40 Yr Old Austrian Doing 2nd IVF: Use PICSI Or "Embryo Glue"? Antibiotics OK?

QUESTION:

Dear Dr. Ramirez, my name is J. from Austria. I am 40 years old, have a failed 1.IVF (in vitro fertilization) this year (6 eggs, 4 fertilized, only 2 were transferred, because the other 2 arrested development before the transfer) , FSH of 10.6 mIU/mL, AMH of 0.8 ng/mL. My husband has anti-sperm antibody. So, we used ICSI (intra cytoplasmic sperm injection). I want to try the 2.IVF.

An IVF-clinic in Austria offers PICSI or "embryo glue". Are PICSI and embryo glue useful? They also use Prednisolon 5mg to avoid immune system reaction and Aspirin 100 and Lovenox 40 to to make blood more liquid/avoid congestion problem during embryo implantation. Are Prednisolon, Aspirin and Lovenox really helpful? All of these things I did not have at my last IVF.

Do you think that antibiotic taken before egg collection is recommendable? Thank you for your time. Best wishes! J.

ANSWER:

Hello J. from Austria,

Failing the first IVF is not that uncommon. The chances of pregnancy in the first try is 60% That means that 40% have to try more than once. That is because IVF is not a perfect technology. It mimics the natural cycle. There are 9 steps the body goes through to achieve a pregnancy. IVF accomplishes 7 of those 9 steps. The problem is that the last two steps are still natural steps and despite the best embryos and circumstances, it does not always occur.

I would not recommend PICSI or embryo glue. Embryo glue is a total fallacy and has never been proven to help. Implantation is an endometrial lining process, NOT the embryo just attaching to the wall. I do use aspirin, Lovenox and Prednisolone in my patients. They do help. I recommend low dose aspirin 81mg, Lovenox 40 is fine, and Prednisolone (Medrol) 16 mg then decreased to 8 mg after the transfer. Antibiotic should not be given prior to the egg collection but is started on the day of the egg collection.

You have two very big problems: your age and your decreased ovarian function. Age affects the quality of the eggs. The elevated FSH, which is an indication of ovarian function, shows that the ovaries will not stimulate well and so you won't get a lot of eggs. The only way to overcome the age factor is to get a lot of eggs in the hope that a good egg will be found. Because of this, it may take you multiple IVF attempts. You have to be persistent. There is nothing that can reverse the age factor.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.

Serbian Husband Has ASA Or "Antisperm Antibodies": How To Proceed?

Question:

Dear Dr. Ramirez,

My husband and I suffer from idiopathic infertility. My husband was diagnosed positive ASA with MAR direct (90% bounded spermatozoids) and indirect (80% bounded spermatozoids) method, all results are good. He went to urologist, and since he couldn't find cause for it he sent him to do ELISA test from serum which came up negative. For past two years he repeated these tests several times in different laboratories, every time with same results - MAR positive and ELISA negative. The urologist refused to give him any medical treatment since results are confusing.

How is this possible? Which of these tests is more reliable?

S. from Serbia

Answer:

Hello S. from Serbia,

I assume you have gone through an infertility evaluation as well, and that the results cleared you of any problems. Since your husband's sperm shows antisperm antibodies, you should just proceed from there. I think you have done enough repeat tests, and there is NO treatment that a Urologist can do to change that, unfortunately. With antisperm antibodies, your husband is forming antibodies that attach to the sperm and prevent them from being able to fertilize an egg. This leads to a functional defect.

The treatment of choice in this regard, and for this problem, is to undergo ICSI in conjunction with IVF so that the sperm can be washed and the antibodies removed. This can be done for IUI but does not work as well. Once the sperm are washed, they can then be injected into the eggs for fertilization to take effect.

I cannot explain or debate the effectiveness of these testing methods, as I am not a biochemist and not well versed on these testing methods.

Good luck and do not hesitate to continue trying by proceeding to assisted reproductive techniques,

Edward J. Ramirez, M.D., FACOG

Executive Medical Director

The Fertility and Gynecology Center

Monterey Bay IVF Program

http://www.montereybayivf.com/

Monterey, California, U.S.A.