[Anonymous]

You might consider doing a phone consult with Dr. Braverman, who is an RI but also does IVF. The magic answer isn't always RI issues, but can be. And his guarantee program is expensive, but he works with so many women who have had repeat miscarriages that I highly doubt he would exclude you from that program.

[Anonymous]

Do the ERA biopsy. I had repeat chemicals with PGS embryos. Did the ERA and switched my transfer day and got pregnant right away.

[Anonymous]

Oops I see you already did that. Maybe worth trying it again with one more day progesterone and see what results day. The

[Anonymous]

OP - no suggestions from me, just wanted to say HANG IN THERE. Man - that is a really tough situation. I hope that it is successful for you and that your husband is in remission soon.

[Anonymous]

Really appreciate everyone's kind words and support. I will investigate a consult option with Dr. Braverman. Also furiously dialing clinics and asking about the rules for shared risk programs right now!

Dumb question on interpreting the SART data. In our situation now with 3 failed FETs, I want to look for the clinics with best success rates on FETs for my age group (38-40), right? As in, live birth rates with frozen embryos?

[Anonymous]

You've been dealt a really crappy hand. I'm so sorry!

I seriously doubt any egg quality issues. Losing 3 PGS normal embryos is a red flag for immune related problems, especially if you've done the ERA already. Some are picked up in the RPL bloodwork, which most REs will do at this point. Do you have any autoimmune disorders in your family? Otherwise, it would be great to find someone local to at least do some other immune testing for you. Braverman would be a good consult, but you will pay $3000 just to do the testing and talk to him. I think his website has a section where he lists "partners" and maybe there is somebody there in TX who would do it for you?

[Anonymous]

Thanks, 11:47! It's definitely been the worst run of bad medical luck for our family. I don't have any history of immune issues, nor does anyone in my family. Luckily I am pretty healthy overall- I don't even take anything besides prenatal vitamins and the usual fish oil, Vit D, etc! The stress of the cancer fight has made me put on about 20 pounds, though. My husband has cancer and also Crohn's disease, so there could arguably be something "there" in the frozen sperm, but I don't know how that translates to arrested embryos once transferred to me. Our child is male, and I have read on this board and others about "anti-male" antibodies that your body can create... not sure if that's a real thing. I could not find anything on Dr. Braverman's site about local partners, but I have read that SIRM does do some immune testing/investigation, and they have a clinic location in Dallas, so I will call them.

[Anonymous]

Hi again. Here's the list from Braverman's website of doctors who have "consulted" with him. This is one step in the process of being willing to partner with him. So this list doesn't mean these are people who will necessarily run immune bloodwork for you, but they are at least people who are friendly to the idea and it is worth asking them what they do:

http://www.preventmiscarriage.com/consulting-centers.html

[Anonymous]

Ahh, thanks for following up PP! I have a call into two of the folks listed. Unfortunately, I am running into bad news in researching guarantee/shared risk programs, because of my age (38 1/2) and my "failed" previous cycles. Not eligible at AF Chicago, not eligible for Attain's refund program, waiting on CCRM to call me back. Going to call Shady Grove too, although I did not have a good experience with them a few years back.