31 Years of Infertility and IVF Failure: Was It Potentially Avoidable?
A short while ago I consulted with a couple who presented with one of the most perplexing case histories that I have ever encountered. I wish to share it with you because it will be an ongoing saga that I intend to report here as evaluation and treatment unfolds. So brace yourselves for the first installment of a very sad story that I hope will have a happy ending and, in the process, show how important it is for patients to be proactive and for physicians to be more open minded. I will refer to the lady as WB and her husband as HB. Here we go…
WB, a 50 year old woman and HB, her 52 year old husband, first revealed their story here on the IVFauthority.com board. HB had previously fathered children in a prior relationship and had then undergone a vasectomy. Upon marrying in their late 30’s, the couple immediately embarked on a quest to have children together and began a course of numerous attempts at IVF/ICSI using WB’s own eggs and HB’s sperm obtained through testicular sperm aspiration (TESA). There were several fresh ICSI procedures where WB had numerous good quality embryos transferred both as fresh procedures and as FET’s. She conceived several times but on each occasion miscarried in the 1st trimester. Not surprisingly, the couple soon ran desperately low on funds and accordingly, had to take a break from IVF.
Then with WB in her mid-to-late 40’s they decided to liquidate whatever assets they had left and, upon the advice of their fertility doctor, resort to using an egg donor. And so their saga began all over again. They underwent several fresh egg donor IVF attempts and even went so far as having their embryos genetically tested for “competency” using array CGH (aCGH). Finally they conceived, only to be again ravaged and devastated by another early miscarriage.
In spite of having six (6) banked “aCGH-normal” blastocysts, they found themselves in such dire financial circumstances that they could not proceed any further and so, in total despair, they posted their story on this site.
After I responded to their story on this blog, they scheduled a consultation with me and we spoke in depth via Skype. What they went on to describe boggles the mind. WB has a healthy uterus as imaged by hysteroscopy and has always had well developed endometrium. However, she had an autoimmune medical condition that predisposed her to an immunologic implantation dysfunction (IID) which was associated with activation of uterine natural killer cells (NKa). She had discussed this possibility with a reputable reproductive immunologist in the mid-1990’s, but this was before tests for uterine NKa were available and, suspecting an IID, this physician recommended IVIG therapy. However, none of her treating RE’s would even consider the possibility of an immunologic problem being the cause of her prior reproductive dysfunction. In fact, they told the couple they did not believe in immunologic causes of IVF failure and viewed IVIG therapy as being very risky. Simply stated, the couple hit a brick wall.
Because the couple was sent to me through a charitable program that coordinates IVF donations for deserving couples, I agreed to treat them free of charge. I strongly suspect that we will unmask an immunologic cause for their repeated IVF-reproductive failure. If this is the case, I am optimistic that the transfer of their currently available aCGH-normal vitrified blastocysts (combined with treatment of the immune issues) will result in a successful IVF after more than 30 years of trying. I also hope that in the process of diagnosing and treating this couple, we will be able to redirect focus on the absolute imperative of considering IID in all cases where IVF inexplicably fails to propagate a viable pregnancy following repeated transfer of “good quality” embryos.
I will be embarking on an evaluation of this couple for IID and, if justified by the findings, will be performing an FET in January or February 2014.
This is to be the first of several “real time” reports on this very interesting, sad, and compelling case that I will be posting here. As the case progreses, I will update you. I am doing so because I believe that this is a tragic example of how patient timidity and lack of proactivity, combined with a degree of medical arrogance, can condemn unsuspecting patients to unnecessary long-term hardship and childlessness.