Why Should We Try Again?
The embryos that were our LAST CHOICE resulted in twin pregnancy
By Dr. Avanthi Vellala
They sat across from me and asked we have tried everything. Why should we try again?
I didn’t have an easy answer. But I had something better.
She was 29. Premature ovarian failure. Behind her a laparoscopic ovarian rejuvenation with stem cell and PRP, two failed embryo transfers at other centre, and a trail of consultations at multiple clinics before she finally chose me
We tailored a plan.
We did a fresh cycle. Out of 7 embryos that are formed, we tested 4 embryos genetically, only one came back euploid. We did ERA test to map her uterus’s personalised window of implantation. We planned the transfer of PGT euploid embryo around her ERA time with a full Recurrent implantation failure protocol.
UPT negative.
They came back the next day. Well educated. Informed. The kind of couple who understood exactly what had been tried. And they asked me the question I could see coming but still felt when it landed.
“We have tried everything. It’s still negative.”
Unexplained failure after a euploid transfer is one of the hardest conversations in this work. Not because I don’t have answers but because the honest answer is that sometimes, medicine doesn’t have a clean explanation either. It can be microdeletions in the embryo, alloimmune factors. And saying that to a couple who has already tried everything takes something.
I told them we’re not starting from scratch. We still have three untested embryos. We don’t need a new cycle. What I want to do differently is add LIT before the next transfer Lymphocyte Immunization Therapy and then transfer the two best embryos according to ERA timing with strong support.
They looked at me. They were doubtful. The evidence is limited. I’ll be the first to admit that. But after multiple failures with good embryos, limited evidence is still worth a try.
I told them I have a patient with recurrent implantation failure who conceived after LIT. I want you to speak with her.
They didn’t look convinced. But I picked up my phone and dialled right there in front of them.
My patient answered. I put her on speaker. She spoke to them not as a doctor, not with statistics, but as someone who had sat in the same chair, faced the same question, and made the same decision to try one more time. She told them what it had felt like. She told them it was worth it.
They still didn’t say yes in the room. It was just one day after the negative. They went home.
They called back. They wanted to go ahead.
After LIT, we transferred two untested embryos timed to ERA, full RIF protocol, everything we had.
UPT positive. Twin pregnancy.
I referred her at 10 weeks and 5 days. Wishing her a safe delivery.
People don’t speak about Infertility openly not to their families, not to their friends, sometimes not even to each other. Which means most people going through this think they are the only ones. They’re not. And sometimes the most powerful thing isn’t a new protocol or a different medication, it’s hearing from someone who has been through the same thing and came out the other side. That’s what community means to me. It reaches somewhere that clinical reasoning can’t always reach. A real person on the other end of the phone who says I know how this feels. And it’s worth trying again.
Maybe the next try is exactly what’s waiting for you.