QuestionHi Dr. Ramirez,
I've been diagnosed with diminishing ovarian reserve and my husband has poor morphology. I also have a blood disorder PV (polythemia vera). I just had my first IVF and we produced 5 eggs but only 2 were big enough to retrieve, one out of the two fertilized and it was a very good quality embryo although not genetically tested since we only had one. It didn't take and now I am getting tested for NT (natural killer cell). Is is possible that my blood disorder could have been the cause of the embryo not implanting since it is a clotting disorder? When my cycle started after the failed IVF attempt I had severe cramping and it was mostly clots that I passed. I've been reading about heprin and wonder if I should ask my doctor to put me on that for my second IVF attempt. Any suggestions would be very helpful. Thank you.
AnswerHello Janet from the U.S.,
I think that too much is being read into this cycle. I disagree with your doctor's decision to check for NK cells. I can't see what the purpose is. You don't mention your age but the fact that you have decreased ovarian reserve means that your ovaries don't stimulate well, as evidenced by the small number of follicles and eggs retrieved. Of course, the number of follicles and eggs is also dependent on the protocol (amount of medication used). But, part of the success that comes with IVF is just statistical chance because the last two step required to become pregnant are natural steps. We don't have the technology to make those two steps happen. They have to happen on their own. Those steps are embryo hatching and implantation. The fact that the cycle failed with only one embryo means that one of those two steps failed, or the embryo did not develop to the point where implantation could have taken place. That does not necessarily mean that there is something else going on. I would not attribute it to your polycythemia vera or natural killer cells. IVF pregnancy rates are NOT 100% and so 40-50% of patient have to try more than one time, just as a woman trying naturally usually has to try several months before pregnancy occurs.
At this point I would recommend that you continue to try with IVF. I am concerned that out of 5 follicles, only 2 were large enough to retrieve. I think your doctor seriously needs to re-evaluate your protocol. With IVF, the more eggs you can retrieve, the more embryos you will produce and the higher the chances are of finding the perfect embryo to achieve a pregnancy. It is statistical chance. Without specific information I cannot comment on your specific protocol, but I will hope for the best for you.
Good Luck,
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
