# 3 failed FETS (PCOS) - what to do?



## ShimmaShine (Jun 19, 2014)

Hi everyone, 

I, like everyone else, am just trying to get some advice/guidance/information/support. 

In a nutshell (ok, a big nutshell), 
- I am 29, my husband is 30. I am of a good BMI, if not a little low. DH is of good BMI. 
- We are in New Zealand
- Beginning of 2011: I was on the pill from about 15, stopped taking it at the beginning of 2011 and using other methods of protection, just to 'come off the pill' to be ready when we did start TTC
- End of 2011: By the end of the year, my periods had stopped completely. I was diagnosed with PCOS, and put back on the pill to regulate my cycles until we were ready to TTC
- April 2013: I went off the pill and we began TTC. We were timing sex, but I wasn't charting or anything to know if I was OV'ing or not (we were taking a 'low impact' approach)
- Nov 2013: My cycles had been getting progressively longer (28, 31, 31, 32, 33, 36, 36 --> then periods stopped)
- Dec 2013: We had a consultation with fertility specialists, and I also started fertility acupuncture (which I have done weekly/twice weekly ever since). All the tests they did on both of us came back normal, but for the PCOS
- Jan 2014: Because of the Christmas close-down period for our clinic, we did not start treatment until Jan 2014. I stopped drinking alcohol and caffeine. Put on a dose of 50mg of Clomid, I had no response. Cycle was abandoned.
- Feb 2014: On a dose of 100mg of Clomid, I responded, developed a good looking follicle (among others), took a trigger, but the BT showed I did not ovulate. Cycle abandoned. 
- March 2014: Because of new time constraints (my husband was offered a job abroad and he was going to be leaving, with me to follow) we moved on to IVF (privately funded $$$). I had a good (almost too good) response - they collected 35 eggs, 17 fertilised, 9 good quality blastocyst embryos. It was a freeze-all cycle because of the risk of OHSS (which I luckily did not end up with)
- April 2014: I did my first FET on a manufactured cycle, taking oestrogen oral tablets and progesterone pessaries. My DH flew out to move to Italy 2 days before it. Did acupuncture before and after transfer. Grade 5AA embryo, perfect transfer. It resulted in a BFN. 
- May 2014: I decided to do another FET (manufactured cycle) before I left to join DH. No changes to the plan. Quit my job (as a lawyer) so stress totally reduced. Grade 5AA embryo. Resulted in a BFN. 
- June 2014: I decided to do one last FET before I left to join DH in Italy. Fought hard for some changes (doctors were reluctant!) - had a Day 12 endometrium scan which showed 8mm and great appearance, which was not done with the past two FETs. Also added the Colorado Protocol (daily aspirin, then 5 days of prednisone and an antibiotic leading up to transfer). Grade 4AA embryo, perfect transfer. Got results today, BFN. 

So that's me. I guess my questions are: 
Is there still hope? 
Should I be concerned? 
Should I be asking questions, and if so - what? 
Should I be worried there is something else at play that is causing me to not fall pregnant with all these 'perfect' conditions - I don't drink, smoke, consume caffeine, Im a healthy weight, I eat fairly well, I am young, I have no lining issues it seems, I am getting regular acupuncture, I have 'great' embryos, perfect transfers, I have no stress of a job, I have no other known issues etc. 

I do get quite sudden and severe sharp pain in my left side of my abdomen (around where I imagine my ovary would be) every so often when I sneeze/stretch/stand up too fast. It is getting more frequent though, and my acupuncturist said that they could feel a 'blockage' when they pushed down hard into my abdomen (before me even telling them about the pain I felt there). What could this be, does anyone know?

I suppose I am just trying to see if anyone has any suggestions on where to from here - what might be going on, what should I ask about, what can I test for and so on. I know NZ fertility is VERY conservative and I worry that we are missing something. I don't want to just 'keep plugging them in' just because we have 6 left, because surely 3 failed FETs isn't 'normal'?! I don't want to 'waste' them if there is something else going on, and I also don't want to keep wasting our time (and money!!!!) if there might be something wrong with the embryos. At this point, I am just so despondent - we couldn't make the bun because my ingredients were stuck in the jar. We got the ingredients out, got 9 lovely buns, but now it looks like the oven is broken too and noone knows why....

(I am leaving NZ in about 3-4 weeks to join DH. I will come back in November (as we are both coming back for Christmas, so I will come first) and then either try again or do whatever procedures I need then. At this stage, we just need to be back together - it is too hard apart). 

Help? And thank you for reading my novel!


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## njr_26 (Aug 27, 2011)

Hi Shimmershine

I have PCOS as well and after coming off the pill (on it from age 16 to 36) my cycle was very irregular and some cycles were 72 days! I also tried accupuncture and chinese herbal medicine but it did nothing.

The thing that made my cycle regular was metformin 1500mg a day. I also knew I was ovulating as I had egg white CM and felt ovulation pain.

Have you had your thyroid tested? TSH needs to be between 0.5 and 2.

Njr26


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## SWGirl (Aug 19, 2004)

Hi Shimmashine,

Yes there is definitely still hope.  As you can see my first egg collection (in 2005) produced 34 eggs,  my second egg collection (in 2009 with medication reduced appropriately) produced 22 Eggs which resulted in a freeze all followed by three negative FETs.  My third egg collection (in 2012)produced 24 eggs,  I argued my case for not having another freeze all (they had gone ahead with transfer in 2005 when less strict guidelines for OHSS/freeze all and I didn't develop OHSS that time).  This fresh transfer resulted in my little boy.  Had I have known At the time of my second egg collection that the difference in success rates at that clinic was so huge between fresh transfers (about 34%)and FETs (about 10%) I would have begged for a fresh transfer in 2009.  Unfortunately they answered this question just after freezing.  I would suggest you find out what the different success rates are for FETs and fresh transfers. If you are having a frozen transfer then yes you need to be scanned (I had two FETs due to thin lining/under responding to the meds for FETs).  If you are having a fresh cycle make sure you remind the consultant at every single appointment that you over respond to the meds (A few times my doses were slightly adjusted following me reminding people about my over response to stims).  Hope that helps.  Best of luck.


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## mierran (Apr 24, 2009)

Hi,
noone really knows why one cyxle works and another one fails but there is definitely hope. You have only had 3 embryos transferred. I know that seems like a lot but in natural conception they think an embryo develops most months when there is ovulation  but a lot of these even in young women are chromosomally abnormal.  ( one study showed up to 90% chromosomal abnormality in you healthy women ).
Equally when pgd is performed to check re embryo chromosomes, often the normal ones are the worst looking. And clinics start from the best )

Secondly, depending on the method of freezing , thaw survival can be between 30 and 90 %. An embryo is said to have survived if over 50% of its cells are intact. As swgirl said success rates vary hugely. Part of the reason I chose the clinic I did this time is their success rates are actually higher for fets than fresh ( as they only freeze blasts but will do some day 3 transfers ). I am with iakentro in athens through Ruth, a brittish fertility nurse who acts as ivf coordinator. You can contact heron [email protected]  after the communication issues I had with my previous clinic it was nice to have the reassurance. She also has a good combination of knowledge and is good at listening to you  and being prepared to try things a bit different if you can provide a good argument. 


I think the thing you have to consider if you now live in italy is what to do. You may be better chosing a different clinic close by ( tho I would advise greece or turkey rather than italy as they have more ivf experience and no religous limits on things such as embryo freezing ). It may be more cost effective than continuing with your frosties atm. I am currently with iakentro in athens through ruth, a brittish uk trained fertility nurse who acts as coordinator with iakentro and other clinics. Contact her on [email protected]  . She is great.

Other things I would advise are an endometrial scratch about a week before af is induced. Do see what other bloods such as testosterone and tsh are, and make sure they are normal. While a lot of fertility drs do now say tsh sub 2 mine was just over 3 and was fine.. But high testosterone can also affect quality of eggs.

You don't say whether there was any implantation in any of your bfns. Was hcg over 2 ? Or under, or was it just a hpt.

The other thing that can be an issue is immune problems. But tbh you haven't transferred enough embryos to make that a real liklihood. 

The stats given for donor egg cycles ( so higher sucess than oe overall ) are 90% or women will get pregnant over 3 cycles. One cycle is the fresh cycle and all the frozen embryos associated with it. So by that reckoning you have only done 1/3 or a cycle. ( it comes from us shared risk programs )

If I were you and you wanted to do everything I would advise

get the test done at serum in athens for hidden c and other infections
get an endometrial scratch before next transfer
Recheck hormone levels
Do another few transfers
get bloods checked not just hpt to check oestrogen progesterone and hcg to see all ok and see if any implantation

my friend had 22 donor egg embryos transfered before she had her little boy. 

If still no bfp after 10 good quality embryosembryos transferred i would advise

level one, two immune bloods and nk cells test
A hysteroscopy ideally a greek one through serum in athens as they do implantation cuts too
fish and dna fragmentation and sperm chromosomal tests on dh's sperm
A low grade stims ( if you cant do natural ) / natural / triggered natural  cycle ( in me artificial oestrogen seems to prevent implantation )
Biopsies of uterine lining to check re implantation window ( some women have a very short implantation window after progesterone started. This is more common onmhigh doses of progesterone.  You don't say what level you are on ). 

Sometimes it does take quite a few transfers. 

X x


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