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2007ItIs - December 15th, 2006 2:17 AM

Hi Everyone,

I want to give a little background about myself.

I was diagnosed with blocked tubes in 2005. But prior to that I got pregnant naturally but that resulted in ectopic pregnancy in 5 weeks. Shortly after my HSG that identified the blocked tube situation, I had a Lap. The Lap didn't quite reveal any major issues and ruled out the possibility of hydrosalphinx as well. After the Lap, I did my first IUI and that resulted in a chemical pregnancy with the highest recorded beta HCG of 194. After this, me and my husband pretty much came to the conclusion that IVF was the only way for us to have a child.

I went to one of the top specialists to get my IVF done in June 2006. The hsyteroscopy performed before the fresh IVF cycle didn't bring forth any issues with my uterus. My fresh cycle had a wonderful start in that I didn't feel any side effects from the meds nor had any complications from my retrieval. They retrieved 23 follicles out of which 16 fertilized. Out of 16, 13 made it to blastocysts. They were all blastocyst in the grading ranging from high to low of 6 AA through 4BB.

I had the doc transfer 2 embryos in my fresh cycle happily assuming that it would work considering my young age of 32. To my great disappointment, that cycle was a bust. But I tried to console myself that all was still not lost and conditioned myself to remain calm. But I am at a point now where I feel that I am fighting a lost battle.

I have had 3 frozen transfers (had 11 frozen, 2 didn't survive, 3 embryos were put back in each of the 3 cycles) in the last 5 months following my fresh cycle and all but one have been negatives. I got a positive HCG on first frozen transfer which lasted just a few days. My HCG didn't rise above 38. I had stimulation only for my fresh cycle. I used Gonal-F, Menopur, Lupron for the fresh. For all my frozen transfers, I was asked to take only the HCG shot, baby aspirin and folgrad since I ovulate pretty regularly on my own. For the last frozen cycle, I went for acupuncture for almost like 1.5 months once a week.

Sorry that I have given a rather lengthier intro about myself. I am now at a juncture where everything seems so dismal to me. I really respect my doctor but I am not able to pull myself out of these failures. I have a lot of questions and I want to see if any of you have had undergone the same situation as me.

1. Can anyone suggest what I should be doing next? I am definitely planning to do a fresh cycle but the fact that I have 4 failed cycles in my record, I am not having the nerve to expect a positive outcome. Has anyone had problems with implantation like mine?

2. In all my ectopic and 2 chemical pregnancies, the embryo had never attached to the uterus. At least that's what it seems like. What do you think could be wrong with me despite the fact that my hysteroscopy didn't highlight any obvious issues? Believe me, I have already raised this question with my doctor, but he says that everything looks fine except that I am falling on the bad side of the statistics and is plain unlucky.

3. I have done the basic blood tests like insulin resistance, thrombophilia, MTHFR, etc and they all have come back negative. My RE does not subscribe to the IVIG technique so that is something I haven't done so far neither do I plan to do for my next cycle. Can you think of any tests that I should be doing in order to find out why my embryos do not implant?

4. I am planning to do PGD with my next fresh cycle. What do you think are my chances of achieving success with PGD?

5. Do you think that I should go with a different protocol for my fresh cycle. My doc feels that since I responded very well to the protocol given before, it makes sense to follow the same. Does changing medications have any effect in improving implantation rates?

6. Is it common to include frozen cycle as a valid IVF cycles. It looks like I have had 4 cycles so far without success. Does that put me in the group of people who are NOT responding to IVF well and may NEVER be able to get positive outcomes.

I really would love to hear from you all. I am in my all time low. I want honest opinions and I don't want to be given false hopes. I am looking forward to hearing some success stories which hopefully will give me some energy boost. At the same time, I also want advice from people who have had failures and had to resort to alternatives.

Thanks for patiently reading through my post.

Grace - December 16th, 2006 1:44 AM

Hi, 2007

Sorry about all the misfortunes, but just to let you know, you are not alone, I have had two failed IVF treatments, the last with no implantation at all, this just happend two weeks ago, I also have blocked Tubes and the only way out is IVF and that is even not working for me, I have been very depressed for the past week, but there is nothing I can do right now, I have a third and probably my last chance to go for the 3rd cycle and insurance will not cover any more, due to the two failures I am so nervours going for the third time, my only ulternative right now is resorting to prayers and asking God for a miracle baby, sometimes doctors will tell everything that can be wrong with you but I believe what God says is final, I am not trying to impose my religion on you, but I am just trying to believe in a supernatural miracle, it is hard, there is not a single day that I don't cry, I don't want to hear anymore bad news from the doctors so I have taken a break for now. If you don't mind which state are you in, and if we do share the same believe we can be praying together. All the best...grace

Dr Smith - December 18th, 2006 11:04 AM

207ItIs:

A.2 Two of the chemical pregnacies were intrauterine. The embryo attached to the endometrium, initiated implantation, but did not continue to develop. That could have been a result of (a) embryo genetics (I'll address the PGD issue below) and/or (b) problems with the endometrium. Your RE says everything looks "fine". In that conterxt, what does "everything looks fine" mean? It means that the ultrasound of your uterus showed an adequate endometrial thicknes at the time of hCG. Endometrial thickness is only one measure of "everything" and does not address any issues at the molecular level of embryo-endometrium interaction. After 3 chemicals, it looks like something is going wrong with embryo-endometrium interaction. You have ruled out blood clotting problems. At our current level of understanding of the implantation process, that only leaves one explanation - immunological rejection of the embryo. O.K. ,so your RE is not a "believer" that the immune system is involved in early miscarriage. That's fine. Everyone is entitled to their opinion, but telling a 32 year old patient that, after failing a fresh IVF cycle with the highest grade blastocysts and three FETs with frozen-thawed blastocysts of good quality, that its just the "luck of the draw" is pretty lame. If that's the case, you are very unlucky indeed. I think its really, really, really time for a second opinion. And even if your program is the best program in the world and your doctor's the greatest IVF doctor on the planet, it is still time for a second opinion. You're getting nowhere fast at this program.

A3. Its clinical. Dr. Miller will answer.

A4. I think it is highly unlikey that PGD will increase your chances of pregnancy. PGD is a very crude tool to evaluate the genetic normalacy of an embryo. At best, it can evaluate 11/23 chromosomes to determine if there are pairs of each of the 11 chromosome (evaluation for anueploidy). What about the other 12 pairs? What if the problen does not involve an abnormal number of chromosomes? What if its a genetic translocation? What if the results from the embryo biopsies are inconclusive? What if they are simply wrong (PGD accuracy is not 100%)? Secondly, your problem does not appear to be related to anueploidy. Most (but not all) anueploidies are screened out before reaching the blastocyst stage and those anueploid embryos that do reach the blastocyst stage often have too few stem cells to continue development. These embryos can be identified and "weeded out " prior to transfer. All your blastocyst stage embryos had an adequate number of stem cells as indicated by their grades (even the 4BB is fine). In my opinion, PGD is not where the money is, although that's where yours will be. PGD is not cheap.

A5. The management of the stimulation by the RE, not the brand of medications, is what makes a difference in implantation rate. If your RE thinks you did fine (and I think you did too), there's no need to change.

A6. Failed FETs do not count as a failed IVF cycle. They count only as a failed FET. In the context to which you refer, you have had one failed IVF cycle. However, in view of your repeated chemical pregnancies (fresh and FET), it is clear that something's going on that's not just the luck of the draw.


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