# Recurrent implantation failure - what's the real cause?



## bankie (Dec 27, 2007)

Hi all,

Last week I got my 5th IVF BFN.      Other than the 5 IVFs I've been ttc for nearly 5 years and in all that time have never once had a positive pg test.  I have two main issues (that I know about):

1. is low ovarian reserve - this was diagnosed 3 years ago when I was 30.  I've had FSH up to 12.3 and my AMH is 7.5 - my ovaries are physically small in size and I pretty much only ever get eggs from my left ovary.  However, the few eggs that I do get seem to be OK and I always get high fertilisation rates and grade 1 embryos - once I even made it to a blastocyst transfer.

2. Immune issues - diagnosed after my 4th IVF.  With my latest tx I had full immune treatment under Dr Gorgy (IVIG, intralipids, humira, LIT, prednisolone, clexane and gestone - basically the works!) and although I responded really well to all treatments and my immunes were normal before starting my IVF, another BFN.   

Basically my question is which of these two issues do you think is most likely to be causing my recurrent BFNs?  I have seen many women on FF with lower quality embryos getting pregnant, which makes me think that maybe it's not my eggs, but my immunes that are the problem.  But then equally I have seen ladies with immunes problems who are achieving pg, even if they sadly do not hold on to it without immune treatment.  But here I am never having even got as far as a chemical pg.  I know that I have only done 1 tx with immune tx, and maybe I was just unlucky this time so it's probably worth trying it again at least once more, but I need to start thinking about what will happen if my next tx has the same outcome.

I'm getting to the point where I just don't know how much longer it is worth trying if I can't ever get past OTD with a positive result.  But without knowing the cause of my problems I don't know if it's worth moving on to DE, or if some other route (surrogacy etc) might be better.

I have asked several doctors which of these problems they think is the real issue, but just can't get a straight answer.  If anyone has any thoughts on this, I'd really appreciate it because I just don't know where to turn next.

Thanks,

bankie


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## Zeka (Mar 7, 2009)

Bankie,   . Sorry to hear you are having such a hard time. I really feel for you. It's hard enough after a couple of BFN, let alone five I can't imagine. Unfortunately I don't think even those most experienced cons are able to put their finger on whether the lack of implantation is down to immune issues or problems with the embryos - at least that's what I've been told to date from the argc and fga.

I was told by the argc that I may need to have 3/4 cycles with immune tx before a bfp, so if you have 'only' had one cycle with all the immune meds this may suggest you should try again.

You don't mention whether you have had any chromosonal testing (Karyotyping, PGS/PGD, Array CGH? As I undestand it, only a few places in the UK do CGH (and I think only Care Nottingham do Array CGH http://www.carefertility.com/fertility-treatments-sc1/treatments-sj2/anc-1/ ). I've been advised to do karyotyping to see if chromosonal issues are preventing implantation, whereas a couple of friends that have had as many BFN's as you have been advised to look into CGH.

Good luck Bankie, this is such a difficult all consuming journey.
May 2010 be a great year for all of us!
Zeka x


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## bankie (Dec 27, 2007)

Hi Zeka and Lirac - thanks for your replies.

Zeka - I agree that one cycle with immune tx is not enough, so we do plan to try again next year.  I just need to start thinking beyond that to next steps, as it is so soul-destroying to keep getting BFN after BFN.  We have both had the karyotyping test which came back normal.  I asked my cons about PGD a while ago and she told me that it wouldn't be suitable in my case, because I get so few embryos there are not normally many spare ones to choose from.  It may be worth asking again though, because if our embryos are fundamentally abnormal then I'd rather know now so that we can stop putting ourselves through pointless IVFs.

Lirac - I have also heard about improved pg rates after hysteroscopies, but unfortunately it didn't happen for me!  I had a hysteroscopy and laparoscopy 18 months ago - at least that did confirm that there was nothing present that would prevent me from getting pregnant.  I also always develop a good lining, so no problems there.  

I guess maybe there isn't an answer to whether it's one thing or the other, it's just so frustrating I feel like screaming.    

bankie


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## livity k (May 19, 2009)

Hi Bankie, 
This is my story- I don't know if it will be helpful to you, but I totally agree you need answers when it keeps not working, 

I've had 3 BFN's this year with good/excellent quality blastocysts (one fresh 2 frozen) and my consultant has said he is surprised it has not worked yet, given my age and quality of embryos, although it could still be chance, 

I had an endometrial sweep/biospsy before last one to improve lining but no joy, 

I have now had immune tests, karotyping and thrombophilia screening which I'm waiting results for, My DH has already had karotyping pre his TESE and he is fine, 

The consultant did say that if all the tests came back fine and our last frostie doesn't work he would be inclined to do Pre genetic screening on any fresh embryos in case we have an interaction problem causing chromosonally abnormal embryos. He said he's treated five people last year with a similar profile and following screening they have got preg with the ok embryos, I agree with you even if you only get a few embryos it might be better to know before you go through transfer- 

We are with CRGH in london and they are excellent, they are very proactive and change/tweak protocols each time, They are also experts in genetic screening, 

For my last FET I'm going to try a natural cycle (other 2 have been medicated) I'm also going to lose some weight in case that 's affecting things ( my BMI is about 29/30) I have PCOS-and weight does affect hormones, I kind of thought I was ok when we got really good embryos but I now think I need everything to be optimal, 

Good luck next year

Kate x


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## bankie (Dec 27, 2007)

Hi Kate,

Thanks for your reply - I'm at the Lister and will be going for a follow up consultation with them in the new year.  Based on what you've told me though I may also contact CRGH to see if they would recommend pre-genetic screening in my case.  Is there a particular consultant you would recommend I speak with?

I too want to lose some weight before my next cycle - my BMI was 23/4 when I started but 2.5 years and 5 IVF cycles later it's now nearer 28.  I have tried pretty much everything diet-wise in the past to try and improve my fertility but nothing has worked.  This time I want to lose the weight just because I'm fed up of being this size.     The way I see it, even if I get another BFN at least I'd like to feel a bit better about myself than I do now.

Good luck to you too, let's hope 2010 is our year!

bankie


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## livity k (May 19, 2009)

Hi 

We're with Ranieri- he's the deputy medical director- I'm really happy with him, 

Good luck, 

Kate x


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## bankie (Dec 27, 2007)

Hi Kate - thanks for that, now I know who to ask for!


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## ciwarner (Oct 15, 2009)

Hi Everyone,

I am in a similarly confusing and frustrating situation. I've just tested negative on my 4th cycle which is really getting me down. There are no known issues with me, the problems lie with my DH (due to chemo in 2001 we are relying on 1 frozen sample of sperm divided into 4 ampules ). I respond very well to the drugs (to well as my first cycle was cancelled due to over stimulation), have no issues with my endometrial lining, produce between 10-12 eggs per cycle, have produced up to 6 embryos and in my last cycle produced 2 good quality blastocysts and still no joy. I've had a hysteroscopy which came back clear and my last embryo transfer went very smoothly. As we have been doing ICSI we've been told that frozen sperm should not be an issue as they only need enough to fertilise a few eggs. 

I'm concerned that the cons keeps saying we are just unlucky and they have not suggested changing my protocol. I'm also conscious of the fact that we only have 2 ampules left (2 more tries) and I don't want to waste it on doing exactly the same thing as we've been doing over the past 2 years.

Any suggestions would be much appreciated as I have my review on the 22nd of January

Have a great Christmas

Ciara


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## Zeka (Mar 7, 2009)

Hi Ciara, sorry to hear you have had another BFN. It must be a scary situation for you to be in and to be facing yet another BFN  
Can I ask which clinic/hospital you are at - or basically does it offer immune testing and treatment (as not all do or even believe in it)? (eg testing for Natural Killer cells, Cytokines (TNFalpha)). This may be something you could look into if you haven't already?
Zeka x


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## ciwarner (Oct 15, 2009)

Hi Zeka,

Im currently with Bourn Hall Clinic in Cambridge, but Im starting to lose confidence in them since they dont offer any information beyond that which I'm aware of and they havent changed my protocol. I have an appointment on the 22nd of Jan and will definitely suggest immune testing.

Have you thought about your next step?

Good Luck

Ciara


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## Zeka (Mar 7, 2009)

Hi Ciara, If you decide to stay at B Hall but for some reason they can't do immune testing, you could always get it done with someone like Mr Gorgy at FGA. He is an ex argc cons who offers extensive immune testing.

I have seen him recently for some additional tests and I am doing an iui cycle with him this month (-i needed something less invasive and not all consuming for a while but to still feeling in control, if that makes sense!) So fingers crossed my body prefers the low tech option this month and there is no need to revert back to IVF later in the year!  )
Good luck with your follow up!
Zeka x


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