# why dont they implant? and other Q's



## 11th hour (Feb 4, 2006)

i had three embs put back.. all fairly mediocre grade, 2 cells and a three and i was told my womb lining was "optimum". 10mm..... so why dont they implant.....?

Is it possible that the cells stopped developing and it is possible to define whether this happened or not? or is that just still in the realms of magic at this stage of IVF reearch.

Is 600ml of Utrogest a day enough . I started bleeding on day 12 after ET, Should I ask for better progestone support my next cycle?


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## daisyg (Jan 7, 2004)

Hi 11th Hour,

Firstly, I am really so sorry that your cycle did not work out - it is very sad and incredibly frustrating I know.

Well, this is the $64,000 question!!  So many possible reasons why embryos don't implant.  Firstly, it may just be bad luck - you simply cannot have a 100% success rate and people sadly do fall on the wrong side of the stats.  Sometimes it takes more than one go.  Next, here is a list of possible reasons:-

- your age - chromosomally abnormal embryos (although this can happen at any age, the number of aneuploid/abnormal embies increases with age)
- your uterus - did you have a triple stripe appearance?  Have you been checked for fibroids, scarring, polyps, endo etc. etc?
- The quality of your clinic's embryologist and their lab techniques
- your protocol did not suit you and produced poor quality embryos
- you have factors that affect implantation e.g. thryoid issues, insulin resistance issues, clotting factors, autoimmune or immune issues, bacterial infection and you have not been tested  or treated for these
- you did not have adequate estrogen support
- you did not have adequate progesterone support - bleeding before a bfp can be a sign that you did not have enough p4.  Did you have a progesterone blood test 1 week after embryo transfer or at beta to see what your blood levels were?  Would recommend you do Gestone next time to be absolutely sure.
- There was an issue with the sperm used

The only way you can test an embryo pre implantation is by doing PGD or PGS.  However, there is no evidence that this increases your chance of a live birth and in fact may hinder it.  Much better to make more embryos and replace them all.  Research has shown that for women over 42 you need to make at least 5 oocytes and replace as many embies as poss.

It is totally possible that the embies were not chromosomally normal, or that there was a systemic issue with you etc.  Sadly, it is a question of perhaps some testing to rule out more common implantation failure issues etc. BUT it may have just been bad luck.  So unhelpful I know and so frustrating.  I wish I could give you the magic answer but ivf is sometimes more art than science.

What is your clinic's success rate with women your age using their own eggs?  I would want to know this info and what they suggest for you?

Sending best wishes,

Daisy
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## bottleofwater (Jun 19, 2007)

Sorry about your BFN 11th hour I hope you find some answers or at least have some tests to see if you have any immune issues or sticky blood etc. I hope whatever you deceide next time is a success.

I just wanted to also clarify with daisy about this triple stripe, I had a scan today as I had been suffering from thin lining and to my delight got 10mm and the cons set my triple stripe was getting there. Now I don't know what that means or how important that is in achieving pregnancy, what are the odds if it is not triple or triple.

thankx


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## daisyg (Jan 7, 2004)

Hi BOW,

The triple stripe appearance (trilaminar - showing the endometrial layers) is something that achieved (in response to rising oestrogen levels) in a normal uterus which has reached a good thickness for implantation - before embryo transfer. The uterus lining responds to the increase in oestrogen before transfer and thickens ready for an embryo to implant. It is thought that higher pregnancy rates are achieved in women who's wombs achieve this triple stripe appearance BUT I don't think there is conclusive proof on this, it is just thought to be better.

Some info. here

http://www.advancedfertility.com/uterus.htm

http://www.inciid.org/faq.php?cat=infertility101&id=1#15

http://books.google.com/books?id=iyhIUSiNOfIC&pg=PA1041&lpg=PA1041&dq=higher+pregnancy+rates+triple+stripe&source=web&ots=hq80N44h4x&sig=DB-itORqPbdUvj15EshhaEphr_s

Anyway, it all sounds pretty good for you judging by your doctor's comments. 10mm is excellent!!

Best of luck,

Daisy
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/links


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## 11th hour (Feb 4, 2006)

I have only recently come across the idea that different embryology labs are better than others. So what is it that they do differently and how can i find out what they are doing. Its tricky is nt it?  

I have found it difficult to get more specific information from Fertimed during my cycle. for example, when i asked how long my follicles were, Dr Sobek basically said he didnt note it down, he just looked and told me i had a one good one  and two small ones. That seem s to be his style, obviously he has done it a lot and can tell for himslef what he needs to know, but i dont get all the finer details that i would like to help me analyse and compare. Maybe it doesnt matter...

I ve got a prob now about changing clinics cos my sperm donor sperm is with fertimed and he goes to australia in November for three months. Im not that sure about how great his sperm quality is but as i had ICSI i thought it didnt matter.I assumed that they selected the normal one to inject and that this would make this aspect of it ok.

I noticed that when i went fior a beta test, there was a check box for autoimmune issues to be checked. I avoided sneakily checking this box and thought it would be best to ok it with  my doctor first. it they do these autoimmune issue blood tests at the hospital, will they be looking for the things important to IVF or d'you reckon it will be other stuff.

Again, they told me i had a 10mm lining but i doubt even if i asked they would tell me about the triple stripe. it really is a bit of a language problem issue with them.

I did ask him about my protocol but i think he would do the same, maybe increasse it a bit.


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## ☼♥ Minxy ♥☼ © (Jan 13, 2005)

Hi

I'm sorry for your BFN 

To be honest, I can't really add any more words of wisdom to what daisy has already said.

We've just had another failed IVF   This was our 5th attempt (3 x IVF & 2 x FETs).  

With our first 4 attempts we had grade 1 (top) embryos put back and with this IVF we had a grade 1 and a grade 2 put back.  With first IVF I started spotting at 10/11dpt but at least made it to test day...with 2nd IVF I started full flow bleeding at 11dpt and with this 3rd attempt, the spotting started at 8dpt and by 10dpt it was full flow.  Our 2 FETs were chemical pregnancy but these were also on natural cycles so I had my own good progesterone levels (as ovulated naturally) as well as additional support.

I do feel that I need much better progesterone support and will be discussing this, again.  Our private consultant feels I need Gestone injections as well as IVIG (as prednisolone is not enough as already tried on 3 attempts).  This was our NHS funded cycle and although same hospital, different consultant, who said I don't need the steroids (prednisolone) and I don't need Gestone or better progesterone support...and this time I bled very early...so who's right ?!

I've had 5 lap/dyes and hysteroscopies for known problems (endo diagnosed almost 20 yrs ago) and bicornuate uterus (diagnosed can't remember when, 9 yrs ago ?)...the last op (lap/dye and hystero) was in February, just before we had our 2nd fresh IVF cycle.  We thought this would improve our chances as I've conceived naturally following ops (7mths after a lap/dye and hystero and then immediately after a hystero) but both ended in early mc.  I've had blood tests which have confirmed several blood clotting disorders as well as raised NK cells and I've had additional medication for this.

Like you, I have always been told my womb lining is really good...we get good quality embies, my eggs are good, DP's sperm is good....

I have conceived no problems 17yrs ago and sadly had termination so I know I can do it and I know I could "hold" a pregnancy...but for some reason, I don't seem to be able to now.

To be honest, I think the problems with implantation are the hardest to detect and the hardest to find reasons for.....our private consultant said I need "superglue"...wouldn't it be great if they could invent some !

I wish you loads of luck in whatever you do next.

Take care
Natasha


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## daisyg (Jan 7, 2004)

Minxy, I am so, so sorry for your negative result.  It just breaks my heart to see it.  I would agree with you that Gestone may be a way forward in addition to the other meds you mention.  You could also have a progesterone check 1 weeks after embryo transfer as this may allow some adjustment to the progesterone if it is low.

I really feel for you.  I too sadly had a termination at age 37 - I just didn't realise about how many issues I would have now.  Although I am absolutely overjoyed with my babes now, I do still wonder about that.....

11th Hour - You cannot rely on your friend's sperm really, unless he has produced a live birth recently and/or had thorough testing including sperm dna fragmentation and karyotyping.  This could be a really big factor for you and I personally would only use donor sperm from a proven clinic donor.  Otherwise it is leaving it too much to chance.

Clinics obviously vary in their skill and expertise.  The most important people are the embryologists and the lab.  Some clinics have good stats, some not so good.  It depends on finances as well - some of the best clinics are in the States but are expensive.  Another v. good clinic is IVI Valencia, but without knowing Fertimeds success rates for your age group it is difficult to tell.  It might help to have a good chat with your doctor about his next plan for you and to find out how he has treated other women of your age etc.  I  would also double check about further testing for you - the list at the top of the investigations and immunology board has all the relevant tests.

Sending best wishes,

Daisy
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## 11th hour (Feb 4, 2006)

hi, 

im really sorry to hear that it didnt work out for you again, it is very frustrating. 

Having now done one cycle... i can appreciate how strong you have had to be to keep at it again and again and you have my admiration.

i just hope that you get ****** with your hub and have a hot shag on the sofa and miraculouslyl get preg natuirally, cos if there was any justice in this world.. thats what should happen. no drugs, no cash,  and a wicked orgasm.  (and have one for me)

all the very best,

Imogen


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## crowsfeet (Oct 8, 2007)

Hi 11th hour,

I'm in the same position - no obvious reason for not implanting (I'm on 2nd cycle 6th and final transfer for this cycle) and based on Daisy and Minxy's experience I think at my next appointment I'm going to ask for a summary to check what I have and haven't been screened for.....then I'll bring it back to FF for the gang to tell me what else I should ask for!

Thanks Daisy and Minxy for advice. Minxy really really sorry to hear about your BFN.
Lots of love and luck to all,
Crowsfeet


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## BMC (Nov 3, 2007)

Hi 11th Hour. I am new to FF and just wanted to say sorry to hear about your negative cycle. I am 47 now - first posting in introductions - and have had 2 cycles of IVF with donor eggs this year - one fresh in April and one frozen 3 weeks ago so am still trying to get over disappointment. On both occasions embryos good and lining 10mm and 9mm respectively. First attempt started bleeding Day 14 after transfer and on second started spotting/bleeding Day12/13. Was advised to increase does of cyclogest pessary from 2 to 3 400mg per day. But felt at that stage it was all over. Will be going back for a follow up consultation which we have to pay for just to add insult to injury so want to make the most of it by asking the right questions before we decide to proceed and try again with 3 remaining frozen embies. One will be the drugs protocol was I taking enough progesterone to support the lining? Do not really understand why bleeding starts - is it because the embryos have died and the lining starts to breakdown or is it because the lining starts to breakdown and the embryos die?? Any thoughts anyone? An ultrasound showed small calcifications within uterine cavity but this was considered as unlikely to affect implantation as the lining had thickened. Undoubtedly diagnostic hysteroscopy will be mentioned again but do not think we can afford it at £3000 on top of everything else. What if anything are these things likely to show that ultrasound can't? Another question I suppose. I think I was really naive to think the DE route was going to work first time or second time judging by some of the postings and the agonies many people have endured.


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