31 Years of Infertility and IVF Failure: Was It Potentially Avoidable?

04 Dec
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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.

24 Comments

  • Jennifer says:

    This is our story. We’re not struggling as long as these folks were, but can absolutely see how this could be us. DH is 48yo and I am 35yo. So many losses. Five losses last year alone – one mmc and four chemicals. Three MMCs before last year. Our RI says NKa is the cause and has little hope of anything other than IVIG (since I failed on prednisone last year). Our RI recommended an RE for local monitoring (we’re 3 hours away). Terrible mistake. The RE said IVIG was dangerous, life-endangering even, and that the latest medical literature didn’t support it. He said that any doc that recommended it was not up to date on the latest medical literature and most likely a “quack.” We spent 4 months in spin, not knowing how to move forward – seeing as how ivig was so dangerous – but failing in our natural cycles. We’ve even had complications w ER, with internal bleeding so severe it felt just like a ruptured appendix. We’re losing hope and motivation.

    With all the cash going out, conflicting information coming in, and no positive outcomes, fatigue sets in. This could easily be us in 10 years. Easily.

    • Geoffrey Sher says:

      Jennifer,

      Respectfully I totally disagree with your RE. Granted it is no longer necessary to use IVIG since we have Intralipid which is far less expensive, virtually free of side effects and equally effective in lowering NK cell activation. But first things first. You newed to be tested for an immune problem.

      Please go to the home page of this blog, http://www.IVFauthority.com . When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

      5. “Thyroid Autoimmune Disease and IVF”

      6. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      7. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

      8.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

      9. “IVF success: Factors that influence outcome”

      10. “Use of the Birth Control Pill in IVF”

      11. Recurrent pregnancy loss!”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization, the ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

      • Lesley says:

        Reading about IID is the first ray of hope I’ve had in a long, long time. We also haven’t been trying as long as the couple in this story, but I think our almost 13 years is long enough! Our Skype appt is set up with the Dallas office. Can’t wait to hear what they think!

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