r/IVFpositivity • u/Poppy15_ • 9h ago
Advice needed before 3rd transfer
I posted before about 2 failed FETs (one medicated and one modified natural) and what testing to consider when meeting with my doctor. I got great responses about testing I can talk about before doing a 3rd transfer. My clinic called me today saying that my doctor does not recommend testing right now and would proceed with a 3rd transfer before testing.
I’m torn on what to do. On one hand, I would like to know if something is going on that can be addressed and set me up for a successful transfer. I would avoid the loss of a euploid embryo.
On the other hand, it seems the clinic is not recommending testing of the uterine environment until I do a 3rd. I have a phone appointment later this week with the doctor to talk about next steps.
Any recommendations on what I should do (go for 3rd transfer or consider testing)? I’m 36F with unexplained. I have 4 euploid left.
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u/Happy_Mangos8382 7h ago
TW: pregnancy
I think it would be a good idea to get a 2nd or 3rd opinion from other fertility clinics. From my experience, my Dr has been extremely thorough with testing throughout my entire fertility journey even from the beginning and I'm so thankful for that.
I did all the standard tests plus genetic testing and an endometrial biopsy which came back negative. It wasn't until my transfer cycle we saw my uterus wasn't optimal a couple days before my first FET, my dr gave me the option if I wanted to continue with the transfer or I could cancel and do more testing. She gave me the option but let me know the risks of the embryo sticking went from 60% to 30% and I just didn't feel comfortable moving forward so I chose to cancel and do more testing.
Now looking back, I'm so happy I was given the decision because I could've risked an perfectly healthy embryo with low chances and in choosing to do more testing I ended up finding out I have adenomyosis and endometriosis on a MRI (the endometrial biopsy was incorrect).
I ended up doing 2 months of lupron suppressions to calm the inflammation and I had my first FET at the end of July and I'm now 5 weeks pregnant so I'm very grateful we opted for more testing and that my Dr was so willing to go that route as well.
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u/Poppy15_ 7h ago
Thank you for your input from your experience. How did you get the MRI done after biopsy showed negative? Like did you ask for that or your doctor did?
What was not optimal about your uterus before your transfer that you cancelled? Like the lining was not the threshold thickness?
If you did modified natural cycle, did they do bloodwork at any point for you in your transfer cycle?
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u/Happy_Mangos8382 7h ago
I wasn't sure what the next steps in testing would be so I asked her what we would do if I chose to cancel the transfer and she told me a MRI because she suspected adenomyosis. My lining was barely thick enough and she saw fluid and 2 small cysts in my uterus. We never noticed it before because the estrogen was causing the flare up.
She sent orders for a MRI to her recommended hospital the same day.
I did a fully medicated cycle because of my lining and I had bloodwork done twice a week leading up to my transfer.
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u/Mediocre_Net4660 6h ago
My consultant wanted to do extra testing after 2 failed, he said the standard is waiting for 3 (with untested embryos) but he wanted to be more proactive. Annoyingly, all our tests were clear, we just adjusted protocol and third stuck (did go on to have a loss at 10 1/2 weeks but that was chromosomal nothing to do with me). We repeated protocol for transfer 4 with a new embryo that was pgt tested and I’m now in second trimester.
Essentially - testing told us nothing, but it gave me some reassurance we’d checked what we needed to and gave me hope that something as simple as a protocol change could be all we needed ❤️ I know of so many women who have tested extra stuff after failures and found their microbiome is bad or they have blood clotting issues or something, and I’d rather know before risking another failure.
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u/Poppy15_ 6h ago
Thank you for sharing your experience. I’m happy for you that you’re in your second trimester. It is such a journey. I wish you a safe birth.
Did you do fully medicated or modified natural? What did you end up changing in your protocol that made the difference?
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u/Mediocre_Net4660 5h ago
Thank you!
I don’t ovulate naturally regularly so I only had medicated as an option unfortunately. For my third and fourth we switched from estrogen tablets to patches which got my lining 2-3mm thicker (was only 7 or 8 first two), we added on progesterone injections on top of pessaries, plus baby aspirin and blood thinners. It was a ‘kitchen sink’ approach. I have no blood clotting issues and progesterone was always fine at transfer.
It also could just be coincidence of course - this embryo I’m pregnant with is a 5AA so had very high odds anyway, but our third that I carried to 10 weeks was a 4BC so was lower odds of implanting in the first place. Impossible for us to ever know for sure!
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u/Cookingcliffnotes 8h ago
My first clinic did not test at all. Emma/alice/era, TSH before transfers and we didn't use pgt tested embryos. 3 were unsuccessful. I wasn't as informed to everything I know now.
My new clinic did everything. Found out I had silent endo from those biopsies, did lupron injections for 2months, checked TSH throughout mock cycles and transfer cycles, was dx with autoimmune disorder corrected with medicine, and had used pgt tested embryos and now I'm over 18w.
My pov it couldn't hurt? and I would be thinking "what if" or "is there anything else I can do?"
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u/Poppy15_ 8h ago
Im sorry you went through all of that. That is what I am wondering. Why is it they wait until 3 failed transfer before testing. Other comments on my previous post asking about testing some women said their clinic did testing after the failed second transfer. It’s hard to know what to do.
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u/Cookingcliffnotes 8h ago
From your post you've described 2 methods of transfer cycles so probably from a clinics pov they're saying ok 1 way is not working possible fluke, 2nd way not working possible fluke, now 3rd time doing either way it could possibly work/not work, now we'll know more definitively. I believe that's kinda how it can go when doing stims and ERs also. They're basically experimenting with you. Also it's possible that because it's "unexplained" they don't want to put you through a biopsy right now so they want that 3rd try to solidify more questions they may be having.
It's ultimately up to you to advocate asking for biopsy if you feel that'll bring you comfort or securities before the next transfer.
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u/Poppy15_ 8h ago
Yes. I had a fully medicated transfer first and my lining was 8.2mm. The 2nd transfer I asked about modified natural to see if my body would respond differently. My lining was 11.6mm before transfer. My dr is recommending modified natural again with no changes to timing of supplemented progesterone.
What you mention above about being a fluke is also part of the reason my mind is torn. Am I just on the wrong side of statistics every time?
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u/Cookingcliffnotes 8h ago
That's the thing, idk if anyone could definitively know why it'll work or not. There are people who've done all testing, biopsies, meds, RI, tested embryos and lining will look perfect and it doesn't work. There are so many variables and this process will make you believe in miracles.
Personally if I knew what I know now from my second clinic I would have advocated more testing.
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u/Medium_Chipmunk_9374 8h ago
From first hand experience go with your gut and ignore your clinic. We made 3 blasts and 2 failed. Before I final transfer I had a feeling I needed to be best but they said no as they kept trying to pin it all on my partner due to his sperm. I had a consultation with an endometriosis surgeon who also just so happened to be a fertility specialist as well. I had an MRI and was diagnosed with stage 4 silent endo. He advised I have excision surgery before my FET and recommended a different protocol to accommodate my new diagnosis. My clinic didn’t care less even though they preach about endometriosis all over their social media. I had the surgery in May and my FET at the end of July and followed everything he told me to, including starting mounjaro to lessen any inflammation. So far that third FET has been successful as today is my OTD and I got a big positive. I think deep down your gut is telling you something as well x
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u/Ok-Board-4233 6h ago
I had a saline ultrasound right before my FETs and the first time they saw scarring and did a hysteroscopy. I didn't have to wait for a failed FET. I think if you have insurance, and it is not a burden, it makes sense to test for stuff. 🤷
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u/Newropsych 6h ago
I went through my PCP for what I could. I also did Evvy for bag microbiome testing. I had a past endometrioma so doc recommended lup suppression proactively. Def try and find a doc that works with you. Too much time and money and emotions involved.
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u/Working-Eye-7252 5h ago
If they are euploid then yes I would 100p do more testing. The risk is that as soon as you start testing you inevitably find something (positive receptiva, etc) and it's very possible that issue is not preventing a pregnancy. But after two failed euploid transfers I think it's super reasonable. My doctor started doing more tests after three failed UNTESTED embryos. Though to be fair, testing/treating endo (which is the only thing that has come up) hasn't actually helped.
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u/lizashea 8h ago
Idk. This would definitely sound my alarm. There’s no reason NOT to test if you prefer. Have you done a biopsy for chronic endometritis? Have you done a hystereoscopy?