tag:blogger.com,1999:blog-1851682447163727760.post2571072046663878366..comments2023-09-08T06:11:33.395-07:00Comments on Women's Health and Fertility: IVF implantation failurewomen:s health and fertilityhttp://www.blogger.com/profile/08894216102467479481noreply@blogger.comBlogger117125tag:blogger.com,1999:blog-1851682447163727760.post-84889343794889247672016-04-07T08:44:23.221-07:002016-04-07T08:44:23.221-07:00Dear Dr Ramirez,
I am 31 years old and my husband...Dear Dr Ramirez, <br />I am 31 years old and my husband has been diagnosed with severe oligospermia (1.1M/ml & 33% progressive motility). He has bilateral varicoceles and was operated 6 months ago on the left one. This improved his sperm count slightly (it used to be 0.3M/ml with 12% prog. motility). His karyotype is normal (no Y chromosome microdeletion). On my side no issues where found although one of the gynecologists I consulted suspected a mild case of adenomyosis, my AMH is high. I also experience spotting every day in my luteal phase each month, with regular cycles and ovulation. We have now just had our 1st failed IVF ICSI cycle. <br />Here was our protocol:<br />Birth Control Pill for 1 month<br />Follitropin beta 200IU for 8 days (combined with Orgalutran on the last 2 days)<br />2 x Ovitrelle injection on day 9 <br />Sadly out of my 15 follicles only 3 oocytes were retrieved, all the others were empty. 2 oocytes fertilized and made it to grade 1 blastocysts on day 5 with no fragmentation. The transfer of both oocytes was done without ultrasound assistance.<br />I am now 8 days post transfer and have started menstruating yesterday.<br />I would be extremely grateful if you could provide your insight on any possible causes of our implantation failure and I welcome your recommendations for our next cycle.<br />Many thanks<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-11041292633637871562015-05-07T18:56:21.241-07:002015-05-07T18:56:21.241-07:00Hello,
Why would PCOS be an issue at this point? ...Hello,<br /><br />Why would PCOS be an issue at this point? IUI and IVF negate the impact of PCOS since it is simply an ovarian or ovulation dysfunction. That is required to make the diagnosis, by the way. It is NOT just an ultrasound diagnosis. You have to have irregular menstrual cycles due to the ovarian dysfunction.<br /><br />I cannot explain why the IVF and FET failed without a close review of your medical records, but don't give up. You should still be able to get pregnant as long as you are going to a good clinic with good protocols and good pregnancy rates.<br /><br />Good Luckwomen:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-51615354391936119632015-05-07T18:53:05.431-07:002015-05-07T18:53:05.431-07:00Hello,
I apologize for not getting back to you soo...Hello,<br />I apologize for not getting back to you sooner, but this blog is not really a Q&A blog. You probably have gotten answers to your questions elsewhere, but I thought I would reply and give you mine.<br /><br />Adenomyosis should have no affect on your pregnancy and will NOT necessitate a c-section. In fact, pregnancy is an excellent treatment for both endometriosis and adenomyosis. It often will put these into remission. In terms of how many embryos to transfer, that is going to depend specifically on the clinic you are working with. What is their pregnancy rates? What is their twin rates with transferring two blastocysts? In your age group and in my clinic, I have been getting a 60% twin rate in transferring two blastocysts so am considering backing off to single embryo transfers. However, I still leave it totally up to my patient. Since you have been successful previously, your chances of twins with two blastocysts would be higher. I would definitely NOT recommend three blastocysts.<br /><br />Good Luck,women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-61207331044015740822015-04-12T06:59:52.681-07:002015-04-12T06:59:52.681-07:00Dear dr,
I am 32 years old, diagnosed uterus didel...Dear dr,<br />I am 32 years old, diagnosed uterus didelphis. I have married 3 years and try one IUI, one fresh ivf and one FET. All fail.. My husband sperms is good. My ET is good ..my tube patent. wondering whether I am having PCOS? My BMi is 17. Had strong family hx of DM. But all my blood test doesnt show PCOS. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-24890062918059227772015-03-05T09:18:35.662-08:002015-03-05T09:18:35.662-08:00Dear Dr. Ramirez,
I have a history of endometrios...Dear Dr. Ramirez, <br />I have a history of endometriosis on my uterus, ureter, bladder and bowel. I am 31. A laproscopic surgery was unable to remove any endometriosis. I had three months of Zoladex and then ivf which resulted in our child who is now 11 months old. It was our first ivf cycle and we transfered two 5 day blasts. We have three other 5 day blasts of excellent quality frozen. My son was delivered at 37 weeks by emergency c section due to Preeclampsia with HELLP syndrome. <br /><br />We are now starting a FET with one embryo. I just found out two weeks ago that I have now developed adenomyosis. I am very concerned this will affect a potential pregnancy and am unsure of if it can cause miscarriages and uterine rupture as I have read through Google searches.<br /><br /> Is a c section necessary with adenomyosis? If pregnancy is achieved should I be concerned about increased miscarriage? Will it be possible to have more children in the future? We plan on giving all of our three embryos a chance. Is there anything I can do to increase our chances? Should we consider transferring two embryos? I'm very anxious and worried. I would appreciate your advice as my doctor is away and will not be able to meet with us until around the expected date if our embryo transfer. <br /><br />Thank you most sincerely. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-64611839710781208712015-02-02T12:06:37.952-08:002015-02-02T12:06:37.952-08:00Hi. You're asking me to second guess your doc...Hi. You're asking me to second guess your doctor's protocol and I can't do that. There are no magic protocols and no gold standards for IVF. Each doctor uses what they feel is the best based on their knowledge and training. In your age group, the primary goal is to try to get as many eggs (<20) as possible in order to try to find a good egg. Because of your age, you have few good eggs and since we can't make egg quality better, our only option is to try to find a good one. Your doctor is using a mid-range stimulation protocol (350IU of FSH) per day, whereas the highest protocol is 600IU per day.<br /><br /><br />I'm afraid I can't speak to the premenstrual symptoms you have. I've never heard of such symptoms before. Obviously there is hormonal involvement since it is just before your menses and better with IVF.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-34002196974634266372015-01-02T21:37:48.538-08:002015-01-02T21:37:48.538-08:0042 y/o F with 3 failed cycles of IUI all the while...42 y/o F with 3 failed cycles of IUI all the while my E2 levels were <100 post treatment. However on day 8, E2 level is around 400's on 3-4 x 75IU menopur. My husband has poor morphology and sometimes poor motility. My symptoms before menstruation consist of (which usually begin on the 2nd half of my cycle), they are shivering in 100F weather, finger cuticles start to peel off, legs, back and breast cramps/tenderness which requires significant pressure such as pounding to relieve excruciating pain sensations. My eye sights become blurry. The frontal aspect of my head feels heavy like it is swollen. Sometimes I get insomnia. Before my period, my iron level is usually low, around11 and iron binding level is 3-19. I would demand hard pounding intercourse and for my partner to bite my upper back with great force to relieve those pain sensations. Then I would get my period a day or two later. Maybe I'm just not made to be pregnant. All of my symptoms resolve after my period. I'll come back on here and share about my first cycle of IVF in a week. So far, this is what is happening to me while going through IVF. I do though cant stand taking 16mg medrol. Took it once and was sweating profusely as if I just came back from a jog. I'm taking 50g DHEA bid, 200mg Coenz Q10 bid, 1200mg fish oil from Nature Made qd, 2000mg D3 bid, 1600mcg folic acid bid and Newchapter perfect prenatal multivitamin. After day 11, 5 follicles on the left ovary and 3 follicles on the right ovary. They are 14-15mm and uterus lining is 11mm. Have been taking 3x75IU menopur SQ, AM and 3vials of bravelle IM at night. 3 days ago I also included Granirelex, one per day. What's next for optimal outcome? Day 8 E2 =642. Day 11 E2 >1000. What's next for best results? I must add that so far, I've not had the urge for great pounding anywhere. Maybe this is a good sign afterall?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-41593568846334988232014-12-15T21:52:55.310-08:002014-12-15T21:52:55.310-08:00I cannot tell you why you failed. Only God knows ...I cannot tell you why you failed. Only God knows the answer to that question. A Grade 1 8 cell embryo does not guarantee that the embryo is a good one. In fact, I am now culturing my embryos to blastocyst stage and finding that many of the embryos that I would have chosen to transfer because they were grade 1 at the 3rd day, do not make it to blastocyst. So in fact, that means that D#3 is not a good time to choose embryos to transfer. That may be the reason for the failure in this cycle.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-47970290583137265012014-12-05T04:33:08.890-08:002014-12-05T04:33:08.890-08:00Dear Dr,
I am 31 years old, married for 3 years,...Dear Dr, <br />I am 31 years old, married for 3 years, tried 6 cycle time conception, 1 IUI and recentlyjust had a failed IVF with is I. <br />I have only 10 eggs with 8 fertilized. Two embryo transfered ( first -grade 1 and 8cells , second -grade 2, 6 cells). My husband have good sperm count. ET is 10 mm. <br />Everything seems good, but why my cycle fail?<br />Is it because i have didelphis uterus? All the investigations done on uterus saying that the uterus have good size and good ET..<br /><br /><br />thanksAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-56131405131344789362014-02-07T21:03:02.370-08:002014-02-07T21:03:02.370-08:00Hi. I can't give you specific advice without ...Hi. I can't give you specific advice without a review of your medical records to see exactly what was done. It is certainly unusual for a 28 year old to fail several times. If good embryos are available, then failure can only be due to poor transfer technique or failure of one of the last three natural steps (embryo hatching and emerging from the cell, attachment to the lining and growth of the lining around the embryo). Since there is no technology that can help these last three natural steps, all you can do is continue trying. Keep in mind that pregnancy rates are highly variable and can vary between doctors and clinics. For that reason it is important to research the quality of the doctor and clinic you go to.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-80000329182877532532014-01-24T01:57:23.953-08:002014-01-24T01:57:23.953-08:00Dear dr ,
Im 28 yrs old and we have been classifi...Dear dr , <br />Im 28 yrs old and we have been classified unexplained infertility . Laproscopy done showed no endometriosis or anything but the dye test showed mildly slow spill on both sides fallopian tubes .but no blocks or fluid .<br />Then we had one icsi and a fet both failed . I produced 11 eggs on a short antagonist protocol of which ten fertilized . For the icsi they transferred 2 blasts . The fet transferred 3 embryos on day 3 .<br />Both times i was on aspirin and progynova after transfer . Gestone injections too after transfer .<br />We have lost hope now as to why it has not worked and don know how to move further .,. Please advice doctor <br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-26777717731072724922013-11-22T20:09:05.439-08:002013-11-22T20:09:05.439-08:00Hello. Progynova is estradiol (estrogen) and once...Hello. Progynova is estradiol (estrogen) and once pregnant, it not absolutely necessary to sustain the pregnancy. However, progesterone is absolutely necessary and if the pregnancy is no producing adequate amounts, a miscarriage can ensue. So in answer to your question, the clinic was correct that the progynova was not necessary. However, whether or not progesterone supplementation was required was neither "here nor there" as we say in the U.S. Meaning you could go either way. Most natural pregnancies do not need progesterone supplementation and do just fine. However, patients with recurrent miscarriages sometimes do so because of inadequate progesterone (luteal phase defect). So, my personal preference, because progesterone is easy to give, take and use, and could be important, is to give progesterone. I don't want to wait and see if you miscarry or not to decide that "oh, I probably should have given it."women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-40518305454097839812013-11-09T15:54:42.867-08:002013-11-09T15:54:42.867-08:00I fell pregnant naturally the cycle before startin...I fell pregnant naturally the cycle before starting IVF treatment. My clinic had advised me to start taking cyclo progynova tablets a week after I ovulated. Once I realised that I was pregnant I contacted the clinic. They advised me to stop taking the cyclo progynova. I asked if I needed to use progesterone pessaries to support the pregnancy but was advised that I did not need to. I stopped taking the progynova on the Monday and started spotting 5 days later on the Friday. The following day (Saturday) I started bleeding and miscarried. Was I given the correct advice? Did stopping the cyclo progynova cause me to start bleeding?SarahLouisehttps://www.blogger.com/profile/07016344558156969115noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-40807683029899622802013-09-20T20:13:52.109-07:002013-09-20T20:13:52.109-07:00I'm sorry there is no way for me to know what ...I'm sorry there is no way for me to know what went wrong. There are too many possibilities. For instance, after the embryo is transferred into the uterus, three more steps have to occur naturally in order for a pregnancy to occur. These steps occur naturally because we do not have the technology to make them happen. So, that means there are at least three places (steps) where an IVF cycle can fail. We also dont' have the technology to know which step did not work.<br /><br />Sorry.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-58281383645755782242013-08-26T02:44:13.725-07:002013-08-26T02:44:13.725-07:00Dear Dr,
I just had my first failed ivf cycle. It...Dear Dr,<br /><br />I just had my first failed ivf cycle. It was 3day transfer. Four grade B (6-8)cells were transferred . My doctor put me on<br />Cap.Ultigest 300mg/TID (vaginal use)<br />Inj.Naturogest 200mg(IM) once in 3 days(5)<br />Cap.Co Q forte <br />Tb. Rudimin<br />Tb. Wingora 1\2 BD.<br /><br />We have unexplained infertility. Now my doctor says that implantation failure may be due to sperm quality. But while analysing my husbands sperm report she said it is normal.<br />The report says<br />Total count : 28 million per ml<br />Fast progressive : 20%<br />Slow progressive : 25%<br />Non progressive : 5%<br />pH 7.5<br />MORPHOLOGY<br />NORMAL :85%<br /><br />Can you please tell me what went wrong in my cycle. Does sperm qualilty is the reason as my doctor says......<br />Please help<br />thank you<br />durga<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-1338291045411573612013-03-09T21:26:20.413-08:002013-03-09T21:26:20.413-08:00Hello, I cannot tell you or explain why your cycle...Hello, I cannot tell you or explain why your cycle failed. No one can know that. I also cannot explain the bleeding except that it is probably your period, not a miscarriage. Finally, there is a decrease in pregnancy rates with frozen embryos, depending on the quality of the freeze. With the new freezing techniques, pregnancy rates have actually increased and so some clinics are moving frozen embryo transfers as a standard.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-15275677856528360362013-03-09T21:22:13.793-08:002013-03-09T21:22:13.793-08:00One other thing to consider would be to change fro...One other thing to consider would be to change from the Long Lupron protocol that you have been using and trying an antagonist protocol to minimize the ovarian suppression, and possibly increase the number of follicles produced.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-32714508076330032112013-03-09T21:20:30.124-08:002013-03-09T21:20:30.124-08:00Hi,
The additional information doesn't help t...Hi,<br /><br />The additional information doesn't help too much but it shows that you were on the highest stimulation protocol. It shows that your ovaries are not very responsive to the stimulatory medication and we would classify you as a poor responder. Despite only having a few eggs, however, your embryos should be good quality and your chances of pregnancy should be high.<br /><br />The only think I add to my patients that fail is low dose heparin to help mute any immunological effects you might have and to increase blood flow to the implantation site. I also add a steroid called Medrol.<br /><br />But again, without a close review of your medical records, it's hard to give specific advice. I am still skeptical of your clinic as well.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-12934622714338683342013-03-06T21:41:41.816-08:002013-03-06T21:41:41.816-08:00Dear Dr Ramirez,
I must say i really find your ar...Dear Dr Ramirez,<br /><br />I must say i really find your articles and blog so interesting and informative. I am 30 yrs old, husband is 32 diagnosed with azoospermia . i have no family history of any medical issues so we went ahead for our first icsi last month. My AMH level was 33.5 and the doctor put me on menopur inj 150 daily and cetrotide 0.25mg daily for approx 10 days. Finally for my egg collection they were able to retrieve 14 eggs ( of which 7 fertilized) and 4 made it to 5 day blastocyst. they embrologist assured us that they were top quality and she was very pleased with the progress. prior to my transfer they had already begun hatching. i was told to take cronine vaginal 8% 1.125g at night before sleeping and 2 pessaries of viagra.seven days post transfer i started light spotting which then lead to heavy bleeding. My doctor advised me to do the beta hcg and progesterone test on day 8 post transfer .results were progesterone 1.22ml and hdc beta 0.100ml. i feel absolutely devasted but am trying to understand the cause for the negative result. My doctor is shocked to see the low progesterone level and advised that next time he will need to close monitor the progesterone level and that i was probably no absorbing the gel properly. Could this be the cause for the result? Also i am stil having bleeding , is this my period which has come 6 days early or a miscarraige? I have 2 frozen embryo's left but have been told that the success rates decline after thawing ( if they survive). i would really appreciate your advice on this .<br /><br />Thanks jadaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-60530840742726346582013-02-09T20:53:31.132-08:002013-02-09T20:53:31.132-08:00For my second cycle i was put on birth control for...For my second cycle i was put on birth control for a minth prior to stim start then stsrted with 10 units of Lupron. During stim I was treated with 450 units folllistim and 2 amps of menopur with 5 units of lupron. After egg retrieval I was on femtrace bid and endometrin bid. Before and during my cycle I was on 75 Mg of DHEA and 81 Mg ASA.<br /><br />Is this helpful ? <br /><br />From anonymous on Feb 7 2013Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-88565257170275617742013-02-09T14:50:30.418-08:002013-02-09T14:50:30.418-08:00Hi,
I would really need to review your medical re...Hi,<br /><br />I would really need to review your medical records to give you any specific advice. Tere could be a lot of changes that I might suggest or medication to add, but that would depend on how you were exactly treated.<br /><br />My first worry in reading your account is the quality of the clinic you are going to. Your age and the fact that you have been pregnant before puts you in the "gold standard" category, which means we measure IVF success and compare clinics by women that are the most fertile i.e. under 35 years old. Sometimes IVF can take more than one try, even in young women, but your response to stimulation is suspicious.<br /><br />Good Luckwomen:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-31813930767150376642013-02-07T06:15:38.697-08:002013-02-07T06:15:38.697-08:00Hi Dr. Ramirez-
I am 32yrs old. I have had a suc...Hi Dr. Ramirez-<br /><br />I am 32yrs old. I have had a successful natural pregnancy and birth at the age of 17 with my current husband of 16 yrs.(neither one of us has ever had any other partners) My first pregnancy was very textbook with no problems.<br /><br />We started attempting another pregnancy when we were 27 and easily got pregnant within the first month of trying that I was off of birth control pills. It ended up being a tubal pregnancy which was suprising as I don't have any risk factors for it (no hx of STD's or surgeries). My OBGYN did a salpingotomy leaving my tube intact. <br /><br />We waited for about a year to try again, well because life gets in the way, but when we did it ended up in another tubal pregnancy. This time in the opposite tube. My OBGYN then did another salpingotomy of that tube, but when she went in she saw that the first tube (left) was really scarred and was hydrosalpinx so she removed it.<br /><br />About two weeks after that procedure I ended up in the ER again because some cells from the pregnancy must have been left and regrew causing the tube to rupture and then we had to do a salpingectomy on that side (right). Leaving me with a bilateral salpingectomy.<br /><br />We have recently have had two failed IVF cycles. My husbands sperm quality is normal, my ovarian reserve is normal, and I have no other health problems.<br /><br />During both IVF cycles my E2 levels were very slow to elevate, despite the fact the we almost tripled dosage of follistim on second cycle, and I took DHEA throughout second cycle. We ended up with only 5 eggs per cylcle (all fertilized in first cycle, but only 2 made it to day 5)(2nd cycle only two fertilized, but both were grade 1 on day 3 transfer). We did not have implantation with either cycle regardless of a normal uterus and 12mm stripe and laser embryo hatching on second cycle.<br /><br />I was on 81mg of ASA, femtrace bid P.O. and progesterone intrauterine from egg retrival to negative pregnancy test.<br /><br />Do you have any advice for changes to a 3rd cycle?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-33036436461492513712013-01-16T22:09:17.422-08:002013-01-16T22:09:17.422-08:00Hello,
I cannot answer your question without a c...Hello, <br /><br />I cannot answer your question without a complete review of your medical records. In answer to your ICSI question, I suspect that the embryologist err'd because the egg does not "disintegrate upon the needle touching it."women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-39236581970134115482013-01-12T11:18:23.216-08:002013-01-12T11:18:23.216-08:00hi Dr,
i have had 2 failed ivf.i was on aspirin,pr...hi Dr,<br />i have had 2 failed ivf.i was on aspirin,progynove6mg,clexane,predisolone,bromoprohin,doxytocin,cyclogest and progesterone inj. i have turner's syndrome so i used donor eggs.<br />now my clinc is telling me that they want to test for nk to see if thats the cause for the failed implantation.they kept saying that everything was perfect and cant understand the prob. the grades of the eggs transferred was good and was a dy 5 blasto.what treatment do you think i should take tohelp my sit?<br />also my first ivf they said the eggs rejected the icsi and disintegrated as soon as the needle touched it. is this possible?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1851682447163727760.post-24412775508946070002012-12-30T13:57:09.177-08:002012-12-30T13:57:09.177-08:00You had a positive bHCG so it should be followed e...You had a positive bHCG so it should be followed every 48 hours to make sure it is progressing correctly and increasing. As long as this is happening, there is certainly hope.women:s health and fertilityhttps://www.blogger.com/profile/08894216102467479481noreply@blogger.com