QuestionI am a Registered Nurse 34 years old and I have a 13 year old. My husband is 32. We have tried 6 attempts all have failed. I have a hx of endo and ovarian cyst and had 4 abdominal surgeries to remove them, I have only 1 ovary since 12 yrs and no fallopian tube. I have made up to 22 eggs with my cycles but my embryos do not implant. What do you think is my problem. Thanks
AnswerHello Lisa-Marie from the U.S.,
Your question is difficult to answer without more specific information. In general, you have implantations failure. This could be due to embryo factors, such as poor embryo quality, endometrial factors, such as inadequate endometrial lining thickness, luteal phase factors, such as poor progesterone support, laboratory factors, such as damage/injury to the embryos from poor lab quality control/techniques or transfer factors, such as poor or traumatic transfer technique. We have no way to know whether there is embryo factors or endometrial factors, since there is no test to check these once the embryos are transferred. However, in many cases, you can have great embryo quality and adequate endometrium, but the cycle fails because of poor transfer technique. This is the most critical stage of all in IVF. That being said, there are some patients, that despite all the factors being perfect, do not implant for whatever reason. It good be due to poor uterine factors, such as fibroids, or immunological factors. Some of these will have to use a surrogate. Others will respond to treatment with low-dose aspirin, low-dose heparin, increased progesterone and estrogen supplementation. I have had much success with the latter, despite the fact that studies do not verify these as advantageous. My protocol is to put patients on this regimen once they fail an IVF cycle, just to cover all the bases.
I am presuming that you have not done all of your 6 cycles at the same clinic. However, if you have, you might want to try a different clinic. Pregnancy rates certainly vary because of the above factors, and because of the techniques of individual physicians. For example, I was at a different facility from where I am now. In the last year there, the building owner was doing a lot of remodeling, and tenant improvements for new tenants. My pregnancy rates plummeted to 27% in under 35 year olds for that year (I previously was averaging 53%). They I moved to my new current facility where I was able to improve the facility and airflow. I now have a completely filtered and isolated airflow system, whereby the airflow in the procedure room and embryology lab are isolated from the rest of the building. My under 35 pregnancy rates since then are 74%. It shows how different factors can make a huge difference in pregnancy rates.
I hope that helps a little.
Sincerely,
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 facebook and twitter with me at @montereybayivf
