Dear team of experts,
We have been trying in vain to get pregnant for almost 5 years.
Here is a summary of our story so far:
- We tried naturally for 1 year from the end of 2021. Due to severe pain at the beginning of each cycle, we had a laparoscopy in October 2022. Diagnosis: Endometriosis, one fallopian tube with delayed patency, second not patency. We were advised to undergo fertility treatment. (Pain-free since the operation)
- Start of fertility treatment in February 2023 (age: 32w, 31m). The spermiogram was good once, the second time borderline okay. We were advised to have ICSI.
- 1st & 2nd ICSI: stimulation with Gonal F. There were 2 transfers from 3-day-old embryos from the 1st ICSI. One blastocyst transfer from the 2nd ICSI. All three attempts negative. 6 weeks of Zafrilla intake.
- 3rd ICSI with Pergoveris. Freeze all due to a high progesterone level. One cryo with 2 blastos resulted in a chemical pregnancy (HCG 35). This was followed by 3 more cryos. Twice with very good blastos. Once with 2 cells. All transfers negative.
- 4th ICSi (Pergoveris & Triptofam/ Decapeptyl) in 2024: 3 A1 blastos. Freeze all due to high progesterone value. Transfer in the subsequent cycle. Another chemical pregnancy (HCG 10). Break for further examinations:
- HOMA index, microbiome examination, KIR genes, plasma cells, genetic test: unremarkable
- September 2024: MRI of the pelvis to clarify the status of endometriosis: findings of adenomyosis
- Cryotransfer in November 2024 with 4AA blastocyst. Pre-cycle with Zafrilla 4 weeks. Pre-transfer infusion with Privigen. Unfortunately negative again.
- Cryotransfer in March 2025 with a 3AA blastocyst. Unfortunately negative again --> renewed blood test, no abnormalities.
- Suspicion: disturbing factor in the environment, new laparoscopy planned for clarification. Preliminary 5th ICSI with planned freeze all, downregulation with Synarela, puncture in July 2025.
- Laparoscopy in August 2025 incl. uterine endoscopy, removal of endometrial tissue and lavage of the fallopian tubes: foci of endometriosis found in the abdomen and removed, adenomyosis mild/medium according to surgeon. Classification according to surgical report: RASRM: III, ENZIAN: P2 / T1-/1-FA. Unfortunately, it was discovered that one fallopian tube was severely inflamed (salpingitis isthmica nodosa) and was therefore removed. The second one was no longer patency. The tissue sample revealed no abnormalities in terms of plasma cells or inflammation of the mucosa. However, the BCL6 marker was slightly elevated at 1.6.
- In preparation for the next cryo, 7 days of doxycycline. Downregulation with Ryeco for a period of 9 weeks.
- 11th cryotransfer in December 2025 with a 5AB blastocyst (Letrozole, Duphaston 1-1-1, Clexane 200, ASA, Utrogest), negative result
- 12th cryotransfer in February 2026 with prior PRP flushing. Same medication, except for Duphaston. Again unsuccessful. One month of taking Zafrilla until the next cryotransfer.
- 13th cryotransfer in April 2026. Same medication. Higher Letrozole dose this time. PRP flushing in advance. Again no success.
- AMH value is currently still at 5
I am currently taking Ryeco to bridge the gap and we are considering a 6th ICSI in July.
How would you recommend we proceed? How do you tell whether it is purely due to the environment or possibly also due to the embryos? Would egg donation be an option with a better chance of success for us?
We are now 36 and are very worried about remaining childless. I hope you have some advice for us.
Kind regards
M
Adenomyosis, implantation failure
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Minnie019 -
April 25, 2026 at 7:20 AM -
Thread is Resolved
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Dear Minnie, even though I'm not from the team of experts, I'm replying to you. I hope it's ok
Just reading your message makes you realize what a crazy journey you've had so far!!! As you still have a good Amh value, you are still young and you have had a few blastocysts, I would definitely go abroad and have an ICSI with genetic PGT-A testing there! Then you can see if it's not simply down to the embryos. Only then would I switch to egg donation. We did a total of 8 ICSIs in Germany, but as I was already in my late 30s and unfortunately a low responder with few embryos, we went straight to egg donation.
I wish you every success! 🍀Best regards
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Dear Minnie, even though I'm not from the team of experts, I'm replying to you. I hope it's ok
Just reading your message makes you realize what a crazy journey you've had so far!!! As you still have a good Amh value, you are still young and you have had a few blastocysts, I would definitely go abroad and have an ICSI with genetic PGT-A testing there! Then you can see if it's not simply down to the embryos. Only then would I switch to egg donation. We did a total of 8 ICSIs in Germany, but as I was already in my late 30s and unfortunately a low responder with few embryos, we went straight to egg donation.
I wish you every success! 🍀Best regards
Dear Ninusch,
Thank you for your message ♥️! It's always good to hear that you're not alone and that others are going down a similar path.
I hope it turned out well in your case and that you were successful🙏.
PGT-A would of course also be a consideration for us as an intermediate step. In the meantime, we have so much behind us that I might even be prepared to skip it to avoid being stuck in this waiting loop of hopes and disappointments for another X years 🙈, but hopefully it won't fail because of the environment... -
You're definitely not alone, feel supported! 🤗I can understand you so well, the waiting and the wavering between hope and disappointment is just exhausting. At some point I couldn't take it anymore either. Unfortunately, the EZS also demanded a lot of waiting from us again, but the 5th TF finally led to our daughter 🥰 sometimes you can also stimulate yourself and have the donor eggs fertilized. So as a tandem treatment... LG!
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Dear Minnie019,
Like Ninusch84, I would like to start by expressing my admiration for how strong and brave you and your partner are to go this long way.
As I always say, you need a good embryo and a good uterine lining for a successful pregnancy.
I would like to get a full review of your records before giving you a definitive answer, but it seems that it is more likely that your uterine lining is interfering with implantation.
To be safe and rule out that embryo quality is the problem, Ninusch84 is right: you need to have the genetic data checked before talking about egg donation. And this technique (PGTa) is not approved in Germany. My advice would be to have your next ICSI at a place where the genetic data can be checked before another transfer. Because if they are good embryos, you should hold off on transferring good embryos until it is known exactly what the problem is with your endometrium: Again, I will need to see your entire file, but surely there are still important parameters to check (susceptibility, immunology, thrombophilia, etc.) and measures we can take to treat or reduce your ademnyosis before another transfer.
I hope this helps you and do not hesitate to take the first step with a free initial consultation where we can discuss everything together in detail.
Yours sincerely,
Dr. Katharina Spies.
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Dear Minnie019,
You are welcome!
To make an appointment for an initial consultation, please write to contact@vidafertility.com.
In your email you can already:
- Indicate your availability for an online consultation (please give me some dates for the next two weeks, as my schedule is already quite full)
- send me your medical file so that your coordinator can enter everything in your file and I can view it before our consultation.
I hope to meet you soon and be able to help you.
Yours sincerely,
Dr. Kathi Spies
