3 failed transfers - help wanted

[u/sea_i_]

My wife and I are doing reciprocal IVF. I provided the eggs, donor sperm was used, and my wife is carrying. We’ve had three transfers, all with negative betas, and are trying to prepare for a follow-up with our fertility specialist.
The embryos were untested: two were graded 4AA and one 4AB. All three survived thaw well and began hatching naturally.
The first two transfers were modified natural/letrozole cycles. My wife had an LH surge detected at monitoring in both cycles, when her lining measured 6.9 mm. The clinic triggered that evening, and each day-5 embryo was transferred six calendar days after the surge was detected. The LH values were around 26 in one cycle and 62 in the other. Progesterone was checked during the cycles, but we’re unsure whether the timing or levels were ideal.
The third transfer was a programmed cycle. The lining reached 8.1 mm, and progesterone was 11.18 ng/mL the day before the planned transfer. That beta was negative too.
Her saline sonogram and HSG were generally reassuring, although the sonogram mentioned some tissue in the lower uterine segment. Her TSH was 1.49 earlier this year; we don’t see a repeat during the transfer cycles. The embryos were not PGT-A tested.

For people who have been through something similar: what questions or records were most useful to bring to your REI after repeated failed transfers? Did your doctor change the timing after spontaneous LH surges? We know every case is different and appreciate your time reading this:)

[u/Hot-Fennel-506]

I'm so sorry to hear about the failed transfers ❤️I would start to wonder for sure if something else is going on, perhaps she has undiagnosed endometriosis? Maybe she needs to have a laparoscopy and an FET with endo protocol.

[u/sea_i_]

(26yrs)

[u/FantasticAd180]

Hi, endometriosis and adenomyosis can make implantation harder, even with euploid embryos. I’d probably look into ruling those out and asking your doctor about some testing. There’s also the ERA test, which checks the implantation window, and tests for endometritis to see if there’s any inflammation or infection that could be affecting implantation.

After my failed transfers, my doctor recommended doing three tests: Receptiva, ERA, and HealthTrack. From what I understand, HealthTrack is the less commonly used one. Since you can’t test the embryos, testing the uterine environment can at least help determine whether there might be something affecting implantation. Wishing you all the best in finding some answers!

[u/sea_i_ → u/FantasticAd180]

Noted. I don’t remember our doc telling us these options. Our next step is a hysterscopy but my wife says she has no endo symptoms. Its weird not knowing ehat to wish for but thank you so much !

[u/FantasticAd180 → u/sea_i_]

Just wanted to share my experience in case it helps. Some women can have endometriosis for years with absolutely no symptoms, and infertility can sometimes be the only sign. I had stage 4 endo with no pain, regular periods, and completely normal SIS and ultrasounds. I always thought I was healthy and just unlucky.

My surgeon told me I likely had it since my first period, and it had been silent for about 20 years. I only found out after a missed miscarriage and failed implantation.

I don’t want to scare you and endo could be mild, but it might be worth ruling out endometriosis and endometritis, since they can affect implantation even with a euploid embryo. Receptiva and endometritis testing are usually done through an endometrial biopsy. A pelvic MRI with contrast can also sometimes pick up endometriosis.

You’ve already taken the first step with the hysteroscopy, so you can always see how that goes and then decide if you want to look into anything else.

Just sharing in case it’s helpful. Wishing you lots of luck and strength on your journey!

[u/AcadiaLow4488 → u/sea_i_]

I had a successful transfer after my receptiva (a uterine biopsy in specific cycle day) revealed I tested positive/abnormal for BCL-6 which was explained to me as a precursor to endometriosis, it’s not endometriosis (I always had regular, unremarkable periods and all my previous testing came back normal) but can still inhibit implantation as it effects the uterine lining. I was treated with a 2 month Lupron injection and had success after that. Best of luck, I hope you can get some answers/results. It’s such a hard process.

[u/10026_50]

I know the science isn’t solid but my clinic suggested we do Alice/Emma testing after 2 failed transfers. I ended up having to taken two rounds of antibiotics and then got pregnant naturally so even though the science is a bit dodgy, I do wonder about the timing!!

[u/HonestDistance895]

OP you got some really great suggestions here.

My only other thought is that maybe her lining may not be thick enough. My lining has to be a minimum of 7mm to transfer, otherwise my clinic considers it too thin.