I recently had a failed IVF cycle. I transferred two 5 day blastocyst. (4aa & 4ab). My RE raved about the quality of the blastocyst. Being that all of my infertility tests have come back normal, my RE thought my chances of getting pregnant this cycle were excellent. Background: Me -34 yrs old- unknown infertility. HSG - clear, uterus healthy, PAP normal, normal 28/ 29 day cycle, blood levels (FSH, E2, etc) are all good to normal except prolactin was slightly elevated - 34. I have been pregnant in the past. DH- 34- SA revealed that motility was low 24%
We had 7 eggs that fertilized. 2 tranfered and 5 frozen.
Two days before my beta, I started to spot. I took the beta a day early and my level was less than 1. I was not pregnant and seems as though, the blast never implanted. I was on PIO shots. I was being monitored for progesterone levels which were normal.
Based on the information above do you have any suggestion why this cycle did not work. My RE, said that there is no reason. I am very concerned about repeating the same process and getting another BFN. Is there anything further to testing that we may be overlooking that may have cause the failed cycle. Can your offer any reason why to great quality blastocyst would not implant. Could I have implantation problems that my RE is over looking.
Any feed back or tips would be greatly appreciated. Sorry for being long winded, I am really at a lost. We have being trying to concieve for 2 years and thought that the IVF would be a good option for us.
Each good quality blastocyst stage embryo has about a 25% chance of resulting in a term pregnancy. So transferring two good embryos gave you a 50/50 chance. Unfortunately, you were in the wrong half. Your RE is right in that there does not appear to be any other reasons. It appears to have been the luck of the draw.
However, there is one test that may provide additional information about why they didn't implant. You may have aquired an elevated level of natural killer (NK) cell activity since your last pregnancy. NK cells are part of your immune system. Over zealous NK cells perceive the embryo as "foreign" and prevent it from implanting. Elevated NK cells can be treated through intravenous immunoglobulins (IVIg), but the treatment is expensive and controversial. You could ask your doctor about testing for NK level.
Dr. Smith, Thank you sooo much for your speedy response. I really do appreciate the feedback and insight. I will speak to my RE about testing me for elevated NK levels. I do have follow up questions. What would cause a woman to build up NK levels? What are some of the likely reason that a woman's body would have increased NK levels? How long would the body keep producing these levels? Are elevated NK levels common?
Again thanks for the speedy response. Anyfeed back would be greatly appreciated!
Wish I could answer all your questions, but I'm not a reproductive immunologist and this is outside my area of expertise. I don't know what causes the NK level to increase after a successful pregnancy. I'm afraid we are in uncharted waters here and it may be that no one knows. However, it does appear that once the NK level is elevated, it remains elevated. We have found that elevated NK levels are more common in women with "unexplained" infertility and implantation failure than in other groups.
Hello I was reading thread and I thought I would interject something that I was prescribed as part of my IVF w/ ICSI back in 1997. I was given steroids as part of my protocol which they told me was to prevent rejection of the embryos by my body. Is this something that is used for NK or is that just standard protocol by some IVF clinics? Thought that it may help...thank you in advance for answering, Doctor.
36 years old. Married for 17 years. 1 son, 7 years old, conceived w/ ICSI. 2nd IVF w/ ICSI in June=No Fertilization. August cycle cancelled for poor response. Considering options.
You're right. Medrol, a type of steroid, is given routinely to dampen any minor immune response mounted against the embryo. Unfortunately, Medrol alone is not adequate to dampen the immune response in individuals with elevated natural killer cells. That level of abnormal immune response is treated with intravenous immunoglobulins (IVIg).
Once again thank you Dr. Smith for your response. I have been trying to do some research on NK, so that I will be somewhat knowledgeable when I speak to my RE. I really do appreciate your feedback. Meridith, I was prescibed a steriod (medrol) during my IVF cycle.
Hi Dr. Smith, I wanted to ask your opinion on doing a FET with eggs that may be questionable. I am Cindy, the woman who started this topic (Failed cycle). My IVF failed. We transferred 2 high quality blastocyst ( 4aa, 4ab) which never seemed to attempt to implant. We froze 5 blastocyst (3 five day & 2 six day blast) After reading your feed back, I spoke to my RE about testing for NK. He is considering the testing, but believes with my history, that it was just a matter of circumstance that the cycled failed. He believes, though the eggs looked great, they most likely defective. He recommends trying another cycle before doing the NK testing. This was my 1st IVF. My concern is if these great looking eggs were defective, is there a good chance that that whole batch of eggs are defective. Would it be more advantageous to do a fresh cycle or would the FET be worth a shot.
Thanks for all of your feedback Dr. Smith. It is extremely helpful and comforting during this very emotional journey. We sometimes need opinions that we know are totally impartial. Thank you!
I tend to agree with your RE that there's no reason to jump into expensive testing just yet. I suggested NK testing so that you would be aware of the potential problem.
The embryos that were transferred on the fresh cycle weren't necessarily "defective". The embryos may have been fine, but just didn't "connect" with a receptive part of the endometrium. I would strongly recommend proceeding with the FET cycle. The embryos frozen on Day 5 and Day 6 are of good developmental potential and should not be discounted. There is no need to start over again with a fresh cycle while you have blastocyst stage embryos in the freezer. I would suggest thawing the three Day 5 embryos and, if all survive, transferring all three (leaving the two Day 6 embryos for a later attempt). If one or more of the Day 5 embryos fails to survive the thaw, I would suggest thawing the remaining two Day 6 embryos and transferring whatever looks good.
Hello Dr. Smith, I have a weird question. If a women has an elevlated NK level, Is it possible to feel (have pain) when NK attack a blast that is trying to attached to the lining? I am in between IVF cycles. My first cycle failed and I am waiting to do a FET in May. (History below) While waiting for the FET cycle, we decided to do an IUI with injectables. I produced about 6 to 8 mature eggs. DH's post wash motile number was 6.7 million. On the 21st day of the cycle (around the time that implantation would occur) I had severe pain in my uterus. It almost felt like contractions. It was extremely painful. It lasted for a couple of hours then it subsided. My uterus was sore for a couple days following. I was out of the country on vacation, so I did not call my RE. By the end of the vacation, 7 days later my cycle begin. So I guess I am not pregnant. I was wondering if perhaps an egg was fertilized and attempting to implant, but something fought it off and forced by body to reject the egg. I hope that this makes since. Any insight would be helpful. Thank you in advance Dr. Smith.
Dr. Smith, I wanted to add that I was only on Stims (Gonal F) for 7 days before triggering. My eggs were developing pretty fast. I am not sure if this would contribute to the complications that I just posted to you . See the previous post. Thanks in advance
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