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    • Embryo Implantation: What Farmers Can Teach us About Growing Healthy Babies

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      I often refer to the conception process in terms of a “seed/soil” relationship.  Just as a plant can’t grow and thrive without first assuring that both seed and soil are good, neither can a pregnancy be successful without both the seed (embryo) and the soil (uterine environment) being ideal.  Over the next few posts, we’ll examine factors related to the “soil” half of the equation – the uterine environment.  The uterine factors are as critical to this equation as is the “competency” of the embryo (the seed).  When uterine factors are less than optimal, this can be manifest as “unexplained” infertility/IVF failure, early miscarriage, placental insufficiency with intrauterine growth retardation, and sometimes fetal demise.

      In today’s post, I’ll discuss the physical characteristics of the uterus that can influence embryo implantation.

      1. Contour of the uterine cavity: It has long been suspected that anatomical defects of the uterus might result in infertility. While the presence of fibroid tumors in the uterine wall are unlikely to cause infertility, an association between their presence and infertility has been observed in cases where they distort the uterine cavity, or protrude as submucous polyps through the endometrial lining. It would appear that even small submucosal fibroids have the potential to hinder implantation.

      It is likely that any surface lesion in the uterine cavity, whether an endometrial, placental or fibroid polyp (no matter how small), or intrauterine adhesions, has the potential to interfere with implantation by producing a local inflammatory response, similar in nature to that which is caused by a foreign body such as a intrauterine contraceptive device (IUD). Unfortunately, a dye X-Ray test (hysterosalpingogram or HSG) will miss the diagnosis in approximately 20% of cases. The best methods by which to diagnose and assess even the smallest of such lesions is through the performance of a sonohysterogram (SHG), or by hysteroscopy.

      2. Endometrial Thickness: In 1989, I published on the fact that in both normal and “stimulated” cycles, preovulatory endometrial thickness is predictive of embryo implantation (pregnancy) potential following IVF. Ideally, the endometrium should measure at least 9.0mm in thickness. However, healthy pregnancies can occur with linings that measure between 7.5 and 9.0mm (although much less likely). A “poor” endometrial lining is most commonly due to:

      • Inflammation of the uterine lining (endometritis) that usually occurs as a result of a septic delivery, abortion or miscarriage,
      • Severe adenomyosis (gross invasion of the uterine muscle by endometrial glandular tissue)
      • Multiple fibroid tumors of the uterine wall
      • Prenatal exposure to the synthetic hormone, diethylstilbestrol (DES)
      • Following back-to-back cycles of clomiphene citrate ovulation induction.

      My next post will discuss outside factors that can affect embryo implantation: Immunologic factors and the embryo transfer itself.

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      10 Responses to “Embryo Implantation: What Farmers Can Teach us About Growing Healthy Babies”

      1. Jane says:

        Hi Dr. Sher,
        I am a 32 and just failed my 2nd Ivf. Through 2 failed ivfs I learned that not only do I have thin endometrium issue due to multiple d&c procedures but I also suffer from poor embryo quality. I am suffering from both the soil and the seed problem. The thickest lining I ever reached was 7.5mm, during a fresh cycle. During the last failed fresh cycle, we retrieved 8 eggs fertilised 6 and transferred 3 and froze 1. Is it really impossible for me to have a child?

        • Geoffrey Sher says:

          Hi Jane,

          It all depends on the reason that you have a thin lining and whether by modifying the protocol of ovarian stimulation, and/or using vaginal Viagra, this can be improved. I might well be able to help here, but to do so we would need to talk. I suggest that you call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

      2. Shweta says:

        Hi Dr. Sher
        I am from india. I have a 4 yo girl born via i.u.i. This IVF cycle was somewhat modified agonist/antagonist protocol as cetrotide was added after initial few injections of gonal f. My ET was 7.4mm at the time of hcg trigger. this was told to us as perfectly within range as we also had some doubts. out of the 11 eggs aspirated, 3 good quality embryos were formed by ICSI as the overall quality of the eggs and sperm was not good( initial semen analysis showed 11 million/ml with 50%motility). All the three embryos were transfered on 22 oct 12. Luteal phase support includes 100mg gestone i.m on alternate days, ing chorion(2000iu hcg) on alternate days(3 injections, given as the E2 on the day of transfer was 922) and gestone 400mg vag pessary twice daily. My query: Was 7.4mm endometrium ok? Is the luteal support adequate? I have been told to check for beta hcg on 05 nov 12. will chorion injections given for luteal support interfere with the test result?

      3. satwinder kaur says:

        Hi Dr. Sher,
        I had abdominal tb ,bilateral hydrosalprinx ,tubes removed,hystroscopy normal cavity, two failed ivf grade1 7 embryos, endometrial thickness 9.5mm.What u suggest us should we try another cycle of ivf?

        • Geoffrey Sher says:

          There is so much more to that decision. 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

      4. Lucia Walters says:

        Hi Dr Sher.
        I am 40 years old, 41 in 3 months. I had 2 miscarriages in 2010 and I failed Ivf last year. I am going to second IVF and don’t want it to fail. We opted for egg donor since the quality of my eggs was very poor. We’d like to know if you recommend transferring one or two embryos.
        We want twins….
        Thank you

      5. Rachel Grandfield says:

        Hi Dr Sher,
        I am 37yrs old & and about to go for my 5th attempt of mild ivf. I will be injecting 75 of menopur. My doctor has prescribed the same protocol each cycle. I have produced eggs that fertilise and are good grades on every cycle. He wont change anything and just says fingers crossed for next time! I cant see what will be different this time as we haven’t tried anything different. Do you have any suggestions? I have had an intralipid drip & endo scratch>

        • Geoffrey Sher says:

          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”

          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

      6. Gail says:

        Hi unexplained fertility.

        My name is gail. I have 2 children in a previous marriage my girl is now 19 and a boy who is 15. I am 40 now and have had 2 failed ivf’s the first ivf was when i was 39 before this i had a laproscypy and they found i had endometreosis and they cortorised this.as i was saying then had my ivf had 5 eggs 4 fertilized and they put 2 embryo’s back at day 3 they did not go to blasocyst as there was not enough eggs i was on 300 gonal f. whilst i was due to go in the nurse found something on the scan which was a polyp i had that removed by a hyperscopy after the ivf failed. I have just had my 2nd ivf which has just failed again this time though i had 15 eggs 13 fertilized i was on 375 gonal f 4 went to blastocyst the 2 they put back were good 4a grade, the other 2 have been frozen they said i can have them put in after 3 bleeds. I think they were shocked as everything looked very good and said 15 eggs and 4 go to blastocyst for my age was very good. can u help me? i have just read about killer cells after endometreosis. Is there anything you can suggest or advise before we go ahead with the 2 frozen blastocysts for our 3rd and final attempt. look forward to response. ps. sorry about the spelling. regards gail.

      7. Geoff says:

        hi it’s gail again i forgot to mention when i asked about the uterine lining they just said it looked good did not give me the thickness. I am at a loss. everytime i ask a question they say they dont know it could be the quality of my eggs but no other explantion or help it just seems like they like the money and a production line.

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