? for Ghost and anyone with repeated BFN's

[Lisa SC]

Hi all. I'm sorry if you are reading this post with repeated BFN's

I have just completed my 2nd fresh cycle and it's looking like another BFN (no +'ves on HPT's, BETA is Thursday - I am 11 dp3dt).

This cycle, my Day 2 FSH was 6.6. We had 17 mature eggs, 11 fertilised and on Day 3 we had 3 x10 cell grade one embies and 7 x 8 cell grade one embies . (Grade 1 is the best here in Singapore). 1 x 10 cell and 2x 8 cell were transferred on Day 3, and the rest were frozen.

DH has low morphology ( ranges 1 - 6 %) but has good no.s.

I had 2 natural m/c's before IVF and we had another m/c from our FET cycle.

We are always told that our embies look great and my lining is fine.

BUT - we haven't got a baby

I am seeing my RE on Thursday and would welcome your thoughts on where we should go from here.

My questions to Ghost -

1. What questions should I be asking the RE?

2. I appreciate from your previous posts that endometrial receptivity can be a problem with fresh cycles. Are there any tests that can be done to check it? ( I have seen some info on testing for B3 Integrin - do you know anything about this ? - As I have achieved implantation a few times maybe it isn't an issue??)

3. Are there any tests that you think we could try?

4. Finally (!) I note that you have commented that your clinic doesn't do a natural FET cycle. What is the proceedure for FET at your clinic?

Ghost, as always your help is invaluable and much appreciated.
Many thanks and kindest regards
Lisa

[cwrj00]

Hi Lisa

I don't know if it helpful to tell you this but it isn't over for you yet. I didn't get a +ve until day 17 after EC. (My Beta got as high as 650 then unfort things didn't progress). I can't answer your scientific questions but I hope and pray you get your little miracle BFP.

Tracey

[Ghost]

1. What questions should I be asking the RE?

2. I appreciate from your previous posts that endometrial receptivity can be a problem with fresh cycles. Are there any tests that can be done to check it? ( I have seen some info on testing for B3 Integrin - do you know anything about this ? - As I have achieved implantation a few times maybe it isn't an issue??)

3. Are there any tests that you think we could try?

4. Finally (!) I note that you have commented that your clinic doesn't do a natural FET cycle. What is the proceedure for FET at your clinic?

1. I don't know if there are any probing questions to ask just yet. Although your response is above average for age 39, it's possible that male factor may be your limitation. Keep in mind that embryos grow to day 3 before the embryonic DNA kicks in. Arrested development after day 3 can reflect flawed DNA, potentially from the male. Since you transferred on day 3, you don't know how severe the rate of arrest was after day 3. So you might consider requesting blastocyst (day 5) transfer next time?

2. I don't know of a good test for endometrial receptivity in a given patient at the proper time. It's not something we want to disturb with a biopsy while there is an embryo present. The issues with endometrial receptivity have been inferred from observed general patterns of implantation, inconsistent with models of embryo quality alone. Yes, you have achieved implantation, but that does not rule out the potential of an endometrial issue, maybe, being related to your losses. There seems to be such a thing as a flawed implantation.

3. Basically the same answer. Keep in mind, at 39, the chance of a failure is high regardless of any specific and unusual difficulties. In the USA, only about 1/4 of cycles in your age group result in a live birth. Even in the youngest age group, most cycles fail. And I've heard that the USA has the highest success rates (that's not a nationalistic boast, just the effect of a general lack of insurance coverage, pressing us for higher success rates to motivate uninsured patients to pay cash for IVF).

4. We suppress the FET patient with Lupron, then prepare their endometrium with estradiol and, later, progesterone. About 5 days after progesterone start, we transfer blastocysts. It's fairly common. We do much better than the national average with FET cycles, but I'm not sure why.

[Lisa SC]

Tracey HI - thanks for your kind thoughts.

Ghost - as always thank you for being so generous with your time and advice.

Lisa