Unexplained Infertility - Am I missing something?
1 Replies
crystal79 - April 4

Dr. Jacobs,

I am 29yo female w/unexplained infertility...no history of any pregnancy. 26yo husband with normal s/a & very high count (always near 200 million...or 400+ total volume count)....also no history of pregnancy.

4 failed cycles doing IUI/timed intercourse w/gonal-f 75x12 days. Always produced two 18-20mm follies and lining 8-10mm. E2 peaked at 250 day before HCG trigger. Last cycle ended in premature spontaneous ovulation.

IVF #1 - Follistim/Repronex/Lupron protocol. By day 4 of stims, E2 reached 750. Stopped repronex 75, and dropped follistim to 150. By day 10 of stims, E2 reached 7500. Transfer canceled, but retrieval produced 20 eggs. We donated 10 to another couple, but of the 10 we kept, all fertilized and were frozen.

FET#1 - Estrace step protocol, starting at 2x/day, increasing to estrace 2mg 4x/day by day 11. U/S on day 14 of meds showed 8mm trip lining. Started progesterone (vag & oral...total 1000mg/day), doxy, & medrol. 4 days post 3day transfer, lining converted to HH, 9mm. Regarding embies, 5 were thawed, 2 transferred using assited hatching, 2 refrozen. On day 3 transfer, the two best were 8-cell 25% fragmented (grade B), irregular cell size & shape (graded a 3 on a scale of 1-3). Next was 4-cell A2. Negative beta.

My only concern in terms of my history is irregular ovulation leading to 27-90 day cycles. Additionally, on natural cycles, luteal phase never exceeds 11 days. Progesterone rises per day 21 tests (and per my terribly sore breasts). The best luteal support I have ever received was during this FET w/ oral prometrium 200 twice daily and vaginal progesterone 3x/daily. I had slight spotting 5dpt but believe it was from cervical irritation due to a new polybase suppository I tried for a couple of days mid-luteal phase.

Note that lining has never exceeded 10mm, and is often around 8mm on medicated cycles.

Again, I am 29, FSH was 6.7 a year ago, TSH was 4-6, but is being controlled w/levothyroxine 25mcg, thus reducing to 1.97. 170lbs, 5'5". Normal HSG, nothing else notable.

Considering all of this, does anything stand out that might be problematic? I have never had any tests other than HSG performed. Should I be requesting further analysis? Would you be concerned over embryo quality, lining issues...something else I'm not considering? I'm just looking for anything else I might need to consider before moving on to FET #2.

I should also note that recipient of eggs did not become pregnant, although I am not sure why. I was told they don't believe it was an egg quality issue for her...just "unusual circumstances".

Thank you for sticking with this!


B. Jacobs, M. D. - April 4

Please see the information I have provided on our web page, <www.texasfertility.com>. I have tried to make it as informative as possible.
Good luck.



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