# multiple failed cycles, never had implantation



## katkat2014 (Nov 28, 2014)

I am hoping that someone can give me some hope and advice and tell me anything I have overlooked in terms if tests.

I have had 5 x bfn with no implantation, ever. I am 39 and I know that this could be the main reason - having no normal eggs. Should PGS be the one and only thing I should look at? I am unable to look at DE right now. Or should I do any other investigations be for doing anything else, but what?

I tested for Hidden C,  karyotype, basic immunes, thrombophilia, had hycosy and hysteroscopy - all negative (one tube looked obliterated). My lining is triple layer but never particularly thick (8.3-8.7mm on trigger day). I tend to spot during a normal cycle about 4 days before my period and I have a short luteal phase of about 10 days. I also spotted before otd on icsi cycles but I have absorbed progesterone well according to blood tests. 

On my last mild IVF cycle this month, I had terrible AF cramps all night long on day 5 after a 5-day transfer of two good (not perfect) blastocysts. Then nothing..then started bleeding om 13dp5dt I don't tens to take hot so I don't know if implantation was attempted but blood test showed zero.

Thoughts that go through my head are to do more in depth immunes (Dr quenby??), ERA testing (is it worth it?), incompatibility with DP (alpha testing or whatever it is called?), and PGS (can it be done if you only have 1-2 blastocysts?). Does anyone have any input for me as I am at the end of my tether and it hurts so much! As mentioned before I am unable to move on to DE right now even after all these bfn. Thank  you!


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## IloveWesties (Aug 15, 2014)

Hello katkat I've woken up in a sweat having a nightmare (literally!) about this same thing. I've had four cycles - two fresh (ICSI) and two frozen using five good quality blastocysts in total and not even a hint of a BFP. I just wanted to say I know how you feel and you're not alone. Big hugs  

In terms of tests, look in to Dr Gorgy. I had my initial consultation with him on Tuesday re: level two immunes that I hadn't done and am now currently waiting for the test results. When they're all back, we'll go for a follow-up to get all the results translated and a protocol (if needed) to run alongside our last FET at CRGW (we have two frosties left).

Other things that we've tried (not sure if you have?): I've had a laparoscopy with dye (July 2014) and a diagnostic hysteroscopy (September 2015). I've had the endometrial scratch twice, tried emphirical treatment with low level immunes (Clexane, steroids and injectable progesterone) and even had an intralipids on day of transfer last time. We used the embryoscope for our second fresh cycle. We also used embryoglue and assisted hatching (two blasts) on our last FET cycle. In terms of alternative therapies, I've tried most things - acupuncture, fertility reflexology, reiki, hypnotherapy... I've even seen a medium and fertility astrologer! I literally have tried everything in the last four + years but nothing has worked yet. 

I'm hoping that Dr Gorgy will have some suggestions for us to make this next cycle work.

Oh and I bled early on my first cycle - didn't get to OTD - so since then have taken injectable progesterone (Lubion) and that's got me through to OTD each time since so may be worth looking in to if you're bleeding early.

Also, Dr Gorgy suggested a sperm DNA test to us but as we're doing a FET next this isn't something we're going to do now. If our next FET cycle is unsuccessful (which of course I hope it works!) then we'll be doing this test before our next/third fresh cycle. We'll also test the embryos to select the viable embryos.

Good luck and please do keep in touch xx


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## Lilypink (Oct 8, 2013)

Katkat big hugs I'm in the same boat as you! 
It's soooo frustrating! I have had every test imaginable done full immunes lap dye hysteroscopy etc and nothing found. 
As westies said endometrial biopsy for imflamation /NK  or ERA test can look at the uterus specifically ( and I think is my next port of call ) 
I had a consultation with penny in serum this week and she frightened me a bit as thinks that even though I have no DQ alpha match with my husband there could be an underlying issue with sperm DNA ( even though we had fragmentation test and it couldn't have been more positive ) and if that's the case she thinks I'd only have success with donor sperm ( which is not an option with my DH! ) she suggested I did a cycle with half DH sperm half donor. 
I have a follow up next week with an NHS consultant who is new and apparently quite keen on investigation implantation failiure and also one in a few weeks with London women's clinic and Dr Gorgy again - I'll let you know if they suggest anything not covered for implantation failiure. 
If you havent had level  2 testing done I would defo look at this as most women find some issue here - it is expensive but could be very revealing. 
Good luck xx


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## Lilypink (Oct 8, 2013)

Ps I always spot for a day about 4/5 days before my period and penny thinks this is my trying to get implantation each month. I don't know if there is anyone u could test that theory as I don't think HGC levels would be higher enough. I never made it to otd cyclogest but this time I was doing gestone injections twice daily & got there with no spotting at all x


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## katkat2014 (Nov 28, 2014)

I lovewesties, I am so sorry to hear you are in the same boat! It is so stressful and emotionally draining   big hugs to you too  and thank you SOOO much for your input! Sorry about your nightmare ...I cannot sleep well either.

I have also thrown the whole lot at it, never in the same cycle, but did embryoscope, embryoglue,  assisted hatching, yoga, dhea, melatonin and a million other supplements. I never did a laparoscopy with dye. What is it for and how does it compare to a hysteroscopy?

Sorry to hear you bleed before otd. This last cycle my otd was 14 days after a 5 day transfer..I find this very late, shouldn't it be 14 days after egg collection. I bled 12dp5dt even though I took 800mg cyclogest plus Prolutex injections, so bled 2 days before otd. But maybe that's not that worrying given the fact otd was so late.

Lilypink, I am also so very sorry for this awful time you're going through. Is the dq alpha tested with Dr Gorgy? We never did a dna fragmentation test either as we thought we have ok implantation and we just empirically took high dose vit c and e and one 10 day course of antibiotics plus ejaculation every other day or every day. We meant to do IMSI but the embryologist said it wasn't necessary and we should just do ICSI. Now I wonder if I should have insisted! I know that a test result may mean DS so we've avoided this. Also as I think it may be my eggs.. I emailed that online Dr Sher and he thinks a dna frag test isn't useful  it need to do SCSA instead but I cannot find where this can be done. I am so sorry that your so afraid of using DS. It terrifies me to think DS or DE either way!

Both you lovelt ladies: about Dr Gorgy, I hear that's very expensive. How long is the wait for the first appointment and will.he just take a blood sample there and then or is there more involved than a simple blood test? If you do level 2 tests what does it include and how much is it? Does he also do the biopsy as Dr Quenby does?

Do you consider the ERA test?

Lilypink, how did you go about finding an NHS consultant? I am not even in to check with a fertility specialist, I always need to go  see my GP who hasn't got a clue. I just insisted to redo my thyroid test TSH plus T4 but they don't want to do T3 or the antibodies test.


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## Lilypink (Oct 8, 2013)

I think a laparoscopy can look for things like endometriosis. I had one with nhs as first part of investigations.
Where I am in South Wales you have 2 fresh cycles on nhs and any subsequent frozen if your embryos are good enough to freeze - luckily I had 9 on first cycle so have been able to have 4 goes using 1 nhs go if that makes sense? My GP referred me to fertility unit in local hosp after about 18 TTC and then it was about 2 years until having treatments - at the time I wasn't too worried about the wait as was 25/26. I think all areas have different ruling on nhs. Luckily because I have been having nhs treatment we could afford to have a lot of private investigations. I saw Dr Gorgy after my third bfn although I did do intralipids, steroids clexane and gestone empirically on third round. 
I only had to wait about a week to see Dr Gorgy - I did read so your body baby friendly book in preparation as he does talk very high level - worth a read if you haven't already. Had all testing through him, Chicago immunes, DQ alpha, karyotyping, KIR receptors and DNA frag - all normal. 
He suggested the only thing left to do is a biopsy to see if NK cells in uterus are diff to blood but if I'm honest I think it will come back normal. He offers biopsy but prof queenbys is more detailed as looks for inflammation as well as NK cells although she only treats with steriods I think Dr Gorgy will use a more aggressive approach - humira,  iVIG, neupogen etc. 
I had a consultation with dr gorgy then he sent me a few doors down and took about 10 vials of blood and I was done, DH also had to provide a sample.
I think if the biopsy throws nothing back then I'll look at ERA but it terrifies me! 
I think donor is a very personal thing - I would be quite open to it, but at this stage its a big no no with DH.

Have all your cycles been with same clinic? 
X


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## Trigger38 (Feb 15, 2014)

Hi kitkat 

I would highly suggest you consider pgs testing. I've part way through our 5th cycle and out of the 9 embryos collected 5 fertilised and made it to blast for pgs testing. Of those 1 is normal which is the expectation in women of our age. It's highly probably the transfers to date were abnormal. I can't tell you the relief I feel knowing we will transfer a normal one and that if it doesn't take I know it's bad luck - my consultant has said if it doesn't take the fact we know we have a top quality genetically normal embryo he doesn't feel donor is a route for us yet and would recommend another go with own eggs. I have had the dr gorgy tests which showed slight immune issues and intralipids, steroids, clexane was recommended. A lot of clinics will do this empirically if cost to test is issue.im doing a hysteroscopy with d&c next to provide fresh lining and then medicated fet next year with steroids, intralipids, clexane and loads of progesterone (oral, vaginal and injections). I feel my clinic are doing everything they can. 

We did sperm DNA fragmentation test - all ok and dr quenby biopsy - all ok. If like me you need answers to find peace then pgs is the only way of knowing if the embryos you create are normal. If you get at least one that is then focus on the lining/immune etc


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## MoM11 (Nov 18, 2015)

Hi
I'm in the same boat but dealing with secondary infertility. 
TTC almost 4 years. 5 IVF cycles in two years, twice with blasts transferred, once day, 2 once day 3. Had good fertilization rate 1st and 4th time. This last time no fertilization... So, previously implementation failure, now also fert problem... No problem has been found. Devastated!


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## katkat2014 (Nov 28, 2014)

Lilypink - have you had your results yet for the last few tests? About ERA, I just feel it is so odd to take stims and then have nothing in the end. Can I actually be combined with IVF and then that cycle freeze embryos? Ie EC and 8 days later ERA? I find it such a waste to use all those drugs and go through a cycle just for a biopsy. 
I was at a UK clonic rhe first two times via the NHS and then 3 times in Prague. I am looking at a new clinic just now although nothing wrong with Prague..

Trigger I am sure you are completely right and in the end it is about abnormal embryos. The issue is i only had blastocysts twice and then only just 2 or so at the time. In this case, is PGS worth it? I cannot bear any 2ww any longer though and at least if I knew there was a real chance then that would make a difference. What happens during PGS, do they take a biopsy on day 5 and then freeze the embryo (s)? Is there a cost per embryo or per PGS cycle? About the intra lipids,  on what basis has this been prescribed?

MoM11 - I am so sorry to hear that!! Big hug! Are you looking into the sperm side of things as well as someone has told me that sperm does play a role ok fertilisation and then from day 3 onwards?


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## Trigger38 (Feb 15, 2014)

In my opinion yes it's worth it even if only one as I needed to know if what I was producing was chromosomably capable of becoming baby. Uf none made it I felt I could then consider donor and never have doubts. Now I know I can produce good quality normal one I'm more inclined to keep going with own eggs. On my first 2 goes I only had 2 blasts and they only early blasts. On third go I had 3 early blasts and full blast but that was at day 6. This time with different drugs and clinic we got 9 eggs but only 5 fertilised and they got all 5 to full blasts. Just one is chromosomably normal so I'm glad I've not wasted time having transfers ( fresh or frozen unnecessarily.  They will biopsy day 5 and day 6 so I had 2 that they did day 5 and 3 made it to blast on day 6. Cost is one off fee for up to 8 embryos but different clinics may offer differently. My clinic would of given me intralipids regardless due to previous failures as there are no/very minimal risks. My imlune results from dr gorgy showed I have slightly raised natural killer cells but when treating with intralipids they are reduced to normal range. Due to the lack of risks most clinics will do intralipids with no specific immune testing. Interestingly while the immune tests showed raised killer cells in blood, the uterine biopsy with dr quenby showed as all ok. It's a very unknown area and little scientific evidence to show if immune treatment is necessary however for ladies like us having repeat implantation failure there is growing evidence that it's least worth a try.


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## katkat2014 (Nov 28, 2014)

Thanks, Trigger. That's really useful. Those intra lipids, if you have very low NK cells and they treat you empirically with intralipids, could it actually hinder implantation rather than help? I wonder if it's then worth even doing the tests or rather treat empirically to start with
. PGS is a different story, I totally understand what you mean. Although again having doubts because what if you only have one abnormal embryo, does it mean you will have abnormal embryos every month/every IVF.. perhaps not. It's really difficult to then make the call to stop even if negative as you always have this hope that one day there will be one embryo that's ok...


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## IloveWesties (Aug 15, 2014)

Hi ladies hope you're all doing OK  

Re: treating emphirically - my personal view was to give it a go but after three cycles with low level immunes treatment (Prednisolone (steroids), Clexane and Lubion) and adding intralipids on the last, it hasn't worked for me... That's why we've bitten the bullet and paid to see Dr Gorgy for full immunes testing. We're currently waiting for the results to come through, having had the blood taken and sent off. It really depends how far down this road you are and how much capacity (mental/emotional/financial) you have left as to whether you should gamble with being treated emphirically when the situation is unknown/tests not done. We're getting towards the end of our capacity in all areas so it was time to figure out exactly what's going on and treat specifically, if necessary, for those issues.

Interesting that there's been some chat on here about PGD/PGS - I had a long chat with my consultant about this at my follow-up on Thursday (this is my clinic consultant, not Dr G) and her view was that it's totally unproven and can be very unreliable. We had it in mind to do if we get to a third fresh cycle (our next cycle will use our last remaining two frosties). She said various things including that embryos can be classed as not viable when they are (they take one cell which may have not developed properly on day 3, for example, but by day 5 the embryo would have been fine). Another example was that when a biopsy is done, it can actually damage an embryo so if it looks viable on day 3 the biopsy can cause damage to then cause it not to divide properly and therefore change it from being viable to not viable. There were various things that frankly were quite worrying so I'll need to do more research on this but we're now leaning towards not doing it if we get to that point, even though we would have transferred seven good quality blastocysts with no BFP if it got to that point x


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## Michimoo (Oct 13, 2011)

I would like to give you some hope.

After 6 failed OE ivfs, using immune treatment on some, copious amounts of investigations and still being classed as normal both my husband and I we are nearly there. 

We'd never had a sniff of implantation ever. I'd never seen 2 lines on a pee stick. 

We were still classed as unexplained which drove me nuts. Technically there was nothing wrong with either of us. We were just "unlucky"! ( I hate that word!)

We are now 37 weeks pg naturally. No ivf, nada, nothing.

Don't get me wrong it's been a difficult pregnancy and a bumpy road.

My diary will tell you more as there's far too much to write in a paragraph. 
However don't ever give up hope. 
I was in exactly the same position and trying to get my head around potentially having to go down the DE route. 

I'm sorry you've had another failed cycle. But if you are considering immunes etc I really would think about contacting Serum in Greece. For starters you can test your menstral blood and just send it in the post for womb infections. This isn't done in the uk. If you do have it, then it's just a simple course of antibiotics and sometimes this is the answer for ladies to get pg. financially it also is a lot cheaper than the UK and sometimes a lot more thorough.

I wish you all the luck and hope my journey may give you a brighter outlook.

Much love
M xxx


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## katkat2014 (Nov 28, 2014)

Michimoo, I am reading your diary. That's amazing!! Thanks for sharing


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## Michimoo (Oct 13, 2011)

Don't give up my darling xx


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