Any thoughts?
8 Replies
Asunflower - August 10

My DH and I have been through 3 unsuccessful IVF cycles. First one in Jan. was BFN! We did a day 3 transfer of 2 6 cell embies and I was on an Antagon protocal where I produced 18 follices and 15 were mature, 11 fertilized with ICSI and we froze 2. Tried 2nd time in April. This time was on Lupron protocal. We got 28 follicles, 21 were mature and 19 fertilized and we got 3 frozen. We did a 5 day transfer of 2 grade 1 blastocysts this second time. We had a chemical pregnancy. Third time was just in July. We used the Lupron again and we got 18 follicles, 15 mature, 11 fertilized and we transferred 3 blastocysts on day 5 that were grade 2 and 1 was grade 3. We also got 1 to freeze. It was a BFN. We are going to try a FET of our 6 frozens in Sept. My question to you is if we get another BFN, what in your personla opinion would be our chances if we continued to try with IVF. I just don't know if it is worth it to keep going with IVF. When we went to our RE, I shared my history where I had an abortion when I was 17. He had me do the HGC test and it came back normal. We did a semen analysis and we have low count, low morphology. He diagnosed us with MF. That is why we use ICSI and AH. Do you think that there is some other testing that may need to be done on me? For example, should I be tested for NK cells or should I have my lining tested (biopsied)? I am just not sure why we got a chemical one time and no success the other times with such good cycles. Any suggestions or thoughts that you have would be helpful!


B. Jacobs, M. D. - August 11

The data about natural killer cells is extremely suspect for a number of reasons. I do not bother testing for that issue. There is good evidence that there is an adhesion molecule important for embryo implantation. It is induced by progesterone, and inhibited by endometriosis, andfluid trapped in fallopian tubes in the case of hydrosalpinx. Even after ICSI, if there are DNA
Good luck.


Asunflower - August 11

Through all of my cycles I have been given 1 CC of Progesterone starting on the evening of ER. Wouldn't this take care of this issue?


B. Jacobs, M. D. - August 11

The progesterone you were given would help, unless there were something inhibiting the production of the adhesion molecule - like endometriosis, or hydrosalpinx.


DianaEvans2 - August 12

Dr. Jacobs:

please excuse the intrusion in this thread, but you piqued my curiosity as a chemist. What precisely is this "adhesion" molecule? Would more of it, be better in that it would facilitate more success in implantation? Or is the adhesion molecule not synthesiz-able in the lab? Or is there just research going on about it?

It seems with all the IVF protocols, a lot of the molecules/meds mimic or enhance nature's why not goose up the adhesion molecule capabilities?? Thanks in advance for sharing your expertise-much appreciated!!


B. Jacobs, M. D. - August 12

You are absolutely right, if we could do it. It is a cell membrane associated protein, designated alpha 5 beta 3 integrin. It is present on endometrial cell surfaces for a few says about a week after ovulation. It is induced by progesterone, and its production is inhibited by the clinical conditions of endometriosis and the inflamatory proteins found in hydrosalpinges. I make an assumption that the body's inflamatory response to endometriosis plays a role in the poor production of the integrin by women who have endometriosis.


DianaEvans2 - August 13

Thanks so ever much Dr. Jacobs!

mmm, so this "alpha 5 beta 3 integrin" associated protein is not presently synthesize-able as I rhyme together.... rats....

Is there any experiemental reseach happening here? Any clinical trials even on the remote horizon? As a lay person, I can only find so much on the net, but I am aware that there must be professional talk at conferences, meetings, etc. I am assuming here that a pharma firm would be motivated by $ which seems to be the case with a lot of these other meds. There may also be motivation at the research level as critical "kicker"/breakthrough recgonition in making embryos stick around for a pregnancy.

Also, if I surmise correctly, if a women does NOT have the two conditions you mention (endometriosis or inflammatory proteins), then the best you can hope for is using progestrone to "assist" the natural alpha 5 beta 3 integrin molecule doing its job?

I am simply fascinated by all this technology (hence my clarifying questions and excuse if I am being a pain here) and recognize I am at the end of my personal possibilities except for DE. I am all too aware of the statistics, nonetheless the technology is all so cool. I wish I could live another 100 years. Thanks again for taking your time and trouble. Wishing you a sunny Sunday and a marvelous Monday! Diana


B. Jacobs, M. D. - August 13

Integrins are a family of adhesion molecules produced as part of the cell membrane. So far, we do not have a means of introducing an induced molecular componant of a cell membrane. This particular integrin is expressed for only a few days in an ovulatory cycle, about a week after ovulation. A significant amount of research ahs been done to investigate the roole played by this integrin and other factors which may play a role on embryo implantation. This integrin is probably only one of the factors involved. There are others which we yhink are important, and, I assume, there are others yet to be discovered. Our continually expanding data base is part of what makes this disciline fun.


Lila - August 17

I was reading on an old post of Dr Smith's where "Embryo Glue" was briefly mentioned. Is this a product that is beginning to address this adhesion molecule issue?



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