QuestionQUESTION: Hi Doc,
I am 28 yrs old and underwent my 1st IVF cycle this month.
My infertility diagnosis was endometrioma on right ovary , the cyst was removed by laparoscopy 1.5 years back.
12 eggs were retrived in total from all 12 follicles that formed.
The IVF cycle yielded good quality embroyos and ET was done on day 2 of egg retrieval. In which 4 embroyos were put, 3 of grade A and 1 of grade B.
Post ET medicines included progesterone/estrogen support and aspirin along with Dexamethosone.
Even after evrey thing being perfect till end my b-HCG test resulted in level if 1.50 miu and after 48 hrs it was 1.69 miu
Please suggest, accoding to u what could be the reason for the implantation failure even when everything seemed good.
I m writing in from India
Thanks and regards
Ria
ANSWER: Hello Ria from India,
IVF is not a perfect technology and does not yield a 100% pregnancy rate. This is because the last two steps in the process to achieve pregnancy, embryo hatching and implantation, are things we do not have the technology to make happen. So, there is a little "chance" or "luck" with IVF. Certainly there are other possible causes of failure, such as embryo transfer technique, timing, endometrial thickness, immune factors, etc., but with the information that you have given me, I cannot determine if any of these might be the case.
I too have young women who have perfect appearing embryos and great transfers who do not get pregnant. It stumps me, but then I remind myself that I am not dealing with a perfect technology, despite doing the absolute best that I can do (and I am pretty good at this treatment), and that GOD reserves the right for himself to produce life and determine when it happens, not me.
For you, you need to just keep trying. It will eventually happen, and usually occurs by the third attempt. Keep in mind that even a "normal" woman your age, trying for natural pregnancy does not get pregnant on her first try. The average number of times that it takes a woman under 30 to achieve natural pregnancy is 8 months (8 tries).
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 follow me on Facebook at http://bit.ly/9Iw9oV
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QUESTION: Hi doc thanks for the response...
I would like to add that the endometrial thickness was also very good as informed by my doctor and ET was ultrasound guided.
I just want to know that what extra checks should be done so as to avoid any other underlying cause like immune factor etc. and how can I know if it exists.
whether i shud got for PGD in my next cycle and which day ET is most suitable.
Thanks doc for ur time and invaluable response.
Regards,
AnswerHello Again,
Because the last two steps of the IVF process are natural steps (hatching of the embryo and implantation), we cannot know exactly why implantation did not occur. Sometimes it is just luck/chance. That is why many people have to try more than one time and IVF does not work on the first try for all patients. Certainly you could do some immune testing, although in the U.S. it is not recommended by the American Society for Reproductive Medicine, or you can just add low dose aspirin, medrol and heparin to cover. You could also increase the progesterone dosage. I would not recommend PGD because it will do nothing to enhance your chances, but could potentially reduce your chances due to the biopsy. Transfer can occur at post retrieval day # 3 or day # 5. There is not difference in pregnancy rates. The only advantage is that going to blastocyst reduces the number of embryos to choose from if you have a lot.
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 follow me on Facebook at http://bit.ly/9Iw9oV
