Uterine testing (updated)

[seeyalater52]

Kind of a WWYD/what have you done post.

We’ve now had two failed transfers (one CP, one total negative.) For the first time my RE seems to be starting to wonder if there’s something else we are missing, or if this is just bad luck. It’s a tossup between the two. We have 5 frozen embryos left of varying quality from great (2) to good/fair (3), and have to use at least 3 before we can be approved for another retrieval.

We have two choices:

1) try one more transfer in November (have to wait a cycle due to insurance) with no changes other than vaginal estrogen rather than oral to try to plump up a lining that was mostly fine if a little on the thinner side (8mm). If this transfer failed we would start a mock cycle right away in December/January and go from there.

2) start a mock cycle with my forthcoming period next week, and do two biopsies on “transfer” day: one to test for endometritis and other infections and an ERA. It would likely be done in conjunction with a hysteroscopy. The ERA is experimental and not covered but the rest of the cycle (monitoring, meds, biopsy procedure) would be covered because of the other biopsy. We would just pay OOP for the ERA fee, I think its $650. If we do this we won’t get results back soon enough to transfer in November, so we’d be looking at a December/January transfer.

I really thought I’d be leaning more toward the testing than I am. I’m incredibly torn. Statistics say it’s unlikely that I’d have an infection or a displaced transfer window, but they also say I’d be pregnant by now. The thought of waiting that long until next transfer makes me feel sick. But so does the thought that we could just be throwing embryos in and wasting them on a busted uterus. Two failed transfers doesn’t quite feel like the danger zone yet but I’m terrified of how I’ll feel with a few more fails under my belt too.

What would you do? How would you choose?

[scm1011]

Sept 19, 2018 13:35:44 GMT -5 seeyalater52 said:

Two failed transfers doesn’t quite feel like the danger zone yet 

I'm here, and would probably do a 3rd transfer in November. But I am the least patient person in the world and would feel similarly about waiting until Dec/Jan. I'm not sure if that's the "right" decision, but its what I'd do. 

[scm1011]

Have you or your RE considered a double-embryo transfer with one of your great and one of your good/fair embryos?

[icedcoffee]

Have you ever had any reason to think you have a "busted uterus" before TTC?

SS Answer: I would consider option 3 because I'm super impatient and I'd do the biopsy in October and then transfer in November without getting the results back yet. This way if it fails I'd have the results pending. Then I'd be out $650 and I'd surely get pregnant having wasted the money on the biopsy without the results being in yet. Is this even an option?

I'm sorry. I don't think there's a "right" answer here.

[icedcoffee]

Sept 19, 2018 14:20:40 GMT -5 scm1011 said:

Have you or your RE considered a double-embroyo transfer with one of your great and one of your good/fair embroyos?

I was going to suggest this too.  It's basically what I did on my last fresh cycle.  We transferred two and nothing else ended up making it to freeze.  One of the two was not looking so hot.

[scm1011]

Sept 19, 2018 14:23:16 GMT -5 icedcoffee said:

Sept 19, 2018 14:20:40 GMT -5 scm1011 said:

Have you or your RE considered a double-embroyo transfer with one of your great and one of your good/fair embroyos?

I was going to suggest this too.  It's basically what I did on my last fresh cycle.  We transferred two and nothing else ended up making it to freeze.  One of the two was not looking so hot.

I'm not sure why I misspelled embryo twice here. I swear I know how to spell it by now lol.

[scm1011]

Sept 19, 2018 14:21:54 GMT -5 icedcoffee said:

Have you ever had any reason to think you have a "busted uterus" before TTC?

SS Answer: I would consider option 3 because I'm super impatient and I'd do the biopsy in October and then transfer in November without getting the results back yet. This way if it fails I'd have the results pending. Then I'd be out $650 and I'd surely get pregnant having wasted the money on the biopsy without the results being in yet. Is this even an option?

I'm sorry. I don't think there's a "right" answer here.

Oh I like this. 

[compassrose]

Sept 19, 2018 14:25:06 GMT -5 scm1011 said:

Sept 19, 2018 14:21:54 GMT -5 icedcoffee said:

Have you ever had any reason to think you have a "busted uterus" before TTC?

SS Answer: I would consider option 3 because I'm super impatient and I'd do the biopsy in October and then transfer in November without getting the results back yet. This way if it fails I'd have the results pending. Then I'd be out $650 and I'd surely get pregnant having wasted the money on the biopsy without the results being in yet. Is this even an option?

I'm sorry. I don't think there's a "right" answer here.

Oh I like this. 

Me too, if it's an option. 
I'm so sorry you are dealing with this. ((hugs))

[seeyalater52]

Sept 19, 2018 14:21:54 GMT -5 icedcoffee said:

Have you ever had any reason to think you have a "busted uterus" before TTC?

SS Answer: I would consider option 3 because I'm super impatient and I'd do the biopsy in October and then transfer in November without getting the results back yet. This way if it fails I'd have the results pending. Then I'd be out $650 and I'd surely get pregnant having wasted the money on the biopsy without the results being in yet. Is this even an option?

I'm sorry. I don't think there's a "right" answer here.

RE said we aren’t allowed to do this per insurance rules. If they pay for the mock cycle they will only authorize a new cycle after you get results back because they want you to use them to make a decision about treatment plan (and for them to make a decision about authorization). For example, if I have endometritis they won’t authorize a new transfer until it is treated. This was the first thing I asked lol, so great minds!

Sept 19, 2018 14:20:40 GMT -5 scm1011 said:

Have you or your RE considered a double-embryo transfer with one of your great and one of your good/fair embryos?

I have to fail one more single embryo transfer before we can be authorized for a double. That said, we have been and continue to be extraordinarily averse to anything that would increase risks of twins (trying to be one and done) so that is likely a non-starter, especially with my wife. At least unless we get to a much further and more desperate place down the road. We have one 3BB embryo in particular that I wouldnt mind transferring as a double, but I don’t think we are there yet.

[woowoo]

seeyalater52, we opted to do the ERA biopsy before we even tried transferring ONE embryo because we only have one (after PGS testing).

It was absolutely worth it to me. It told my Dr. clearly that I needed another 24 hours on progesterone than what the normal protocol called for to have optimal conditions at transfer....even with my progesterone BLOOD levels within normal range. I don't full understand how/why, but it definitely impacted our FET cycle plan and I feel at least a little more confident going into our transfer on Friday.

It took 2.5 weeks to get the results back. My cycle started 5 days after the biopsy and they still let me roll RIGHT into the next cycle and it worked out just fine timing-wise (although my insurance didn't cover the biopsy at all, it cost us $800 OOP). In a way I'm glad insurance wasn't involved on that one because they couldn't deny coverage for the start of our FET cycle.

If you can afford the biopsy, I recommend it. It certainly can't HURT (other than $$ and time wise).

It's all so hard...It's like they either hand us our protocol with no negotiation or they leave these HUGE decisions entirely up to us without giving us the hard data to help us make them. I told me out of town clinic Dr. today that IVF has been the LEAST empowering experience of my entire life.

[scm1011]

Ugh, stupid insurance.

[seeyalater52]

Sept 19, 2018 14:43:47 GMT -5 scm1011 said:

Ugh, stupid insurance.

A blessing and a curse. We couldn’t do any of this without it but it seems to have a way of always making every decision more complex than it needs to be and robbing providers of their ability to use clinical judgment.

[seeyalater52]

Sept 19, 2018 14:43:05 GMT -5 woowoo said:

seeyalater52, we opted to do the ERA biopsy before we even tried transferring ONE embryo because we only have one (after PGS testing).

It was absolutely worth it to me. It told my Dr. clearly that I needed another 24 hours on progesterone than what the normal protocol called for to have optimal conditions at transfer....even with my progesterone BLOOD levels within normal range. I don't full understand how/why, but it definitely impacted our FET cycle plan and I feel at least a little more confident going into our transfer on Friday.

It took 2.5 weeks to get the results back. My cycle started 5 days after the biopsy and they still let me roll RIGHT into the next cycle and it worked out just fine timing-wise (although my insurance didn't cover the biopsy at all, it cost us $800 OOP). In a way I'm glad insurance wasn't involved on that one because they couldn't deny coverage for the start of our FET cycle.

If you can afford the biopsy, I recommend it. It certainly can't HURT (other than $$ and time wise).

It's all so hard...It's like they either hand us our protocol with no negotiation or they leave these HUGE decisions entirely up to us without giving us the hard data to help us make them. I told me out of town clinic Dr. today that IVF has been the LEAST empowering experience of my entire life.

I’m jealous of the roll right into the next cycle! Insurance involvement can be such a double edged sword.

I remembered how helpful the ERA was for you when she was mentioning it. I wish I knew which of our embryos were normal. With 7 embryos chances are good at least a few of them are/were normal and I guess it does worry me that we could put another perfectly good one in there without testing and then not have any normal ones left. That would suck.

Looking at my work schedule there are some advantages to doing another transfer in Nov and then doing testing/mock cycle in January but I’m still so torn. It’s hard when there’s no clear right answer!

[scm1011]

Sept 19, 2018 14:47:17 GMT -5 seeyalater52 said:

Sept 19, 2018 14:43:47 GMT -5 scm1011 said:

Ugh, stupid insurance.

A blessing and a curse. We couldn’t do any of this without it but it seems to have a way of always making every decision more complex than it needs to be and robbing providers of their ability to use clinical judgment.

I completely understand this. I'm so so thankful to live in a mandated state, but I was so frustrated that we were delayed 10 MONTHS after our RE gave her recommendation (go straight to IVF, do not pass go, do not attempt an IUI) to fulfill all the insurance demands/random useless tests. 

[megamous]

I am really glad I did the ERA test. I'm pretty sure now my issue in getting pregnant (never had a positive pregnancy test before) was implantation issues. As you can read below, I was very pre-receptive at a time in my cycle when most people would be receptive. I had three embryos, all PGS normal and we did not want to potentially lose them with unsuccessful transfers because of uterine receptivity. I will say it was hard waiting the two cycles (we did two ERAs), but worth it. Also, we got the results back quickly and did not have to take a month off between cycles.

I wrote this previously in response to another person:

I had testing done to test my uterine receptivity. It entailed doing a mock frozen embryo cycle (taking all the medications) and then doing a biopsy of my uterine lining instead of a frozen embryo transfer. The first time I came back pre-receptive - my uterine lining was not ready for implantation. So we did another mock transfer and another biopsy but I started the meds a day earlier. I still came back pre-receptive but not as much I guess? So for my frozen embryo transfer we started meds 1 and a half days early (yay for doing shots in the morning rather than at night) and that seemed to do the trick.




The cycles cost about $1000 plus meds (I was doing progesterone in oil and estrogen injections), about $500 for the RE office procedures and about $500 for the testing. It was slightly cheaper the second time because the lab charged less for a repeat biopsy. The biopsy was a bit painful for the 15 seconds or so it takes to get a sample, but otherwise was not too bad. I don't think I had any restrictions after the procedures like I did after embryo transfer. Let me know if you have any more questions.

[seeyalater52]

Sept 19, 2018 14:53:53 GMT -5 scm1011 said:

Sept 19, 2018 14:47:17 GMT -5 seeyalater52 said:

A blessing and a curse. We couldn’t do any of this without it but it seems to have a way of always making every decision more complex than it needs to be and robbing providers of their ability to use clinical judgment.

I completely understand this. I'm so so thankful to live in a mandated state, but I was so frustrated that we were delayed 10 MONTHS after our RE gave her recommendation (go straight to IVF, do not pass go, do not attempt an IUI) to fulfill all the insurance demands/random useless tests. 

Also with all the random ass testing they require seemingly for no clinical reason, they then often refuse to cover things like a karyotype or PGS testing that could actually be helpful to both us AND them to be sure that all the treatments they are paying for actually have a shot at working? Trying to explain genetics to the guy at my insurance company after they denied authorization for a karyotype on me claiming it was unnecessary because we are using donor sperm was pretty special (since, you know, the donor didn’t have a karyotype done and even if they did there are abnormalities that can be passed from only one genetic parent that can really jack up your embryos.) It’s so frustrating.

[seeyalater52]

Sept 19, 2018 14:55:19 GMT -5 megamous said:

I am really glad I did the ERA test. I'm pretty sure now my issue in getting pregnant (never had a positive pregnancy test before) was implantation issues. As you can read below, I was very pre-receptive at a time in my cycle when most people would be receptive. I had three embryos, all PGS normal and we did not want to potentially lose them with unsuccessful transfers because of uterine receptivity. I will say it was hard waiting the two cycles (we did two ERAs), but worth it. Also, we got the results back quickly and did not have to take a month off between cycles.

I wrote this previously in response to another person:

I had testing done to test my uterine receptivity. It entailed doing a mock frozen embryo cycle (taking all the medications) and then doing a biopsy of my uterine lining instead of a frozen embryo transfer. The first time I came back pre-receptive - my uterine lining was not ready for implantation. So we did another mock transfer and another biopsy but I started the meds a day earlier. I still came back pre-receptive but not as much I guess? So for my frozen embryo transfer we started meds 1 and a half days early (yay for doing shots in the morning rather than at night) and that seemed to do the trick.




The cycles cost about $1000 plus meds (I was doing progesterone in oil and estrogen injections), about $500 for the RE office procedures and about $500 for the testing. It was slightly cheaper the second time because the lab charged less for a repeat biopsy. The biopsy was a bit painful for the 15 seconds or so it takes to get a sample, but otherwise was not too bad. I don't think I had any restrictions after the procedures like I did after embryo transfer. Let me know if you have any more questions.

This is so helpful, thank you. The good and bad with insurance is that if the mock cycle itself is covered we only need to pay to have the tissue tested which is less expensive. The bad is that it introduces all sorts of extra waiting periods into the mix. May I ask when you did the test? It seems like it was more common to have to do repeat biopsies in the past and for the most part they’re not recommending that it’s necessary anymore and that the first result can usually give you a fairly accurate transfer window. I’m not quite sure when they made that switch but it makes me a little nervous!

[megamous]

Sept 19, 2018 15:21:46 GMT -5 seeyalater52 said:

Sept 19, 2018 14:55:19 GMT -5 megamous said:

I am really glad I did the ERA test. I'm pretty sure now my issue in getting pregnant (never had a positive pregnancy test before) was implantation issues. As you can read below, I was very pre-receptive at a time in my cycle when most people would be receptive. I had three embryos, all PGS normal and we did not want to potentially lose them with unsuccessful transfers because of uterine receptivity. I will say it was hard waiting the two cycles (we did two ERAs), but worth it. Also, we got the results back quickly and did not have to take a month off between cycles.

I wrote this previously in response to another person:

I had testing done to test my uterine receptivity. It entailed doing a mock frozen embryo cycle (taking all the medications) and then doing a biopsy of my uterine lining instead of a frozen embryo transfer. The first time I came back pre-receptive - my uterine lining was not ready for implantation. So we did another mock transfer and another biopsy but I started the meds a day earlier. I still came back pre-receptive but not as much I guess? So for my frozen embryo transfer we started meds 1 and a half days early (yay for doing shots in the morning rather than at night) and that seemed to do the trick.




The cycles cost about $1000 plus meds (I was doing progesterone in oil and estrogen injections), about $500 for the RE office procedures and about $500 for the testing. It was slightly cheaper the second time because the lab charged less for a repeat biopsy. The biopsy was a bit painful for the 15 seconds or so it takes to get a sample, but otherwise was not too bad. I don't think I had any restrictions after the procedures like I did after embryo transfer. Let me know if you have any more questions.

This is so helpful, thank you. The good and bad with insurance is that if the mock cycle itself is covered we only need to pay to have the tissue tested which is less expensive. The bad is that it introduces all sorts of extra waiting periods into the mix. May I ask when you did the test? It seems like it was more common to have to do repeat biopsies in the past and for the most part they’re not recommending that it’s necessary anymore and that the first result can usually give you a fairly accurate transfer window. I’m not quite sure when they made that switch but it makes me a little nervous!

I did the first biopsy in May of last year (2017) and the second in June.  My office does seem to be a little more old school on things, though.  After FET (Last July) I was not allowed to do anything for three days where it sounds like the new advice is to keep up normal activity levels.  Also, if I remember correctly, there are differing levels of "prereceptive" you can come back as.  I was really prereceptive and still was when we did the second biopsy.  So it may have just been based on my results.  Good luck with whatever you choose.  I will say, the peace of mind was really nice to have though. 

[cherryvalance]

I don't want to complicate your decision, but for us, we did one fresh transfer which ended up in a miscarriage and then one failed FET before success (double embryo transfer, though). I was also feeling particularly desperate as those were our last two embryos and we had been in treatment a year at that point. So I do feel your statement that two failed transfers doesn't really feel like the danger zone, but it does feel like each decision is so important. Whatever you decide will be right.

[seeyalater52]

Good timing cherryvalance!

My wife and I talked this in circles and decided we are most likely going to move forward with another transfer in November. We will make the minor tweaks to the protocol (that we likely wouldn’t be allowed to make if we were doing a mock cycle) and roll the dice. If it doesn’t work out the testing will still be there as an option in December/January and we will move forward with it then.

I am a little nervous about ending up right back in this same place if it fails with no additional information gleaned but it just feels like we need that last transfer to have peace of mind with pressing pause and trying to get more at the root of all this.

I do plan to ask RE tomorrow if she has an opinion or recommendation and if she says she recommends the testing we will reconsider.

Thank you all so much for being a support and sounding board. I don’t know how I’d do this without you.

[cherryvalance]

I'm glad you guys have a plan you feel comfortable with!

If you want some woo-y coincidence stuff, I'm pretty sure you are transferring just about exactly when I did (ETA all three times). We did our last transfer two days after the election and I basically thought nothing would ever be good again (I guess that remains to be seen in the national level, lol). Anyway, I think November is an awesome month and the third time's the charm. I'll keep everything crossed for you.

[pandora89]

Another one who had 3 transfers (first was ectopic, second was a bfn and third was a double embryo transfer that resulted in our son. I am glad you guys were able to come to a decision, FX for you guys.

[turboteal]

I also struggled with this question after our first PGS normal transfer failed. (We also had 7 embryos, 4 of which came back PGS normal.) I thought we were going to do ERA testing after that based on a brief convo with RE when he gave me the bfn news, but then when we talked again he recommended trying one more time before doing that test. Our second PGS normal transfer resulted in my current pregnancy. Only thing I did different was add some acupuncture. Just wanted to share that even with known "normal"s it doesn't always work right away, or not for any pin-pointable reason. Without PGS we may have had even more not work before we got to a keeper. Hoping you are getting closer to your successful transfer, though I'm sorry you're having to go through the heartbreak of failed transfers first. ❤

[woowoo]

Having a decision you've made together is always such a relief. Let us know what the RE says. Third times the charm!

[seeyalater52]

Thank you so my everyone.

cherryvalance, spearmintleaf, @pandora89, and turboteal thanks in particular for sharing stories of success through multiple transfers. I don’t know anyone IRL who has had to do more than a fresh or one frozen transfer so it’s throwing me off big time. It sounds stupid but it’s good to know it CAN work even if it’s not the first time.

[scm1011]

I'm glad you've come to a decision, and I really hope third times the charm!

[stellelinds25]

FX that it's lucky #3! I think it's an impossible decision and I'm glad you and your wife were able to make a decision that works best for you!