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Hi
I posted just a few post ago,patient with the Ashermans, had 3 ivf without the Ashermans being corrected, some immune issues during the last miscarriage.
I have additional questions for you and I do appreciate your thoughts.
I emailed the big kahuna on the ashermans who has seen 850 AS patients and has corrected all but 100. I know that is probably not good odds in some fields of medicine but with Ashermans, different. I asked specifically what the ultrasound during the mock cycle will show.
The big kahuna reply was the a specific scar may or may not be visible on ultrasound during a mock cycle. However if a scar tissue is of clinical significance it would be definitely have a negative influence upon the development of the endrometrium.
Your reply said that there may be other implantation issues, what are the other implanation issues to consider?
Our frozen embryos are 12....8 are from a donor egg cycle which the donor hyperstimulated, and the resulting embryos are highly fragmented. the big kahuna embryologist reviewed the information and said bc of the fragmentation rate of the those frozen 8, they will not make the thaw.
can you predict this before the thaw?
Many thanks for your insights and wisdom.
Brenda
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Implantation is a complex intereaction between the trophectoderm (the surface of a blastocyst stage embryo) and the endometrium. This interaction occurs at the molecular level and is poorly understood (as you might imagine, its difficult to get data in vivo). What we do know is that there are several cell adhesion molecules involve in the attachment process and that the trophectoderm invades the endometrium in a way similar to how a tumor invades the surrounding tissues. But that's about it. If one or more of these processes fail to function properly, attachment and implantation wil not proceed. Asuming the embryo gets a foothold in the endometrium, over zealous NK cells can kick the embryo out. Clotting problems can reduce the blood supply to the developing embryo and starve it out.
So, visualizing the endometrium by ulstrasound is a very crude way to evalauate the "receptivity" of the endometrium. Immune problems, once identified, can be treated reasonably successfully. However, if problems are occurring at the molecular level, we haven't got a clue how to diagnose let alone treat this problem. What can I say? Write your congressman and request more funding at the NIH for that chronically underfunded "sex stuff". Good luck. O.K., I'm off my soap box.
On to the embryos. We can predict survival, to some degree, based on the quality of the embryos prior to freezing (i.e. excessive fragmentation = dead). If previous lab director was under pressure from the RE to freeze everything (a common occurance), the new lab director has inherited the problem. At least he's being honest with you and is giving you realistic expectations. I admire his honesty, but that doesn't help solve your predicament. Based on the information you provided, I wouldn't put much stock in the FET with these embryos. With a new lab director in place, the lab may improved overall. Programs don't usually change lab directors unless there's problem, so the new lab director may have been brought in to improve pregnancy rates (including their dismal FET rate). I call it the Messiah effect. I've taken positions like that before. It puts a lot of pressure on the new lab director to deliver. But he cannot change what's already happened (i.e. your frozen embryos).
As an aside, hyperstimulating a donor is a no-no and suggests poor judgement on the part of the RE. There are ways (i.e. "coasting") to slow down the stimulation and avoid hyperstimulation and, to some degree, improve egg quality. However, in his defense, hindsight is 20/20.
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