QuestionI am 31 yo and I have undergone 4 fresh and 1 frozen cycle.. The first time around we got pregnant only to lose the baby at 21 weeks. After much testing it was found that my husband has a balanced translocation. It was never confirmed that the baby was unbalanced because the lab was unable to grow the tissue. After 2 ivf/pgd cycles we had only 2 so so embryos and none took. We moved on to a donor and I had nothing happen with that cycle as well.. I just finished with a fet with 6bb and 4bb blasts and had a chemical pregnancy.. I have had a normal laparascopy/hysteroscopy and normal fsh (5.5) and usually low E2(40-60)on day 3. I have been tested for pretty much everything upon my own insistance. I go to a large practice that seems to be very competent and have a high success rate on SART. I would like some ideas as to why I am not getting pregnant.. is it me? if so what can it be? I have homozygous MTHFR and I have been taking folast but not clotting issues. I have asked my RE if I should take baby aspirin and for the last two cycles have taken in rather consistently.. I have 2 more blasts frozen (4bb and 4bc) and want to know what I can do?? I am so lost in the world of IVF!! Should I go on or is it beyond repair?
AnswerHello Julia from the U.S.,
I cannot tell you what the problem is with the information you have given me, but based on the fact that you had a successful pregnancy the first try, I don't know why you are having so much difficulty getting pregnant now. One thing for sure is, I and many studies have show a decrease in pregnancy rates with PGD. I believe, and heard a PhD embryologist lecturer say the same, that the PGD may injure the embryo, which would account for the decrease in pregnancy rates. There is a new technology called Blastocyst trophectoderm biopsy with CGH, that may be the better way to screen for genetic defects. It is not widely available yet, and is still considered experimental at this time. But I expect that it will have less effects on pregnancy rates than standard PGD. Since the defect was in your husband, I presume that the "donor" you are referring to is sperm donation. If that is the case, then PGD would no longer be needed.
With MTHFR, you are at risk for miscarriages. I would treat with low dose aspirin, low dose heparin or lovenox, low dose Medrol and Estrogen/Progesterone supplementation. I also use this regimen in my poor responder patients and failed IVF cycle patients. It has worked well for me. Some clinics will even add Intralipids or IVIG. I'm not a big fan of either of those, and studies have not confirmed their efficacy, but if you look at Reproductive Immunology Associates website, they seem to recommend this regimen.
The only other advice I could offer is to consider trying a different clinic. That might do the trick as well, despite the fact that you are going to a reputable clinic. Sometimes a fresh approach might work better. However, that is not necessarily always the case. The bottom line is that you may just need to keep trying, and will eventually be successful. Sometimes each cycle is just a matter of chance. Also keep in mind that frozen cycles have a lower pregnancy rate than fresh, so put less value on those cycles.
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
