QuestionDr. Ramirez,
As I prepare myself to undergo IVF for a third time I wonder
if there are questions that I have left unasked, or testing
that needs to be done, with my RE. I am 37 and my hubby is
38. I have stage III asymptomatic endo, (large choco cyst
removed 02/09), and my hubby has low morph/motility. I went
through IVF w/ICSI #1 in 01/10 and suffered a chemical pg.
We tried again and underwent IVF w/ICSI again in 06/10 and
suffered a missed m/c at 8 wks. I underwent a D&C and had
the POC tested, which tested as a normal female, although my
RE seems to think that they tested my tissue and not the
POC. What are the chances of this? My husband and I both
tested normal on karotype testing. Each time my estrogen at
day 7 post transfer has been low. Can you advise if there
are any other tests that you would recommend before
undergoing a 3rd round of IVF? I have an appt with my RE
next week to discuss prior to beginning again. I understand
that because of age I have a higher chance of eggs with
chromosomal abnormalities, but I want to give this the best
shot we can.
Thank you,
Lori
AnswerHello Lori from the U.S.,
Although you haven't had a successful pregnancy yet, it is just around the corner. You have accomplished all that IVF can do, which is to give you the opportunity to become pregnant. IVF cannot make you pregnant, nor can it insure that the pregnancy will proceed normally. With a chemical pregnancy and miscarriage in two tries, you are two out of two for pregnancies and that is a good thing. Statistically, your chances are very good at having a successful pregnancy down the road. Remember, because of your age, it is somewhat of an uphill battle, but certainly one that you can overcome. Don't give up hope.
With the D%26C, the uterine lining is scraped so that some maternal tissue can be mixed in with the fetal tissue. That is how the result can be from you and not just the fetal tissue.
Not knowing what testing you have had done, I can't suggest any further testing. But something you might want to talk to your RE about is whether or not you might want to add some extra medications that have been used for recurrent miscarriages, namely, Medrol, low dose aspirin, extra progesterone and either low dose heparin or lovenox. Multiple studies have shown the benefit of this regimen in recurrent miscarriage patients, although not so much in achieving pregnancy with IVF. I use them routinely in my "failed IVF" patients. If you have not had autoimmune testing done, the antiphospholipid panel including antithyroid antibody, you might want to consider that, but no matter what the results, I would still treat with the above regimen.
I know that patients get very disappointed when the pregnancy they finally achieve does not go all the way, but keep in mind that you have achieved a major milestone, which is that you got pregnant. Many of my patients forget this and abandon me because they think I have failed them, when in reality, we have been successful to the extent that IVF can be. As RE's, we are only assisting God and Nature, we are NOT God or Nature. The last stages, implantation and continuation of the pregnancy, are in their hands. It will just be a matter of time to your dream.
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
