What are other options after multiple IVF failures?

Hello,

Welcome to icliniq.com

I am deeply concerned about your worries

I am really sorry you have had to go through so many disappointments. After multiple failed transfers, especially with tested embryos, it is completely understandable to feel exhausted and start wondering what is even left to try.

The important thing is that there are still evidence-based next steps, and a failed euploid transfer does not mean pregnancy is no longer possible.

A large 2024 study found that even after three failed euploid transfers, many patients still went on to have success with later transfers, with cumulative live birth rates continuing to rise through the fourth and fifth transfers. So this is not hopeless.

Since the C-section niche fluid issue was corrected, the next step is usually to look for other uterine or hormonal factors.

Even when scans look normal, a direct look inside the uterus using hysteroscopy or saline ultrasound can sometimes find small polyps, scar tissue / adhesions, subtle fibroids, persistent niche changes, and inflammation. This is one of the most recommended tests after repeated failed euploid transfers.

You mentioned uterine inflammation testing. This is a big one. Sometimes a biopsy (removal of a part of tissue for testing) shows chronic endometritis (often via Cluster of Differentiation 138 staining), which may need antibiotics before the next transfer. Even mild, untreated inflammation can interfere with implantation.

A very common “hidden” reason for repeated failure is silent endometriosis or adenomyosis, even without pain symptoms. Some clinics use receptivaDx / BCL6 (B-cell lymphoma 6) testing, pelvic MRI (magnetic resonance imaging), or a trial of Lupron suppression (one to two months). This is often considered after repeated euploid failures. Especially with a history of C-section and uterine surgery, adenomyosis is something worth discussing.

Sometimes, the issue is not the embryo or uterus anatomy but the transfer timing/hormone environment. Like your doctor may adjust the fully medicated vs. modified natural cycle, progesterone dose, progesterone blood level on transfer day, and exact transfer day timing. Even with a prior ERA (endometrial receptivity analysis), many specialists still recheck serum progesterone levels before transfer because low levels can reduce implantation.

I want to mention weight and metabolic factors gently because it can matter medically. At 5’6” and 224 lb, the BMI (basal metabolic rate) is around 36. A higher BMI can affect estrogen metabolism, progesterone absorption, endometrial receptivity, and inflammation

This does not mean you cannot get pregnant. But even a modest weight loss of five to ten percent can sometimes improve transfer success and hormone response. This is worth discussing with your REI (reproductive endocrinology and infertility) specialist, especially if transfers are fully medicated.

My honest thought on “what’s left." You can ask your fertility doctor about the following:

1. Hysteroscopy.

2. Check for chronic endometritis.

3. Evaluate silent endometriosis/adenomyosis.

4. Optimize progesterone timing and levels.

Those are the main evidence-based steps still left.

“Embryo glue,” unfortunately, has mixed evidence and usually is not the main deciding factor.

You still absolutely have a path forward. If you want, I can help you prepare a focused list of questions for your fertility specialist before the next transfer, so you can make sure nothing important gets missed.

Do follow up whenever needed.

Let me know if I can assist you further.

Thank you.