Implantation failure

    Dear team of experts,

    I have now had my second unsuccessful transfer without implantation and am wondering what the problem could be. I am now trying to do the ERA test, but have very little time left (two cycles / 9 weeks due to age limit, I am 50). So I'm also looking for other things I could change. Transporting the third and last embryo to another country seems very difficult (which is why I tried a second time without ERA on the advice of the clinic).

    My protocol so far: 14 days of 6 mg estradiol, then an additional 123 h of progesterone. Also: 40 mg Clexane, ASS150, 1000 IU vitamin D, folic acid, thyroxine 125 ug (thyroid clarified). At the first TF I still had Orgalutran for 5 days, now no longer necessary.

    Vitamin D currently at 30 => is that enough?


    My ideas:

    1) It is noticeable that I had a stronger pulling sensation in my abdomen and back after some movement during both transfers. On the first transfer it was after a walk that was partly uphill (on TF + 1) and on the second transfer it was after some cycling (on a Dutch bike on TF + 3). I was told that I wasn't allowed to jog, but climbing stairs or something similar would be okay. Now I'm wondering whether even these light movements (I normally do a lot of sport) could have already caused contractions and thus a rejection? If so, I should have been told explicitly, because cycling is more comfortable for me than going for a walk, and it certainly wasn't too strenuous for me. But perhaps my uterus is also particularly contractile and magnesium would help me?

    2) Prednisolone => My gynecologist suggested it, but my clinic doctor abroad refused. I followed the advice of the clinic abroad, so no prednisolone.

    3) HCG injection => does this support implantation? The clinic refused the injection.

    4) I have noticed that my vaginal pH is slightly elevated (approx. 5 to 5.5). Could this indicate a disturbance of the microbiome? Can I simply take profilactic lactobacilli (OMNi Biotic Flora plus)? I don't have time to do EMMA/ALICE first and then cleanse.

    5) Scratching

    Best regards and many thanks!

    Your Oskar

    P.S.:

    - Hysteroscopy 2022 okay and killer + plasma cells normal

    - Endometrium by 3D ultrasound on 26.04.24 flat and without abnormalities

    - Coagulation checked and treated with Clexane.

    - 4x antiphospholipid syndromes checked: 2x positive, 2 x negative, therefore prophylactic ASA

    Dear experts,

    I noticed something else: shortly before the transfer I had a progesterone level of 18 ng/ml, after a week it had dropped slightly (16.5) and on the BT it was 9.5.

    Could it be that my body was no longer absorbing the progesterone and the progesterone receptors were oversaturated?

    My protocol says 400 mg Famentina vaginally every 12 hours from 120 h before transfer until BT.

    Could this exactly indicate a shifted implantation window? I am still trying to time the Era-test somehow, but am currently still waiting for my bleeding.

    Thank you very much, Oskar

    Dear Mrs. Oskar,

    We think it is advisable to take magnesium. And it is certainly not detrimental. We recommend prednisolone. ERA, EMMA and ALICE are the only meaningful tests. Ph cannot be compared.

    To your 2 questions:

    Could it be that my body no longer absorbed the progesterone, the progesterone receptors were oversaturated? No.

    Could this indicate a delayed implantation window? No.

    Kind regards,

    Dr. Izquierdo

    Ihr Clinica Tambre Team <3

    Hello Dr. Izquierdo,

    I'm beginning to think it's simply down to age!

    At a young age, the female body goes to incredible lengths to protect the uterus from intruders and germs outside of ovulation in order to make it receptive to sperm and the embryo in the middle of the cycle. It is all an enormously balanced system, a miracle of nature. As we approach the menopause, this system becomes increasingly disrupted (e.g. oestrogen dominance and later a temporary lack of oestrogen). This also increases the risk of microbiome imbalance, invasion of germs etc...).

    I am very shocked by this realization, as I was repeatedly told by various clinics at home and abroad that "it will work with a single donation, it's just your old eggs".

    There are so many women here for whom it doesn't work, but the chances per transfer are supposed to be 30 - 60 percent (depending on the clinic)?

    Please excuse the fact that my frustration has now ended up in this treat, but I just wanted to share my thoughts ... This has nothing to do with you, my frustration is not directed at you!

    Best regards! Oskar

    There are so many expensive tests on the market (micobiomas, implantation windows, infections) ...

    But perhaps the solution would be much simpler: treating women interested in individual donation with a light hrt (depending on what is missing) so that the system doesn't get derailed in the first place? And at the latest after a uterine repair hrt in waiting cycles?