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      • Case Study: Poor Quality Eggs/Embryos in Young Women With Good Ovarian Reserve: Case #5 – A Non-Ovulating, Non-Menstruating Woman

      Dr. Geoffrey Sher Recommends

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      This continues our series of case studies on unexplained IVF failure with our fifth case of poor egg/embryo quality in young women with good ovarian reserve. In this case study, we examine the effects of anovulation and Ovarian Hyperstimulation Syndrome

      Background

      “Carolyn” was 29 years of age when I first met her at SIRM. She had not ever menstruated in the past. All attempts to evoke a progesterone withdrawal bleed had failed. It was only after priming her uterus via oral estrogen for a week or two and then administering and withdrawing oral progesterone after a few days that a bleed could result. Three days after eliciting such a bleed hormonally, her blood FSH, LH and [E2] were 1.5 MIU/ml, 1.3MIU/ml, and 17pg/ml, respectively. Her uterus measured 4.3cm in length and her ovaries were deemed to be “smallish” by ultrasound examination.

      Carolyn’s husband was 37 years old, and had established that he was fertile, having fathered two children in a prior relationship.

      Carolyn, who had a normal blood androgen profile, had undergone two prior failed IVF attempts. Her 1st cycle was initiated by evoking an E2+Progesterone withdrawal bleed. This was followed with 225IU Menopur daily gonadotropin stimulation for 7 days. She so severely hyperstimulated (61 follicles ranging between 10 and 14 mm with a blood [E2] of >7,000 pg/ml) that her 1st attempted IVF cycle was summarily canceled without her even undergoing an egg retrieval (ER).

      Her 2nd IVF cycle was again started by initiating an E2/progesterone bleed. This was followed with 150IU Menopur daily for 6 days whereupon a GnRH-antagonist (Ganirelix) was administered daily for 2 additional days. She again had an exaggerated response, developing 54 follicles by the 8th day of COS at which time her follicles were mostly 15-17mm in mean diameter and her blood [E2} was 6,1200 pg/ml. Fearing that she might be at risk of developing Severe Ovarian Hyperstimulation Syndrome (OHSS), a trigger of 10,000U hCG was injected intramuscularly and an ER scheduled for 37 hours later. At this time, her endometrial lining was only 6.8mm in thickness as measured by ultrasound.

      Seventeen (17) eggs were harvested, only 4 of which were “mature” (MII’s). These were fertilized using intracytoplasmic sperm injection (ICSI) and by day-3, three severely fragmented embryos resulted that were 3, 4 & 5 cells respectively. The remaining fertilized egg had arrested in growth. Her clinic transferred all three of her day-3 embryos to her uterus without any difficulty, but she did not conceive.

      Follow up: After consulting with Carolyn and reviewing her treatment history, I decided to put her on a course of cyclical Premarin (E2)/Provera for 3 months to try to revitalize her uterus and improve her endometrial lining for an upcoming cycle of IVFat SIRM. I then overlapped the hormone replacement with dailyGnRH-agonist (Lupron). She menstruated 5 days later, at which point the dosage of Lupron was halved and I began Controlled Ovarian Stimulation with 150U FSH (Follistim) daily.

      After 2 days, I dropped the dosage to 100U Follistim and added Luveris 125U daily. By day 8 of stimulation, she had developed 47 follicles, most of which were 14-17mm in size. At this time her blood [E2] was 4,100pg/ml. I stopped the Follistim/Luveris, while continuing daily Lupron, and monitored her blood [E2] daily until the concentration had fallen below 2,500pg/ml. (“Prolonged Coasting”). At this point, 10,000U of hCG was administered as a “trigger”. By this time, her endometrial thickness was 9.7mm, and most follicles measured 18-22mm.

      Thirty seven hours later, I harvested 34 eggs, 26 of which were MII’s. After fertilization by ICSI, these developed intro 18 embryos, which propagated 9 good quality blastocysts. I transferred two of these on day-5 post-ICSI. The patient did not develop any signs/symptoms of OHSS. She conceived and gave birth to a single healthy baby boy at term. We vitrified (cryobanked) the remaining blastocysts for subsequent dispensation at the couple’s directive.

      Commentary: When evaluating Carolyn’s history, I took into account the following important considerations:

        1. Women such as Carolyn who have hypogonadotropism (low FSH/LH output) with low blood estrogen levels are at severe risk of developing severe ovarian hyperstimulation.

       

        1. Her chronically low blood estrogen level had caused her uterus to shrink and had rendered her uterine lining resistant to short term estrogen-induced proliferation.

       

        1. Her stimulation cycle had been “cut short” (her follicles had not developed sufficiently by the time hCG was given). This was done in an attempt to prevent her from developing OHSS.

       

        1. In prior cycles, less than 50% of her follicles yielded eggs, and less than 25% of these were mature (MII’s)

       

        1. None of the 3 cleaved embryos had been allowed to develop for long enough to attain the blastocyst stage.

       

      1. Given her young age (29Y) she should have yielded many more MII’s and embryos that were of much better quality.

      Age is the major determinant of egg quality (“competence”) which in turn determines embryo quality/competence. Thus, a woman like Carolyn is usually capable of making viable eggs/embryos. In her initial attempts, her failure to do so was largely due to the fact that, in an attempt to avoid OHSS, she was “triggered” with hCG prematurely – before her eggs had an opportunity to develop properly. This resulted in many of her eggs being trapped in her follicles (creating the erroneous impression of “empty follicles”). It also led to poor quality and “unready” (immature) eggs. These eggs were incapable of generating many embryos, and the few that did develop were of poor quality and”incompetent”.

      I addressed this by safely prolonging follicle development until most had attained 18-22mm in size before “triggering” maturation with hCG. The “Prolonged Coasting” implemented here was the key, as demonstrated by her turnaround response to this approach, culminating in a “successful” IVF cycle. It also prevented OHSS and its potentially life endangering consequences.

      Her attenuated uterine size and her poor endometrial response to stimulation were linked to estrogen deprivation and are noteworthy as well. In prior cycles, her “involuted” estrogen-starved uterus was about half its normal size and its endometrial lining was incapable of properly responding to estrogen. The 3-months of estrogen/Progesterone hormone replacement therapy I put her on before beginning the IVF cycle was thus a vital part of the therapeutic approach.

      Conclusion: What this case exemplifies is that just as the growth of a healthy plant requires that a “good seed” be placed in receptive “soil”, so too does successful IVF require the transfer of a “good” embryo to a receptive endometrium.

      Addendum: It is important to understand that IVF is an ART-Science blend and not all practitioners agree on the same strategies. Thus, in the final analysis, it is important, after discussion with your personal doctor, to follow his/her advice to the letter.

      Feel free to present your case history in the comments and I will do my best to offer my opinion.

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      12 Responses to “Case Study: Poor Quality Eggs/Embryos in Young Women With Good Ovarian Reserve: Case #5 – A Non-Ovulating, Non-Menstruating Woman”

      1. Soha says:
        August 16, 2012 at 4:09 pm

        Excellent Dr. Sher
        I decided to have another trial after my failed IVF last month.
        I have PCO with FSH 4.8
        LH 10.5
        Prolactin 12. Day 3 of cycle
        My menses is regular.
        Previous trial they didn’t try to correct hormonal disturbance before IVF, they gave me decapeptyl starting from day 21, I don’t know wheather this is an alternative to trying to adjust hormonal profile. I developed OHSS with E2 24000pg/ ml .
        I’ll go next month to have my frozen embryos transferred. Any advise for me about adjustment of my reversed ratio of FSH& LH. Any other recommendation ?!
        I didn’t have a laparoscope , do you think it’s worth doing & wheather ovarian drilling helps or not cause if this fails I think it will be my next trial.

        Reply
        • Geoffrey Sher says:
          August 20, 2012 at 12:18 pm

          Sounds like you might have a variant of polycystic ovarian syndrome and accordingly, highly susceptible to OHSS. Might I recommend that you go to the home page on this site, find a “search bar” in the upper right hand column and type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
           “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
           “Polycystic Ovarian Syndrome”
           “Ovarian Hyperstimulation Syndrome”
           “IVF success: Factors that influence outcome”
           “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
           “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

          You might consider calling 800-780-7437 or 702-699-7437 to set up a video conference with me (which is free if you reside in the U.S.A or in Canada) so we might discuss your case in detail.
          Geoff Sher

          Reply
      2. Cindy says:
        December 20, 2012 at 9:35 am

        dear Dr. Sher,
        You mentioned above: “Follow up: After consulting with Carolyn and reviewing her treatment history, I decided to put her on a course of cyclical Premarin (E2)/Provera for 3 months to try to revitalize her uterus and improve her endometrial lining for an upcoming cycle of IVFat SIRM.”

        I have low levels of 3rd day E2 (16-26pg/ml) and very thin lining, even after using E2 and viagra. Could you please explain exactaly how this 3 month treatment with Premarin/Provera is done?
        Thanks!

        Reply
      3. Jennifer says:
        March 12, 2013 at 6:21 pm

        Hi Dr. Sher,
        I’m 31 years old and have been diagnosed with severe endometriosis. I underwent laparascopic surgery in 2010. My husband and I did an IVF cycle in 2011 (Gonal-F 125, Repronex 75, and Lupron), 11 eggs were retrieved, 9 fertilized, and 3 relatively poor quality embryos were available for transfer. We transferred 2 on day 5, and the 3rd embryo did not survive to freeze. We did get pregnant and had a live birth in July 2012.
        The goal of our 2nd IVF cycle in 2013 was to increase the quality of my eggs so that we would increase the number of embryos. The protocol was: Follistim 300, Repronex 75, Saizen 2.5 mg, and Lupron for 2 days, then decreasing the Follistim to 225 while keeping the other drugs the same for the remainder of the stimulation phase. I also took 300mg of CoQ10 orally during the stimulation phase. 23 eggs were retrieved and 18 fertilized. By day 5, however, there were only 3 relatively poor quality embryos remaining for transfer. We transferred all 3, and had a bio-chemical pregnancy.
        Do you have any suggestions as to why the quality of our embryos is so poor? Is there anything you can suggest to improve the quality of the embryos and possibly the quantity of available embryos on day 5 so that we might have embryos to freeze?
        Best, Jennifer

        Reply
        • Geoffrey Sher says:
          March 12, 2013 at 7:42 pm

          A couple of things:

          1. Advanced endometriosis can be associated with ovarian endometriotic cysts (endometriomas/chocolate cysts). The presence of any such space occupying lesions (measuring > 1.5cm) in the ovary will often times cause such activation of ovarian connective tissue so as to result in increased male hormone (predominantly testosterone)production …..which if in excess will often compromise egg development in that ovary. This could explain poor egg/embryo quality. The message is that before doing IVF such lesions must be removed surgically or through sclerotherapy (see elsewhere on this blog) before proceeding. Aspirating them often will not cut it.

          2. The protocol used for ovarian stimulation is often critical in such cases. In my opinion, the agonist/antagonist conversion protocol (A/ACP)launched off a BCP is ideal (read about the A/ACP elsewhere on this blog).

          3. Then when egg/embryo quality is dealt with, it is important to recognize that 30% of women with endometriosis (regardless of its severity) have an associated immunologic implantation dysfunction (IID) linked to activated uterine natural killer cells (NKa). When IID coexists it must be addressed through intralipid and steroid therapy.

          Please go to the home page on this blog (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. “Endometriosis and IVF”

          2. “”An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

          3. “Agonist/Antagonist Conversion Protocol”

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

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

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

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

          8. “Sclerotherapy of ovarian endometriomas””

          Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail.

          Geoff Sher

          Reply
      4. Jen G. says:
        April 3, 2013 at 8:21 am

        Hi Dr. Sher,
        My husband and I just experienced our first failed IVF cycle. My clinic utilized the Meldrum protocol. I am 34; my husband is 42. We were diagnosed with unexplained infertility. Before this first IVF cycle, we had 5 IUIs (2 with clomid and 3 with femara) – all failed. In total, we have been trying to conceive for 3 and 1/2 years. I stimulated very well and 17 eggs were removed – 14 fertilized. However, by day 2, they remained 2 cell and the clinic decided to do a day 3 transfer. By day 3, we had two above-average qualitiy 5-cell embryos, which were transferred (the transfer was flawless). I had a Beta of 20 and then 30, so it was diagnosed as a chemical pregnancy and I got my period pretty much on time. My question is, do you have a suggestion for a different protocol? We were shocked that our embryos performed so poorly, especially given our doctor’s confidence that we were almost 100 percent going to get pregnant. The remaining embryos arrested before they could make it to the blastocyst stage (I believe some made it to morulas?), so we did not get to freeze any of them. Thank you in advance for any suggestions!

        Reply
        • Geoffrey Sher says:
          April 3, 2013 at 1:28 pm

          Hi Jen,

          Indeed the issue of protocol of stimulation is central to good egg/embryo quality and we could address this (especially given your young age). However, we still have to explain failure to conceive previously and here 2 big questions arise. Do you have pelvic pathology (e.g. endometriosis) and/or an implantation dysfunction *(see below).

          I think I can help sort this out with you.Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail

          In the interim, 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 corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.

          1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

          2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”

          3. “Agonist/Antagonist Conversion Protocol”

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

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

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

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

          8. “IVF success: Factors that influence outcome”

          9. “Endometriosis”

          Geoff Sher

          Reply
      5. Marie says:
        April 14, 2013 at 1:12 pm

        Hi Dr. Sher,

        I would appreciate your opinion on what happened with my first IVF cycle. I’m 29 and in very good health and all of my blood work is normal. My husband is 30 years old and has great sperm. I am in the unexplained category however I have very irregular cycles ranging from 28 to 50 days. My doctor says that I have chronic anovulation and some symptoms of PCOS. I’m thin, about 120lbs, but do get some some hormonal acne. The stimulation for my first IVF went welll. I took 75 menopur, 75 puregon, and orgalutran and used 250 ovidrel as the trigger. There were 13 eggs retrieved and 9 were fertilized with ICSI. On day three, 7 of the embryos had arrested and the remaining two were not very good quality- one was a 4 cell and the other a 5 cell. Both had fragmentation of about 20%. The two were transferred but I did not get pregnant.

        The Doctor told me that the poor result could have been from the chronic anovulation that I had been experiencing for over a year and that the eggs had been exposed to too many androgens – or the other reason could be that my eggs are abnormal. What is your opinion?

        We are doing another IVF in a few months. We are going to use the same protocol, with one change – use an hcg trigger rather than ovidrel. I’m currently taking 150mg of coq10 per day just in case it’s an egg quality issue.

        Thoughts?

        Thanks for your advice.

        Reply
        • Geoffrey Sher says:
          April 14, 2013 at 2:25 pm

          It is possibly all about the protocol used for ovarian stimulation, i.e., the late antagonist approach and only 250mcg of Ovidrel to trigger with.

          I would suggest you go on to a BCP for 2 months (to suppress LH activity) then launch from the BCP on to a long pituitary down-regulation protocol with Lupron and as soon as menses start, lower the Lupron from 10U daily to 5 units with concomitant initiation of 300U of Folistim stimulation for 2 days and then reduce to 200U adding 75U of Menopur daily. Trigger with 10,0000U of uhCG or 500U of Ovidrel.

          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 corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.

          1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

          2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”

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

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

          5. “IVF success: Factors that influence outcome”

          Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail

          Geoff Sher

          Reply
      6. Nana says:
        May 12, 2013 at 2:29 am

        Dear Dr. Geoffrey,

        I am 28 years old .I got married 5 years ago. My husband has good count and motility but 100% abnormal morphology.
        my 1st attempted IVF cycle(Mar2012) was summarily Dr put me on Levothyroxine25 however my TSH was 2.97 and it decreased to 1.4 after had It and I still on it . My protocol was bc for 30 days and then 150 follistim and 150 Menopur after 3 days they dropped to 150 follistim and 75 menopur and Ganirelix was added, then 75 and 75. The stimulation was 8 days only. The egg sizes were 24, 24, 24, 22, 19, 16, 17, 14, and my E2 was 2800. They retrieved 15 eggs only 7 were mature 2 atretic and 5 fertilized by icsi all eggs were fragile ,granular, dark ,at the end 2 embryos have been transferred they were only 3 cells on day 3 . I know they should bet 6-8 cells. After it failed we did karoytypes which were normal and my testosterone < 20
        In (12/2012) my FSH was 4.1 but my AMH is 1.1, we started with long protocol. The Dr put on me injection called Dycapatyl 0,1mg for 15 days and then dropped to have dosage of it and added 75 fsh &75 fsh ,lh) but after 7 days we cancelled this cycle because this protocol was bad for me

        2nd attempted IVF cycle was on (April2013). Start day 3 from the period. I was on 187 Gonal-f and 75 (fsh&lh) after 5 days, the dosage dropped to 150 and 75 and start cetrotide 0.25..until my egg sizes become bet 21-23.5 also there were bigger and bigger sizes, but the Dr said forget them ,that was on day 11 from my stimulation .my E2 was 4943 it was very high but Dr ask me to take 112 Gonal-F and cetrotide 0.25 plus HCG shot and they retrieved 21 eggs and only 7 mature and another 2 matured on the lab and all were very fragile and granular and bad morphology and 5 fertilized using IMSI and 2 eggs have been dead during ICSI because of fragility and we transferred 1 cell,2 cell, 2 3 cell ,5 cell, with no fragmentation that was after 65 hours.

        I need your advice for next protocol and what about any supplements, like DHEA and Melatonin to be added to my protocol. I know I am difficult case but the only way for me is keeping trying with these poor eggs. I have a hope to be like this successful case.
        Nana

        Reply
        • Geoffrey Sher says:
          May 12, 2013 at 10:07 am

          Clearly thos has 2 components. The first is the protocol used for ovarian stimulation. This in my opinion needs to be re-strategized. You should, in myn opinion not go directly on to a stimulation protocol coming off a BCP without causing a rise in FSH before the stim, to create antral follicles (see below). Also there is the issue of the actual stim protocol itself.

          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 corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.

          1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

          2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”

          3. “Agonist/Antagonist Conversion Protocol”

          4. “Use of the birth control pill in IVF”.

          Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype consultation (free of charge to those who reside in the United States or Canada) with me so we can discuss your case in detail

          Geoff Sher

          Reply

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      DQ-alpha Matching in IVF: The Controversy, How It Affects Outcome, & How to Treat!
      IVF patients, especially those who find themselves inexplicably repeatedly failing treatment after treatment are no longer willing to blindly accept platitudes from those who would ignore the role of immunologic causes of IVF failure while unable to ... more
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      Unexplained Infertility: True Diagnosis or Cop Out?
      For about 10% of all infertile couples, the cause of the infertility cannot be readily determined using conventional diagnostic methods. Such cases are often referred to as “unexplained infertility.” The truth, however, is that in most su... more
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      Egg Banking of Genetically (CGH)-Tested Eggs Could Change The Face Of IVF-Ovum Donation
      For more than a quarter century, medical scientists have attempted to defy the biological clock by freezing a woman’s eggs to preserve her fertility. Most of these efforts have failed. Consider the fact that since the birth of the world’s 1st “... more
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      Complete DQ alpha Match *Without* Natural Killer Cell Activation
      Background: “Joanne”, a 36-year-old lady with normal ovarian reserve, had undergone three IVF procedures in a prior relationship. The indication had been “bilateral tubal occlusion.”  The reason why all three IVF attempts had failed ... more
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      Gestational Surrogacy in a Woman Born Without A Uterus (Rokitansky Syndrome)
      Background: Mary, 30 years of age and married to a fertile male partner, presented to me about four years ago with primary amenorrhea (i.e. she had never menstruated) and wanting to have a baby. She was born with a condition called Rokitansky syndrom... more
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      Case Study: Hydrosalpinx (Blocked/Fluid Filled Fallopian Tubes) and IVF Failure
      RL, a 31-year-old woman, presented with a 7 year history of inability to conceive, in spite of 2 prior fresh and 1 frozen IVF attempts, where a total of six good quality blastocysts had been transferred to her uterus.  Her husband PL, had normal spe... more
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      Recurrent Unexplained IVF Failure with “Good Quality” Embryos
      The following is a case study of a recent patient that came to me for treatment.  CJ, a 34 year old, and her husband RJ (age 35) presented to me with a six-year history of infertility. Based on semen analysis, RJ, who had initiated two pregnancies i... more
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      Karmann and Ryan’s Journey – My Approach to Their Treatment
       Please refer to last week’s blog post, where Karmann tells in her own words her struggles with recurrent miscarriage – nine miscarriages to be exact – and her long journey  of heartbreak, disappointment, and finally – hope.... more
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      Wennerlinds
      Karmann and Ryan – Nine Miscarriages, Then Hope!
      In observation of National Infertility Awareness Week (NIAW), I wanted to share the touching story of a couple that I first met last year – after they had already experienced 8 years of heartbreak and frustration.  Their story is representativ... more
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      IVF in a Same-Sex Male Couple: A Case Study
      Background: About two years ago, I received a call from a gentleman that I will call “John”. John was a movie producer who stated that he and his partner “Brian” had been in a monogamous same-sex relationship for 7 years and each wanted to si... more
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      Recurrent Molar Pregnancy Treated By “IVF Genetic Chess”
      Background: Maria (fictitious name), a childless 34-year-old Hispanic lady, presented with a history of having had five (5) successive spontaneous pregnancy losses at 7 weeks gestation, all due to hydatidiform moles. Four (4) of these losses were ... more
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      Case Study: Donor Egg IVF in a Post Menopausal Woman
      Mary (fictitious name), a 54 year menopausal woman, presented at SIRM-Las Vegas for IVF using an egg donor. She had been menopausal for 7-plus years and had NOT been on any hormone replacement therapy. Mary gave a history of having undergone IVF with... more
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      Case Study: Endometriosis Presenting as “Unexplained Infertility”
      I consulted with a 36 year old lady (whom I will refer to as “Sandra”) and her partner, about 18 months ago. She and her husband of 5 years had been having regular unprotected intercourse throughout this time and had been unable to conceive. Sand... more
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      Karmann and Ryan’s Journey – My Approach to Their Treatment
       Please refer to last week’s blog post, where Karmann tells in her own words her struggles with recurrent miscarriage – nine miscarriages to be exact – and her long journey  of heartbreak, disappointment, and finally – hope.... more
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      Why Did My IVF Fail? Part 2 – Uterine Receptivity and Transfer Technique
      This is the second part of a two-part post on IVF failure. In my January 22nd post, I discussed what I often refer to as the “seed” variable in the “seed/soil” relationship – the embryo. This week’s post will address the “soil” variab... more
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      My IVF Cycle Failed – What Went Wrong? Question #19: Why Do I Keep Having Chemical Pregnancies and Miscarrying?
      This is the 19th in a series of answers to common questions about failed IVF. Early pregnancy loss – whether due to miscarriage or chemical pregnancy – is due to two major factors. In more than 70-80% of cases the cause is attributable to... more
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      My IVF Cycle Failed – What Went Wrong? Question #18: My Fertility Clinic Reports a High Success Rate – How Could I Have 2 Failed Cycles In A Row?
      This is no. 18 in a series of answers to common questions about failed IVF. While it is true that IVF failure can be due to preventable factors, it is as important to understand that optimal medical care does not always equate with an optimal outcome... more
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      My IVF Cycle Failed – What Went Wrong? Question #17: Why Didn’t I Get Pregnant When I Used a Young Egg Donor and Had Good Quality Embryos?
      This is #17 in a series of answers to common questions about failed IVF. For women whose advancing age and/or ovarian resistance make having a baby with their own eggs unfeasible or unlikely, IVF using donated eggs from a young donor (under 35 years)... more
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      My IVF Cycle Failed – What Went Wrong? Question #16: Why did my hCG levels stop rising properly?
      This is the 16th in a series of answers to common questions about failed IVF. Immediately following implantation, the root system (trophoblast) of the embryo begins to release the pregnancyhormone, human chorionic gonadotropin (hCG) into the surround... more
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      My IVF Cycle Failed – What Went Wrong? Question #15: Might My Mental State Have Played a Role?
      This is the 15th in a series of responses to common questions about failed IVF There is little doubt that stress and emotional lability plays a role in the normal physiological/hormonal regulation of the menstrual cycle.After all, Eskimos often stopp... more
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      My IVF Cycle Failed – What Went Wrong? Question #14: Could it Have Been Due to Inadequate Hormonal Support After the Egg Retrieval & Embryo Transfer?
      This is the 14th in a series of answers to common questions about failed IVF. In vitro fertilization establishes an abnormal hormonal environment in the uterus.In some cases (especially older women and those with a diminished ovarian reserve), high o... more
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      My IVF Cycle Failed – What Went Wrong? Question #13: Did the Number of Embryos I Had Transferred Play a Role?
      This is the 13th in a series of answers to common questions about failed IVF. Virtually everyone recognizes that pregnancy with multiples (especially triplets or greater) is associated with a high incidence of premature delivery that has serious cons... more
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      My IVF Cycle Failed – What Went Wrong? Question #12: Might the Timing of Embryo Transfer – Day 2-3 (Cleaved) vs. Day 5-6 (Blastocyst) Play a Role?
      This is the 12th in a series of answers to common questions about failed IVF. (Note: I’ll be hosting a live video chat on Aug. 2 on the topic of Failed IVF where I’ll discuss the issues addressed in this series of posts and take your ques... more
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