Hi, OP. I (successfully) used Sacks and found him very receptive to what I wanted to do. One of my favorite things about him was that, though he had his own recommendations, he was WAY more flexible than SGA w/ protocol once it was clear I was informed/had options. If you push for PGS and explain why, he'll let you do it; if you push for immune testing and explain why, he'll let you do it; if you push for an ERA and explain why, he'll let you do it (in fact, he might be about to recommend that to you, if I had to guess). No implantation at all -- not even chemical -- would actually make me lean away from PGS as an explanation (many/most abnormal embryos will implant/give you a chemical) and towards immune issues, undiagnosed endo or your lining timing being out of whack. Good luck!

I'd push for ERA as well. I've had 4 failed IUIs, 1 Fresh IVF BFN, 2 PGS failed FET transfers and 1 untested embryo FET m/c, all with SG. After all of this madness I made my doctor come up with something different than the "let's just try again" approach. She recommended ERA and I also went to Abbassi for a second opinion who suggested looking into thrombophilia panel and anti-thyroid antibodies testing. Turns out I have MTHFR a1298c (homozygous) so I need extra FOLATE and B vitamins. Also, had high TPO antibodies and TSH was at 2.14, so been on thyroid for about 4 months. Followup testing for these found that my homocysteine is at 7 (<15 is good) and my TPO is still highish, but at least my TSH went down to 1.39. I'm happy with this.

We have 1 PGS normal and 1 untested embryo left. I don't want to waste them. I just spend the last 6+ months in ERA biopsy world as well, where we finally got Receptive after 6 days of progesterone (first at 5 days was pre-receptive. then we did another ERA to confirm the results that 6 was what we need, and so that came up as RECEPTIVE). So now we are in prep for our final FET where we will transfer both of the remaining embryos. We have our fingers TIGHTLY crossed that this will be the answer, but then of course implantation is such a black box, no on really knows. At the very least I can say I tried everything and tested everything to say I gave these last embryos the best chance they deserve.

Good luck to you OP!

Oh wow, congrats! I've got my fingers crossed that we finally figured it out, but not hoping *too* hard. I'm sure I'll be back on DCUM in a month or so to report on results!

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What about ERA testing? (I don't think I've seen that suggested yet.)

After our first retrieval we did three transfers, everything always looked great, but all BFN. After our second [ETA: retrieval] we did PGS, transferred one normal, BFN. Since then I have done three rounds of ERA testing and finally was found to be receptive with 7 days of progesterone. I'm doing another FET in two weeks, hopefully that is the one that sticks. If not, I may see about doing the immune testing. (I've consulted with Abbasi, but I'm not totally sold.)

you mean 7 days prior to FET? or smth else?

Right, instead of the standard 5. When I did 5 days the test came back "pre-receptive." When I did 7 it came back "receptive."

I've posted on here before (ERA biopsy thread). Wanted to say good luck!! This is exactly what worked for me. Did 3 IUI's, 3 fresh IVF's (2 chemicals) and 1 FET. Day 7 transfer did the trick!

I was 28 when I started treatments and had 2 failed IUIs, 3 failed IVFs and then got pregnant on my first FET. I was producing a good number of eggs but many weren't making it to the transfer day so Dr. Widra recommended PGS before my FET. It ends up one of the three of my frozen eggs was abnormal. The transfered the other two and I had a little girl. I have no reason for my infertility and no reason for poor egg quality (I'm healthy and under 30). Good luck!

Anonymous wrote:

Anonymous wrote:What about ERA testing? (I don't think I've seen that suggested yet.)

After our first retrieval we did three transfers, everything always looked great, but all BFN. After our second [ETA: retrieval] we did PGS, transferred one normal, BFN. Since then I have done three rounds of ERA testing and finally was found to be receptive with 7 days of progesterone. I'm doing another FET in two weeks, hopefully that is the one that sticks. If not, I may see about doing the immune testing. (I've consulted with Abbasi, but I'm not totally sold.)

you mean 7 days prior to FET? or smth else?

Right, instead of the standard 5. When I did 5 days the test came back "pre-receptive." When I did 7 it came back "receptive."

Anonymous wrote:What about ERA testing? (I don't think I've seen that suggested yet.)

After our first retrieval we did three transfers, everything always looked great, but all BFN. After our second transfer we did PGS, transferred one normal, BFN. Since then I have done three rounds of ERA testing and finally was found to be receptive with 7 days of progesterone. I'm doing another FET in two weeks, hopefully that is the one that sticks. If not, I may see about doing the immune testing. (I've consulted with Abbasi, but I'm not totally sold.)

you mean 7 days prior to FET? or smth else?

What about ERA testing? (I don't think I've seen that suggested yet.)

After our first retrieval we did three transfers, everything always looked great, but all BFN. After our second transfer we did PGS, transferred one normal, BFN. Since then I have done three rounds of ERA testing and finally was found to be receptive with 7 days of progesterone. I'm doing another FET in two weeks, hopefully that is the one that sticks. If not, I may see about doing the immune testing. (I've consulted with Abbasi, but I'm not totally sold.)

Previous poster here with the 2-year-duration infertility. I also had a male firstborn child and my pregnancy seems to have caused my immune issues, so I fit the pattern of secondary infertility immune issues. We have chosen not to treat however and just keep TTC on our own until I go into menopause, as well as doing acupuncture. It's unlikely to result in a pregnancy since my immune issues are so severe, but I did not feel comfortable with the level of treatment required for my severe level of immune issues.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:New poster here. I have repeat implantation failure and I got immune testing and was found to have immune issues big time. I'm struggling with secondary infertility though. I have one child who I got pregnant with easily the natural way. When he was 6 months old we started TTC again. Fast forward two years later, plus several failed infertility treatments later, and I never had another pregnancy (no miscarriages or chemical pregnancies). All my testing and my DH's testing was completely normal except for mild decreased ovarian reserve, which several REs weren't even sure I had (because my AMH tests and my AFCs never matched up).

But it made no sense to me that I got pregnant on the first try/healthy pregnancy and delivery and then started TTC when my son was 6 months old and nothing at all for two years. Then I remembered that several times during implantation time I would get weird flulike symptoms out of the blue (shaking chills, stomach cramps, nausea) for three hours and then it would all go away.

So I got all the immune testing done and it showed that my immune system is completely overactive and I have high/abnormal results for everything.

So I would suggest getting the immune testing done.

Wow, what a difficult time for you. Thank you for sharing your story. So do they think you developed immune issues after the first pregnancy, or just got very lucky somehow with having your first child? I have a long history of doctors trying to figure out if I have an autoimmune disease because of recurrent joint pain among other things, but nothing has ever been found for sure (definitely not RA, nor lupus or fibro, etc), but hearing these stories I'm wondering more and more if there's something latent that wouldn't impact my life but is majorly impacting my fertility. Definitely going to pursue testing. Thanks for this information.

The theory is that a first pregnancy, especially with a male fetus (which I had), triggers an underlying disposition to the autoimmune issues. (Of course plenty of people have similar issues without having a first pregnancy.) I have a clotting factor too which in retrospect makes sense -- I actually wound up in the ER with a minor clot 4 days after my son was born, but I did not realize there was a real issue until Abbasi ran her tests. Everyone said the clot was from the IV during labor and I'm sure it was, but now that I know there is an issue, it makes sense that I was more likely to develop a clot from the IV or whatever else.

I would definitely get the tests done before you proceed with any more cycles. If you're lucky nothing will turn up. If something does turn up, you can decide on whether and how to treat it before you spend more time and money on cycles that may be doomed if you have major issues and don't get them treated. I am definitely not out of the woods, and in fact have to get blood drawn every 2 or 3 weeks throughout the pregnancy so the various meds I'm on can be adjusted. But I am reassured that the docs are trying and I am not just out on my own like my previous pregnancies.

Sorry, PP here -- not the PP you were responding to -- but my story is similar!

Anonymous wrote:

Anonymous wrote:New poster here. I have repeat implantation failure and I got immune testing and was found to have immune issues big time. I'm struggling with secondary infertility though. I have one child who I got pregnant with easily the natural way. When he was 6 months old we started TTC again. Fast forward two years later, plus several failed infertility treatments later, and I never had another pregnancy (no miscarriages or chemical pregnancies). All my testing and my DH's testing was completely normal except for mild decreased ovarian reserve, which several REs weren't even sure I had (because my AMH tests and my AFCs never matched up).

But it made no sense to me that I got pregnant on the first try/healthy pregnancy and delivery and then started TTC when my son was 6 months old and nothing at all for two years. Then I remembered that several times during implantation time I would get weird flulike symptoms out of the blue (shaking chills, stomach cramps, nausea) for three hours and then it would all go away.

So I got all the immune testing done and it showed that my immune system is completely overactive and I have high/abnormal results for everything.

So I would suggest getting the immune testing done.

Wow, what a difficult time for you. Thank you for sharing your story. So do they think you developed immune issues after the first pregnancy, or just got very lucky somehow with having your first child? I have a long history of doctors trying to figure out if I have an autoimmune disease because of recurrent joint pain among other things, but nothing has ever been found for sure (definitely not RA, nor lupus or fibro, etc), but hearing these stories I'm wondering more and more if there's something latent that wouldn't impact my life but is majorly impacting my fertility. Definitely going to pursue testing. Thanks for this information.

The theory is that a first pregnancy, especially with a male fetus (which I had), triggers an underlying disposition to the autoimmune issues. (Of course plenty of people have similar issues without having a first pregnancy.) I have a clotting factor too which in retrospect makes sense -- I actually wound up in the ER with a minor clot 4 days after my son was born, but I did not realize there was a real issue until Abbasi ran her tests. Everyone said the clot was from the IV during labor and I'm sure it was, but now that I know there is an issue, it makes sense that I was more likely to develop a clot from the IV or whatever else.

I would definitely get the tests done before you proceed with any more cycles. If you're lucky nothing will turn up. If something does turn up, you can decide on whether and how to treat it before you spend more time and money on cycles that may be doomed if you have major issues and don't get them treated. I am definitely not out of the woods, and in fact have to get blood drawn every 2 or 3 weeks throughout the pregnancy so the various meds I'm on can be adjusted. But I am reassured that the docs are trying and I am not just out on my own like my previous pregnancies.

Anonymous wrote:

Anonymous wrote:I had multiple chemical pregnancies that were caused by immune issues. Ask Sacks if he can run the immune panel on you that Abbasi does for her patients. I agree with him on not testing the embryos, that is a waste of money.

Do you have a family history of RA or any autoimmune conditions?

I don't have a family history of RA but my mom's side has a ton of autoimmune issues...and the funny thing is, now that you've mentioned this, they've run multiple tests on me over the years since I have random flareups of joint pain, trying to identify RA, lupus, fibro, anything, but nothing's ever been conclusive. But I never thought that those might indicate an immune issue that could potentially impact pregnancy. So interesting. Thanks for bringing this up, I'm definitely going to pursue immune testing after everything you guys have said.

Poster who recommended Beers' book here. Definitely check it out in light of your family history. Autoimmune issues run in my family -- lupus, Sjogrens, rheumatoid arthritis -- but I've never had any issues, thankfully. Until I got tested for the miscarriages and turns out I have Hashimoto's, which is a thryoid autoimmune issue. Beers' book makes the point that the autoimmune diseases are sneaky and often manifest differently in different generations of the family.

I am lucky in that I was told my issues probably won't significantly impact my life other than pregnancy difficulties. Of course, when you're trying to have a child, even that still sucks!

Good luck OP. If you're comfortable sharing I'm sure we'd all be interested in knowing if the immune testing does turn up anything. And Abbasi has a good track record for treating the issues, depending on their severity I suppose. The best in the area is reputed to be Braverman in NYC -- but he runs his practice like a concierge service and we could not afford his fees (and didn't want to travel to NYC).

Anonymous wrote:

Anonymous wrote:New poster here. I have repeat implantation failure and I got immune testing and was found to have immune issues big time. I'm struggling with secondary infertility though. I have one child who I got pregnant with easily the natural way. When he was 6 months old we started TTC again. Fast forward two years later, plus several failed infertility treatments later, and I never had another pregnancy (no miscarriages or chemical pregnancies). All my testing and my DH's testing was completely normal except for mild decreased ovarian reserve, which several REs weren't even sure I had (because my AMH tests and my AFCs never matched up).

But it made no sense to me that I got pregnant on the first try/healthy pregnancy and delivery and then started TTC when my son was 6 months old and nothing at all for two years. Then I remembered that several times during implantation time I would get weird flulike symptoms out of the blue (shaking chills, stomach cramps, nausea) for three hours and then it would all go away.

So I got all the immune testing done and it showed that my immune system is completely overactive and I have high/abnormal results for everything.

So I would suggest getting the immune testing done.

Wow, what a difficult time for you. Thank you for sharing your story. So do they think you developed immune issues after the first pregnancy, or just got very lucky somehow with having your first child? I have a long history of doctors trying to figure out if I have an autoimmune disease because of recurrent joint pain among other things, but nothing has ever been found for sure (definitely not RA, nor lupus or fibro, etc), but hearing these stories I'm wondering more and more if there's something latent that wouldn't impact my life but is majorly impacting my fertility. Definitely going to pursue testing. Thanks for this information.

PP here. I've seen 6 REs. The 5 who do not believe in immune issues thought that I have some level of sub infertility regarding my decreased ovarian reserve issues (which are mild) and that I just got lucky getting pregnant on the first try. (I find this hard to believe and don;t agree with it).

The RI I saw thought right away that I had repeat implantation failure because of the history of no pregnancy at all over 2 years and the fact that my FSH level is very good, which suggests I have good egg quality.

I got testing done and was found to have severe immune issues--basically an allergy to pregnancy caused by my first pregnancy. I have no personal/family history of allergies or autoimmune problems of any kind and my thyroid has been checked multiple times and is good. I'm baffled quite frankly. But I do know that all my treatments have failed and I have never been pregnant other than my one successful pregnancy.

After a year spent grieving the expanded family we will never be able to have, DH and I decided that we are not going to pursue immune treatments and that we are going to just have an only child. I have accepted that this is the way it is and the immune issues make sense to me given how things have gone in the last two years of TTC but I still cannot believe I got pregnant on the first try then two years of no pregnancy at all in 24 cycles. But I am unwilling to keep trying infertility treatments after the physical/emotional toll they have taken on me. We will continue to TTC on our own each month but our chances are 1% of pregnancy at this point so I'm not buying pregnancy tests anymore, and we are emotionally moving on from infertility.

Anonymous wrote:New poster here. I have repeat implantation failure and I got immune testing and was found to have immune issues big time. I'm struggling with secondary infertility though. I have one child who I got pregnant with easily the natural way. When he was 6 months old we started TTC again. Fast forward two years later, plus several failed infertility treatments later, and I never had another pregnancy (no miscarriages or chemical pregnancies). All my testing and my DH's testing was completely normal except for mild decreased ovarian reserve, which several REs weren't even sure I had (because my AMH tests and my AFCs never matched up).

But it made no sense to me that I got pregnant on the first try/healthy pregnancy and delivery and then started TTC when my son was 6 months old and nothing at all for two years. Then I remembered that several times during implantation time I would get weird flulike symptoms out of the blue (shaking chills, stomach cramps, nausea) for three hours and then it would all go away.

So I got all the immune testing done and it showed that my immune system is completely overactive and I have high/abnormal results for everything.

So I would suggest getting the immune testing done.

Wow, what a difficult time for you. Thank you for sharing your story. So do they think you developed immune issues after the first pregnancy, or just got very lucky somehow with having your first child? I have a long history of doctors trying to figure out if I have an autoimmune disease because of recurrent joint pain among other things, but nothing has ever been found for sure (definitely not RA, nor lupus or fibro, etc), but hearing these stories I'm wondering more and more if there's something latent that wouldn't impact my life but is majorly impacting my fertility. Definitely going to pursue testing. Thanks for this information.

Anonymous wrote:I'm so sad for you, OP. You really have been through way too much.
This is my cheap pop psychology analysis, but I think lesbian couples keep at the grind of ART longer because it's, of course, the only option. You deserve some good answers from your RE about why after all those IUI cycles and THREE unsuccessful IVF cycles you haven't had success.
A big hug to you and your partner.

OP here. Thanks for the hugs. I know others have gone through a lot more - I've known couples who did 12 IVFs which I can't even imagine - but this definitely feels like a lot on my plate! I'm reassured that we now have some frozen embryos - part of me is like, we've never tried FET, maybe that'll be what works! - but it's so daunting to be facing down an unknown number of cycles still to go. I appreciate the support.