Dr. Edward Ramirez is the medical director of Monterey Bay IVF, a women's fertility & gynecology center located in Monterey, California. He hopes to provide those who read his infertility blog with insights into the latest advances in women's health & infertility issues. He respectfully shares his knowledge as a specialist with women and men from all over the world. Visit his center at www.montereybayivf.com
36 Yr. Old Has Repeated Implantation Failure With Great Embryos...What's Wrong?
We have just had our 4th failed IVF (in vitro fertilization).
Our history.I am 36,
my husband is 39. 1st pregnancy was in 2009 after 3 IuI's (intra uterine
insemination) and clomid, but had to terminate at 15 weeks due to large
enphaloceale (was a random genetic mutation)and my 2nd pregnancy with IUI was a
success with a full term healthy baby boy.
Started with IuI's for 2nd child in 2011! We had 10 IuI's
and now 4 IVF's.Each IVF has been with icsi (intracytoplasmic sperm injection)
and this time we had Embryo hatching. Last 3 transfers were 3 top grade 8 cell
embryos each time on day 3.I am not a
great responder and only ever have 5-7 eggs, of which usually 4 fertilise.
I have had all the immunity checks done, my husbands sperm
dna damage is within normal, fertilisation rate is good.My ovarian reserve was also checked and the
level was 1.0- My specialist said that he wasn't overly worried about the
reserve for my age.I have had a
hysteroscopy and all normal.I have been
on various drug protocols and this last one was the long Lupron cycle with
We are just not sure what to do next?Do we keep going, as my doctors are very
positive and we have the finances. Are my doctors missing something?Is there anything else we can do to improve
our chances.I am on DHEA and Royal
Jelly, and my hubby is also on supplements.
I am writing from CapeTown, South Africa.
Thank you for your consideration, R.
Hello R. from South Africa,
The exact cause of your failure cannot be known as there are
still four steps your embryo has to go through in order to produce a pregnancy:
embryo has to develop to blastocyst, the blastocyst has to hatch our of its
shell, it then has to attach to the uterine lining and the lining has to grow
around it.As of now, there is no
technology that can make this happen."Assisted hatching" is just making a defect in the shell so
that the embryo can exit (hatch) more easily.
Something I always
worry about when I have patients tell me they have failed multiple cycles
despite good embryos, is the quality of the final step of the IVF process,
which is the transfer.You can have
the absolute best and perfect embryos but if the transfer technique is not done
well, then it will fail.This has been
shown by numerous studies.Since you
have been going to the same clinic, I wonder if that is not the problem, in
which case, I would recommend that you seek out a different clinic.
One thing that I do with my patients that is not universally
accepted but done by many of us, is to use a recurrent miscarriage protocol to
reduce the immune system, thinking that a heightened immune system might be at
fault.For this regimen I add low dose
heparin or lovenox, medrol, low dose aspirin, extra estrogen and extra
progesterone (both injectable and vaginal).I don't think that DHEA does anything so I don't use it.
At 36 years old, I have a 66% pregnancy rate in my
clinic.By two to three attempts with
good 8 cell embryos, you should already be pregnant.Your rate should especially be increased over
other 36 year olds since you have been pregnant before.For these reasons, I think the fault may lie
in your clinic and not in you or your husband.
Good luck in your journey to have a second child,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility And Gynecology Center
Monterey Bay IVF www.montereybayivf.com