sharedjourney home

I'm copying my history I wrote for another chat just to give additional background....thanks for any insight you can provide.

I just married in April. I am 40 and my husband is 49. I have a long history of hypothyroidism going back to adolescence on Synthroid). Back in 2000, I had some other hormonal abnormalities (low testosterone, slightly elevated prolactin, cortisol was off, etc) Recently had pituitary workup which again showed slightly elevated prolactin, however, I was just out of ovarian stimulation with Follistem. F/U within normal limits. Have had 4 cycles on Clomid (including Clomid Challange test showing borderline functioning but still within normal limits) and one on Follistem. Had 3 failed IUIs. Also had repeated thin endometrium on the IUI cycles. Am starting Lupron today with plans for an IVF on Follistem. Postitive sperm antibody test (68%). They are recommending ICSI and PGD which we are doing as well. RE is recommending transfer of 3 embryos if possible at blastocyst stage but embryologist told us yesterday that they may do day 3 based on development or lack thereof. I've seen your other posts about this issue. Now I'm not having same level of confidence that I did with the clinic. Not sure how to read the statistics for my center. Embryologist says my chances of taking home a baby are 10-15%

Reply

Antisperm anibodies in women are relatively rare, so I'm not surprised that you had some difficulty in finding information. Your immune system has become sensitized to the presence sperm in your body. Accordingly, your immune system started to make anitbodies to the proteins on the surface of the sperm. These antibodies are found in your blood and in bodily secretions such as cervical mucus and uterine and tubal fluids. When these antibodies bind to the surface of the sperm, they immobilize the sperm, thus making it easier for the whites bloods to come and gobble them up (clean up on aisle 3). Of course, if the sperm are being immobilized on their way to fertilize the egg, they never get there and infertility results.

Although there is no "cure" for antisperm antibodies, the workaround for the problem is IVF with ICSI. In that way, the sperm are never exposed to the antibody-containing secretions of you body.

I'm not surprised they may bail out and transfer the embryos early. This is a common practice for many IVF programs for patients that are 40+. If they are performing PGD, the bail out will be on Day 4 because the embryos are biopsied on Day 3 and it takes a day to get the results. This a full 1-2 days before blastocyst development. With PGD, the embryos deemed "normal" are only "normal" in so far as the number of chromosomes that were tested. The maximum number at present is 9 of the 23 pairs of chromosomes. They will test for the most comon chromosome abnormalities, but you must understand that it is neither comprehensive or conslusive. Uncommon aneuploidies (abnormal chromosome number) will not be detected and counting chromosomes only scratches the surface of determining the genetic "normalacy" of an embryo. In addition, PGD is not 100% accurate, more like 90%.

If you combine PGD with blastocyst culture, you'll also know if the resulting "normal" embryos (as determined by PGD) are capable of attaching and initiating implantation. Its one thing to be "normal" and another to develop to the blastocyst stage. In other words, just because an embryo is genetically "normal" (as determined by PGD) doesn't mean it will continue deveopment to the blastocyst stage. The converse is also true. Just because an embryo reaches the blastocyst stage doesn't mean it is "normal", but it much more likely to be "normal" than a Day 3 embryo.

Reply

Thank you for your explanation. The question that this raises for me is whether I should push the center to wait the extra 1-2 days. The inference that the embryologist made was that the decision when to transfer would be made based on an ongoing assessment of a number of developmental qualities. This IVF may be our only shot at pregnancy. I have insurance that covers 3 IVF (this is first). However, I've started a new job and MAY not be able to keep my insurance as it is. I have no doubt I would be excluded as preexisting conditions on any new policy, even it they had fertility coverage. Financially, we could cover a frozen transfer but not full IVF out of pocket. FYI I had a good response shifting from the Clomid (1 follicle) to Follistem (3 mature 4 micro) when we did IUI. Thank you so much for your input

Reply