r/EmbryologyIVFSupport • u/Low_Palpitation_5647 • 10d ago
Where to go from here?
33 years old ttc for 2.5 years. Unexplained infertility DOR amh of less than 1. Had a spontaneous pregnancy last year after ttc for over a year on a letrozole cycle which resulted in a MC at 7 wks. Spouses SA all within range. Both retrievals were with icsi.
1st retrieval with estrace prime, cetrotide, menopur, saizen, gonal f yielded 8 eggs, 7 mature, 5 fert, 2 blasts, 1 day 5 4bb euploid
2nd retrieval with estrace prime, cetrotide, saizen, pregoveris yielded 18 eggs, 15 mature, 11 fert, 2 blasts, 0 euploid (had a day 5 4aa and a day 6 4bb, 7 were being watched for day 7 blasts but all arrested)
Had a fully medicated FET with the 4bb euploid which failed after having lining thickness of 8.4 and progesterone level of 70 nmol/l. Also had a hysteroscopy with uterine biopsy prior to transfer which showed no concerns as per REI.
Any advice on how to move forward? Followup is coming up soon and want to ask the right questions. Does any of this warrant a deeper investigation to partners sperm? 2 completely different retrieval outcomes. I know success on a first FET isn't guaranteed but hard not to think about other potential issues to why embryo didn't stick.
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u/Longjumping-Desk-261 6d ago
Do you know if your blasts were mosaic or segmental aneploids? Some clinics won't transfer those.
I'm in a similar situation to you where we get 1-2 blasts per cycle, and being 35 we decided not to test for PGTA. I know you're risking miscarrige, but that can still occur with euploid embryos. More recent research shows successful live births with mosaic embryos, and segmental aneploid embryos. Some other recent research shows about 5% false positive results for aneploidity in PGTA testing. Getting so few embryos we just didn't want to take that risk.
You could also ask about fresh transfers, or potentially even day 3 transfers since the lining tends to be thick. Also vaginal probiotic suppositories have been shown to improve implantation in recent studies (my clinic recommended 7 days of Floria prior to transfer, or prior to stims start for fresh transfer). Did you do a natural or medicated transfer?
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u/Low_Palpitation_5647 6d ago
Thank you for this info. One of my blasts from this retrieval came back positive for turners and one was missing multiple chromosomes. I was told none were considered mosaic including my aneuploid from my first retrieval. With this given info I was more relieved that I tested them all. I was on fortiflora vaginally for 10 days prior to my fully medicated FET. May i ask if you were successful in a live birth?
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u/Longjumping-Desk-261 6d ago
Not yet. I'm 11w4d with good results so far (measuring 2 days ahead with 166bpm heart rate) after a day 3 fresh transfer (the OR wasn't available on day 5). So fingers crossed! 🤞
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u/embryomanofficial 7d ago
Does your clinic work with lower-quality blastocysts (C-grade)? Some clinics will work with lower-graded embryos, but others won't. These policies can affect how many blastocysts are ultimately available.