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RICHMONDTB - August 15th, 2006 9:11 AM

Hi Dr. Smith
Thank you for all of your most valuable insights on this board, you have made the hurdles easier to overcome.

I have had 3 ivf cycles, 2 ended in miscarriages

3 uterine surgeries-1.) myomectomy with infection after surgery, while in hospital- that started the scar tissue,(based on HSG that happened)
2.)lap/hysteroscopy-with lupron depot administered prior to the procedureand procedure finished with d&C which caused more scar tissue3.)hysteroscopic rectoscope with removal of the 3 fibroids, which the uterine wall was entered and the fibroids removed to the one cell level from the wall!!

I have Ashermans and it currently being evaluated by the leading Ashermans Doctor in the country, Dr. Charles March. There are 3 doctors overseeing this issue. I have had the hysteroscopy with microscissors to remove, no estrogen therapy, but hsg and right now the cavavity looks good. Will be doing a mock cycle to see the development of the endrometrium and if scar tissue is visual.

I am also seeing a hematologist for immune issues and have printed what you posted, and will be taking this to my consult coming up next week. The hematologist is saying that immune or aullioimmune issues do not impact 1st trimester pregnancy, so your response was timely.

My really big issue is this, the clinic were our 12 embryos are located per the CDC website, has no success with frozen donor egg embryos. None. No clinical pregancies or live birth rates.

What is impacting such poor outcomes? could it be bc they freeze all embryos regardless of the quality, or is there any truth in the fact of the actual technique in transferring embryos by the RE is poor? Is guided ultrasound transfers better than other transfers. I am really concerned with such poor outcomes. We have been on a journey of 3 years with one batch of these frozen embryos and need help, I am at the end of my rope.

The protocol to unfreeze the embryos is pretty standard but should I be concerned with the lab and poor frozen success rates?

If need be, we are willing to travel and we do not know what to do at this point? what advice can you give me regarding this sitution.

You are wonderful and we are willing to travel. Help.

Brenda

Dr Smith - August 15th, 2006 3:51 PM

Well... It could be one or all of the factors you suggested (freezing poor quality embryos and/or the RE's skill at embryo transfers). However, it has been my experience in troubleshooting labs (I also work as a consultant) that the problem lay in the freezing protocol rather than the RE's skill at ET or the thawing protocol (which is pretty straight forward). So changing programs may not have the desired results in that if their freezing technique is poor, the embryos are already dead. Moving them to a new clinic will not change the outcome.

The choice of whether or not to use U/S for transfers depends more on the indivdual preference of the RE. The data is spit on wich method is better. As long as a trial transfer to determine the depth of the endometrial cavity and the curvature of the cervical path is performed in the cycle preceeding the IVF cycle, then both methods result in acceptable pregnancy rates.

Asherman's syndrome presents a very difficult problem. Even an U/S of the thckness and pattern of the endometrium during a mock cycle will not necessarily provide useful information about the implantation potential of the endometrium - its more complex than that. Unfortunatey, all we have to go on is your history, which, frankly, doesn't look good. Wait and see what the Asherman's Big Kahunas say about your endometrium and whether or not there is still an area where implantation can occur. Even knowing that does mean the RE can put the embryos in the right place or that the embryos will stay there after transfer.

You may have to consider a surrograte (assuming the embryos survive the thaw). My recommendation, if you do decide to use a surrogate, is the do another "fresh" cycle preferably at another program.

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