Intro

[jerseyjaybird]

Hi!

Many years ago I was an active poster on MM and a lurker on CEP. Life just got too busy to keep posting, but now I'm in a difficult spot with infertility and thought I'd check in here. I hope it's ok to leap in.

TW: loss and living child mentioned below

I'm in a same-sex marriage, and all fertility treatments are for my wife. For a bunch of medical reasons, her body is better suited to this than mine.

We started TTC in 2017. With no fertility history, we skipped IUI and went straight to IVF with PGS---we were compelled by the higher success rates and the potential for family planning. My wife was 35, so we hoped to bank several PGS normal embryos (so naive!). She had a huge number of eggs retrieved, but about 2/3 of them were broken and gray. We still don't know whether this is an egg quality issue or a lab issue or simply that the stims were too much for too long. We ended up with 2 PGS normal embryos. We had success with the first FET. The second FET also resulted in a BFP and normal ultrasounds at 5, 6, and 7 weeks. The 8-week ultrasound showed that the embryo had split into identical twins; though one was larger than the other, they both had strong heartbeats. Next ultrasound, at 12 weeks, showed that both had stopped developing around 9 weeks. D&C.

We actually switched clinics before the FETs and stayed with our current clinic for another IVF cycle, which was just about a year ago. That cycle seemed far more successful: very few broken/gray/grainy eggs and a total of 5 PGS normal embryos plus 1 no-result. Because of Covid, we couldn't start FETs until August, and since then we've had 2 failed FETs---no implantation.

After the first failed FET, we asked for RPL bloodwork, which showed the barest hint of a clotting issue, and a repeat hysteroscopy (normal, and biopsy for endometritis was negative). The hematologist we consulted said that the level was so low that my DW shouldn't need more than baby aspirin, which she takes each cycle, and within 2 months the level was back to normal. So the first failed FET seemed like . . . ok, about 1 out of 3 fail, so we're within the odds.

After the second failed FET, our RE offered two options:
1. Add 12 hours of progesterone (he claims that there's no scientific evidence that the ERA test improves outcomes but suggested that DW might need more progesterone exposure.
2. 2 months of Lupron Depot and Femara (basically treating silent endo absent any endo symptoms or diagnosis---there is a small retrospective study that showed good results with this approach)

We went with option 2 and anticipate a FET late this month. DW always does acupuncture, and we're trying a largely Mediterranean/anti-inflammatory diet, too. She is asking the RE about empirical use of a steroid or blood thinner but expecting him to say no. 

This is getting long. Obviously I'd love to hear if anyone has experience with repeated implantation failure with PGS normal embryos. I suppose I'm mostly looking for community and solidarity, particularly as there is a literal baby boom around us right now and I'm not in a good space with it. 

[Jalapeñomel]

So sorry to hear about your struggles. This is a long, hard journey for so many of us, so please feel free to join in.

seeyalater52 had success with an immune-type protocol after RPL, she would be a good person to chime in.

[seeyalater52]

I’m so sorry about the challenges you have experienced growing your family, friend. ❤️

You may know a little bit of my story but I’ll try to share a few pieces that might be helpful as you explore next steps. Caveat that I’m not sure what changes ultimately made transfer #6 work as there were several things in play: changed FET protocol, PGS testing, different sperm donor, and it was a new batch of embryos from a second retrieval.

Caveat that I didn’t do PGS testing on my first batch of 7 embryos. However, based on my age at retrieval (30) and my diagnosis (unexplained female factor) it is highly unlikely that all 7 were abnormal. After my first 3 transfers (2 early losses and one implantation failure) I did RLP testing (normal results), a karyotype (normal) and biopsies for endometriosis and an ERA (receptive on my clinic’s standard medicated transfer protocol.) It was all very confusing. My clinic would not prescribe anything besides baby aspirin although I asked repeatedly about steroids and blood thinners.

Instead, I did a final medicated FET (transfer #4) with 2 embryos that
ended in another early loss - this was because the ERA said my lining looked good on that protocol.

After that I said fuck it and with my final two embryos I tried a different FET protocol - semi-medicated with letrozol to induce ovulation plus vaginal progesterone. For this transfer I also took an over the counter “immune cocktail” with the blessing of my RE (daily Benadryl, Claritin and Pepcid) as well as bootleg low dose prednisone (which my RE would not prescribe and which I had donated from a variety of sources and took according to the Braverman clinic’s standard low dose steroid protocol.) That transfer was successful until I lost it at 8 weeks. The loss was later confirmed to be caused by trisomy 16.

That felt like a winning transfer combo to me so we did the same thing for transfer #6 with a new batch of embryos that were PGS tested and that was a live birth. My second retrieval I had 8 embryos, 3 normal and 1 no result.

To answer your questions:

I know pre-receptive is the most common ERA result (besides receptive) but I’d be hesitant to just do the extra progesterone without confirmation from the test. It just as easily could be that your wife is receptive on the current protocol and progesterone timing isn’t the issue at all, in which case you’d be transferring at the wrong time.

If that transfer hadn’t worked I would have done the letrozole and DL regimen your DW is doing now. So I think that is a good plan! I hope it works for you guys.

Does your wife ovulate at all? If that’s a possibility and you end up needing to do another transfer I’d ask about the semi-medicated protocol, as anecdotally in my own experience and from talking to others with early RPL and RIF it is hypothesized that the implantation window is bigger and/or stronger for some people on that protocol va fully medicated.

All I can say is that I’m so sorry it’s been so difficult and I hope a new plan of action will help you to have a healthy pregnancy. I would also say that based on your wife’s egg quality, which sounds like it may not be ideal, it is possible that there may be issues with the embryos that PGS testing can’t identify. Obviously that is not helpful in that there’s likely nothing you can do about that, but I think it’s really easy to forget (at least it is for me) that there’s only so much the testing can tell us.

[jerseyjaybird]

seeyalater52, thank you so much for taking the time to type that all up. I truly appreciate it. And I’m so happy you have your little miracle in your arms.

Honestly, if this transfer doesn’t work, we will probably discuss changing clinics again. We don’t want to, in large part because our current clinic is so convenient (which isn’t nothing!), but we’re pretty frustrated by the rigidity. My gut reaction to changing up the progesterone exposure without an ERA is 🤨😬. Super-interesting about the semi-medicated FET protocol!

My wife does ovulate regularly (though how soon that will be true again after 2 months of Lupron Depot, I’m not sure), but we wonder about egg quality. Our current RE felt that the issues with gray/grainy/broken eggs from the first retrieval was likely post-mature/fried eggs since the results seemed so much better with one less day of stims. But we are starting to wonder.