Question:
Dr. Ramirez,
My husband and I have been trying to start our family for a few years. I have been pregnant and miscarried 3 times, but is has been over a year and a half since my last miscarriage. I am seeing a Reproductive Endocrinologist and their diagnosis for not getting pregnant again is unexplained infertility. We have are trying the IUI process now using Letrozole and I have also been given a prescription to do HCG injections on days 3, 6, and 9 past my LH surge. I am not finding very much information about using HCG after ovulation. I know their reasoning is to supplement my progesterone... but not sure why then, they don't just use progesterone? Please help!
Thank you! G. from Colorado
Answer:
Hello G. from the U.S. (Colorado),
HCG (human chorionic gonadotropin) injections can be used to support the luteal phase in place of progesterone and there is nothing wrong with that protocol. Most don't use that method because you have to take it as injections and the medication is considerably more expensive. There are many progesterone alternatives such as Crinone, Endometrin, Prometrium that can be used vaginally as a supplement. You should ask your doctor why they don't just use a progesterone supplement.
The other question to ask is "what are they treating or trying to achieve"? Do they suspect that your miscarriages are due to a luteal phase defect i.e. decreased progesterone? In that case testing by an end of cycle endometrial biopsy for dating and/or b-integrin would have diagnosed luteal phase defect and your diagnosis would not be "unexplained infertility." I am not a strong believer in "unexplained infertility" as a real entity. I think it is more like undiagnosed infertility. The cause just has not been found because either a test has not been done to find it or doesn't exist. Often we find that many of these cases of fertilization failures or defects with the sperm (found at the time of IVF) or endometriosis found on laparoscopy. Sometimes age is the problem as well leading to poor embryo quality.
Your question is a good one and you should ask your doctor. Be sure they explain everything to you!
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
Comment: Thank you so much... for all of your information and quick response! I will follow up with my doctor.
Hi,
ReplyDeleteI am diagnosed as ” unexplained infertility” for 5 yrs ( I am in early 30s ) and I suffered from 1 mc at 9th week ( 2009) …my cycle s regular every 28- 30 days…my partner sperm analysis s normal ..
My test results are normal ( 2nd day blood,Amh normal values mid cycle scan, progesterone blood test, hsg normal, hysteroscopy normal) I had 3 cycles of clomid 50 mg ..but no success …later tested for natural killer cells ..test results says my cd19, cd19+5 are high ( 23.5, 25.5)…so I hve taken 2 dose of humira ..after 2 doses of humira …tested cytokines levels are in borderline 30.8 …
Then we started 1st ivf cycle last month.. Long protocol…( had ivig during the middle of ivf ..approx 6 days before ec)…collected 10 eggs and 8 fertilised in total…and 2 transferred finally ( one emb on 3rd day (8 cells ), and another one on day 6 but not blastocyst stage… Stage before that) … And we tested for beta hcg ..and it’s negative …
Also taken dexamethasone , aspirin , clexane, prednisolone , gestone, cyclogest pessaries..
Could u pls advise wats wrong with us? Where the PBm arise? And wat could b the solution to move into next step?
Hello. Of course I cannot tell you why your cycle failed. That cannot be known. However, you need to keep in mind that IVF is replicating the natural process so just as it can take several attempts to get pregnant naturally (several months), it can take several attempts with IVF. No matter how the first part of the IVF goes, and even with the best embryos, the last three steps of the IVF process has to occur on its own because we don't have any technology to help them. These steps are: inner embryo needs to hatch and exit from the shell, thi mass needs to attach to the uterine lining, and the lining needs to engulf or grow around the embryo.
DeleteYour doctor is doing a lot of things that most IVF docs, including me, don't do, but everything seems to be covered. Protocols vary among IVF docs so I can't comment on any particular protocol. All I can say is that you need to keep trying and continue the protocol your doctor recommends if you have confidence on this doctor. He's certainly doing more than the majority of U.S. doctors would do.
decreased progesterone? In that case testing by an end of cycle endometrial biopsy for dating and/or b-integrin would have diagnosed luteal phase defect and your diagnosis would not be hcg
ReplyDeleteExactly! Progesterone level does not make a diagnosis of luteal phase defect. It is made by an end cycle endometrial biopsy that is dated and found to be out of sync with the cycle dating.
Delete8 days post 5day FET and took a sensitive HPT (6.3 miu) and negative. Beta is tomorrow. What are the chances of being pregnant.
ReplyDelete