QuestionDear Dr Ramirez
I wrote to you after my first failed Ivf cycle which had failed a week after transfer with an early bleed. I was taking two progesterone pessaries a day at the time. In the second cycle, consultant tried several different things:
-a hysteroscopy/d+c a couple of weeks before transfer (the lining was observed as having thick patches and a possible polypoid appearance)
-intralipid infusion the day after egg retrieval
-daily low dose aspirin after transfer
-daily injections of Clexane after transfer
-daily injections of progesterone in oil (as well as the two cyclogest pessaries)
The outcome was unfortunately negative - I had a tiny red bleed 12 days post 2 day transfer followed by 2 days of brown discharge. This turned into a red bleed the day after the official test date, despite the fact that I was still taking the progesterone. By the way we transferred 2 embryos, one grade 1, one grade 1/2. We had 8 mature eggs retrieved, but the other 6 did not fertilize (last time we had 100% fertilization with six eggs).
I am trying to decide whether to go for a 3rd. It feels like I have too many problems with bleeding breaking through and this polypoid appearance might be an issue. I am 42, about to be 43 which is obviously also a factor. I wondered if you had any views on our situation and what causes these early bleeds and whether a possible polypoid appearance is a significant issue.
Thanks for your help
Jane
AnswerHello Jane from the U.K.,
I have not heard the term "polypoid" appearance in my medical training. I can't believe that this was the factor that has prevented your success. It is interesting to see that your consultant proceeded with a very aggressive treatment plan, adding many of the medications that I use. I rarely see, vis-a-vis letters that I receive, European doctors and doctors in the U.K. that are aggressive enough. I have to laud your consultant's attempt.
I don't think that the bleeding after embryo transfer (which I have written extensively about in my blog), is a significant factor. We often see some spotting after embryo transfer and despite this bleeding, successful pregnancies do ensue.
I think that the biggest problem you are facing is in your last paragraph, and that is your age. A woman's natural fertility decreases with increasing age because the eggs that you are born with are aging and deteriorating in quality with increasing age. This is the major factor that determines success. That is not to say that you can't get pregnant. It means that it is going to be more difficult for you to get pregnant because you are searching for the very few perfect eggs that you have left. You may not have one with each cycle, so it may take more cycles.
I think that despite your two experiences, if you can afford it and are dedicated to becoming pregnant, then you have to keep trying. At some point you may have to reassess your strategy, such as whether or not you have any good eggs left, but if you are persistent, I am confident that eventually you will be successful. It will not be an easy path, however, and you need to be prepared and accepting of this difficulty.
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.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate
