Question:
Hi Doc,
I am 28 yrs old and underwent my 1st IVF cycle this month. My infertility diagnosis was endometrioma on right ovary , the cyst was removed by laparoscopy 1.5 years back. Twelve eggs were retrieved in total from all 12 follicles that formed.
I am 28 yrs old and underwent my 1st IVF cycle this month. My infertility diagnosis was endometrioma on right ovary , the cyst was removed by laparoscopy 1.5 years back. Twelve eggs were retrieved in total from all 12 follicles that formed.
The IVF cycle yielded good quality embryos and ET was done on day 2 of egg retrieval. In which 4 embryos were put, 3 of grade A and 1 of grade B.
Post ET medicines included progesterone/estrogen support and aspirin along with Dexamethosone. Even after every thing being perfect till end my b-HCG test resulted in level if 1.50 miu and after 48 hrs it was 1.69 miu. Please suggest, according to u what could be the reason for the implantation failure even when everything seemed good.
I'm writing in from India. Thanks and regards, R.
Answer:
Hello R. from India,
IVF is not a perfect technology and does not yield a 100% pregnancy rate. This is because the last two steps in the process to achieve pregnancy, embryo hatching and implantation, are things we do not have the technology to make happen. So, there is a little "chance" or "luck" with IVF. Certainly there are other possible causes of failure, such as embryo transfer technique, embryology laboratory quality, timing, endometrial thickness, immune factors, etc., but with the information that you have given me, I cannot determine if any of these might be the case. I too have young women who have perfect appearing embryos and great transfers who do not get pregnant. It stumps me, but then I remind myself that I am not dealing with a perfect technology, despite doing the absolute best that I can do (and I am pretty good at this treatment), and that GOD reserves the right for himself to produce life and determine when it happens, not me.
For you, you need to just keep trying. It will eventually happen, and usually occurs by the third attempt. Keep in mind that even a "normal" woman your age, trying for natural pregnancy does not get pregnant on her first try. The average number of times that it takes a woman under 30 to achieve natural pregnancy is 8 months (8 tries).
Final note: Please refer to my July 2009 blog post on IVF Implantation Failure: womenshealthandfertility.blogspot.com/2009/07/ivf-implantation-failure.html for further information. You may want to glance at the comment section as well, as there are many questions from readers which I have answered with more details regarding this disappointing aspect of IVF.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
Well maybe we are "normal" then. It took us 8 tries (8 tranfers) before we achieved a pregnancy.
ReplyDeleteWell, I don't know if it is considered "normal" to have to go through 8 attempts. If some were frozen embryo transfers, then perhaps, since the success rate for those tends to be lower. The most any patient of mine had to try was six times, and we worked very, very hard to achieve pregnancy for her!
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