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      • Endometriosis and Infertility: Common Misconceptions

      Dr. Geoffrey Sher Recommends

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      Endometriosis is one of the most common conditions associated with infertility. I say “associated with” rather than “causing” infertility because in many cases, it can be an ( added) contributing factor to another underlying issue that is the root cause of a woman’s infertility.

      Many times, women are given an oversimplified picture of the correlation between endometriosis and infertility – in essence, that:

      • The primary effect of endometriosis is that it impedes the eggs from reaching the fallopian tubes…

      and therefore,

      • That the severity of infertility is directly proportionate to the anatomical severity of the endometriosis itself.

      This gross over-simplification and erroneous view is often used to justify the performance of many unnecessary surgeries for the removal of small innocuous endometriotic lesions, on the basis that such “treatment” can evoke a cure of the infertility.

      It is indeed indisputable that even the mildest form of endometriosis can compromise fertility. It is equally true that mild to moderate endometriosis is by no means a cause of absolute “sterility”.

      When compared with normally ovulating women of a similar age who do not have endometriosis, women with mild to moderate endometriosis are about three to four times less likely to have a successful pregnancy. Two important reasons for such reduction in fertility potential are:

      1. Endometriosis is associated with the release of local pelvic “toxins” that significantly reduce the fertilization potential of eggs as they pass via the pelvic cavity from the ovary to the awaiting sperm in the outer fallopian tube
      2. Given that the origins of endometriosis almost certainly also involve an abnormal immune response of the uterine lining, many such women tend to reject the embryo (fertilized egg) as it attempts to gain attachment to the uterine wall (endometrium).

      The reason that women with mild to moderate endometriosis have a much poorer reproductive performance has less to do with ovulation dysfunction or anatomical disease than the two factors mentioned above. Therefore, it should come as no surprise that the use of fertility drugs, surgery (to ablate small endometriotic deposits and free pelvic adhesions), as well as treatment by intrauterine insemination (IUI) which do not address the primary causes, are unlikely to provide any improvement in pregnancy rate over no treatment at all.

      Of course, there are women with mild to moderate endometriosis who are under 35 years and who, in spite of such barriers to fertility, do conceive following fertility hormone therapy, intrauterine insemination (IUI) or surgery. But these women should realize that they probably became pregnant in spite of – rather than due to – such treatment. Then, there is the danger that women who conceive in spite of mild to moderate endometriosis might be lulled into a false sense of complacency, thinking that because they were able to achieve a pregnancy once, they will have no problem doing so again. In reality, the achievement of a viable pregnancy by a woman with mild/moderate endometriosis (by whatever means), does not improve her chances or provide assurance that she will be able to do so again.

      Younger women (under 30 yrs.) with mild/moderate pelvic endometriosis (who have patent fallopian tubes, are ovulating normally, and have fertile male partners), have about a 30-40% chance of having a baby within 3 years. Accordingly, they would be fully justified in taking a “wait and see” approach, avoiding surgery, fertility drugs and intrauterine insemination (none of which, in my opinion, is likely to improve their chance of a successful pregnancy over no treatment at all). However, if they prefer to take a more active approach to conception, their best bet is In Vitro Fertilization. The nature of the IVF procedure allows eggs to be removed without their being exposed to the “toxic” pelvic environment. The eggs are then fertilized outside the body and transferred as embryos to the uterus. This nullifies one of the major factors in endometriosis-related infertility.

      In addition to this toxic “peritoneal factor” present in all women with endometriosis, our research has shown that up to 1/3 of women with endometriosis (regardless of severity) have an immunologic barrier to implantation. That is, the body’s natural immune response rejects the embryo as a foreign body before it can implant in the uterus. This population of women is not generally able to conceive until the immunologic problem has been diagnosed and suppressed through selective immunotherapy.

      It therefore behooves all women with endometriosis who are planning to have a family to be thoroughly tested for immunologic factors including Antiphospholipid Antibodies (APA) and Natural Killer cell activation (NKa). These tests should only be performed by a reproductive immunology reference lab. To my knowledge, no more than a half dozen exist in the United States that are capable of performing these tests with the required sensitivity.

      Given the effect of the biological clock, women over 35 years of age who have endometriosis-related infertility need to be very proactive, as they do not have time to waste. Such women should, in my opinion, do IVF as a first line approach.

      In the absence of clear evidence of immunologic implantation dysfunction (increased NK cell activity), I often recommend a conservative approach in women under 35 years (who potentially can afford the time to wait). However, it is my opinion that regardless of age, women who have increased NK cell activity should undergo IVF accompanied by immunotherapy with Intralipid (and sometimes with heparin, Clexane or Lovenox added ). Without such treatment, they are not likely to conceive regardless of the treatment approach.

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      27 Responses to “Endometriosis and Infertility: Common Misconceptions”

      1. Kendahl says:
        January 20, 2011 at 8:14 am

        Is it still possible for a woman with NKa to conceive via IVF without immunotherapy?

        Reply
      2. Monica says:
        September 4, 2012 at 7:39 am

        Do you recommend having surgery to remove endometriosis first before trying IVF? And removal of endometriomas even if this can decrease ovarian reserve?

        Reply
        • Geoffrey Sher says:
          September 6, 2012 at 9:08 am

          Definitely remove endometriomas >1cm in size by surgery or use sclerotherapy. Read on the latter, here on my blog. Also read the article I posted on endometriosis.

          geoff Sher

          Reply
      3. Mary says:
        November 28, 2012 at 12:51 pm

        Dr. Sher,
        We cycled 3 times with SIRM NJ this year, (One fresh, one frozen, one frozen with gestational carrier ) I have stage 1 endometriosis & NKa+, my sister was our GC and it didn’t work. We have 3 frozen embryos left (grade 1 and 2) and don’t know what to do next… Should I try with a new protocol? lovenox, heparin or clexane? Or do I assume after the 3 cycles, 6 embryos later… that its the quality of the embryos? Im 27, husband is 30.

        Reply
        • Geoffrey Sher says:
          November 28, 2012 at 7:50 pm

          You have an outstanding RE in Dr Peters. Ask him to check both you and your partner for DQ alpha and HLA gene matching.

          Geoff Sher

          Reply
      4. Mary says:
        December 6, 2012 at 1:20 am

        He already checked, we are not a DQ match. I had lap surgery 16 months ago and my pain from my endometriosis is back (& excruciating/debilitating) by obgyn thinks its time we do another laproscopic surgery to remove it, but I recently read on RESOLVE that this type of surgery may be detrimental in conceiving? In your expert opinion (Im planning on doing another IVF) should I skip the surgery???

        Reply
        • Geoffrey Sher says:
          December 6, 2012 at 9:40 am

          If you do not have an endometrioma (chocolate cyst) or tubes distended with fluid (hydrosalpinx), surgery will not help IVF. So why do it if amnother IVF cycle is coming up soon.

          Make sure you do not have an immune issue (NK cell activation) because 1/3 of women with endo do .

          Geoff Sher

          Reply
      5. mel says:
        January 7, 2013 at 11:29 am

        Dr Sher,

        I have read this article as well as one written by Dr Wilah (Dallas) about lap surgery not being a good idea for fertility treatment.

        I have endometriosos and PCOS and have been TTC for 5 1/2 years. I had my first diagnostic lap four years ago and then an emergency laporoscopy due to an ectopic pregnancy following my first and only IVF. At that time, my tube was salvaged (the pregnancy was in my right tube) and the surgeon ‘cleaned up’ any endometrioma and visible endometriosis.

        Since I live in Europe, where insurance and length of hospitalization stays are not an issue, they tend to ‘wash out’ the abdominal cavity with water or some other liquid and leave a drainage tube for several days to decrease the risk of further adhesions/scar tissue (sorry I don’t know the medical term for this). Because I had lost a lot of blood and had the water/liquid inserted in my cavity, I had to stay in the hospital for several days until I had ‘drained’ out enough fluids. I don’t know of anyone in the US who has this done as usually patients don’t even spend the night in hospital. What are your thoughts on this?

        This was a horribly traumatic (mentally and physically) painful experience and I have been against any treatment-IVF since then.

        I do see my specialist every 6 months for routine check ups and hormone arrays. He is very respectful of my decision not to do another IVF, yet reminds me that time is an issue-I am 37.

        I have very, very painful and heavy periods and my thought is that if I am not going to be a mother, then I would at least like some relief from the pain that I have on a monthly basis. My doctor agreed that we could do another lap. I also realize that if one or both of my tubes were to be dilated, then this can be detrimental in an IVF/spontaneous because of implantation issues. I have had HCG’s done about a year ago and it showed patent tubes.

        I am concerned that by manipulating the ovaries that this can diminish ovarian reserve which is now a second fear of mine, along with the risk of scar tissue formation and the general risk of surgery. Could I ask the surgeon to not touch my ovaries if he goes in or is this a ridiculous request?

        My idea is two-fold for having the lap:
        1) to clean up any endo for pain relief 2) if I do move ahead with an IVF to remove a damaged/dilated tube which they can find when they perform the dye test during surgery.

        Am I justified in wanting this surgery or do the risks outweigh the benefits?

        Also, how soon after can one do IVF after a lap?

        Thank you very much,

        Reply
        • Geoffrey Sher says:
          January 7, 2013 at 5:50 pm

          You are fully justified if the surgery is to alleviate pain. However, if it is doen for this reason then ask your surgeon to do a presacral neurectomy to transect the nerves that transmit pain fibres to the pelvis. This help substantially.

          On the other hand, I agree with Dr Saleh that the surgery is likely to do little to enhance your fertility and yes, repeated surgeries can add to the pelvic adhesions and compromise ovarian reserve even further.

          If the main objective is having a baby, then you need IVF but not until you have been fuklly assessed for an immunologic Implantation dysfunction associated with the fact that approximately 1/3 of women with endometriosis (regardless of severity) have activated uterine natural killer cells (NKa) that interfere with embryo implantation (see below).T

          Please go to the home page of 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. “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 and IVF”

          Consider calling 702-699-7437 to arrange a telephone or Skype consultation with me so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sherhttp://haveababy.com/wp-admin/edit-comments.php#comments-form

          Reply
      6. mel says:
        January 7, 2013 at 12:39 pm

        Sorry, I meant HSG not HCG above!

        Reply
      7. Iram says:
        February 8, 2013 at 2:59 am

        Hi,I’m suffering from endometriosis ,I hv gone through 5 IUi and 4 ivf ,Im 36 years old….I need ur advice

        Reply
        • Iram says:
          February 8, 2013 at 3:42 am

          Little background history……
          I never had any any counterceptives,I hv been trying to have baby for 9 years now,I always had painful periods,I had laparoscopy 6 years back which was done by doctor unfortunately who done nothing I had severe endometriosis which was not treated properly,then I had 4 iUis n 2 ivfs which made myt endometriosis more worse …this was all happened in Pakistan ….then I went to middle east country Bahrain where my parents live,there I met a doc who suggested laparoscopic surgery ,I opted for the surgery ,I discovered to hv lots of chocolate cysts,n endo ,my left ovary was infected with endo,after the surgery the doc was hopeful ,he stopped my cycle for 5 months,then again I attempted for 1 more ivf attempt which failed in Pakistan…..got so much deppressed,I thought to make one more attempt in Bahrain…the doctor suggested me hv the final procedure in Dubai ,at conceive by doc Pankaj Shirivastav,I did so,I was satisfied with their treatment,they put me on Gluphage,baby aspirin,Actos for the whole month n ofcorse on family planning medicine,after the embroyo collection,I was put on predesolon ,celexene injections also,egg transfer was on the 5th day as they were blastocyst,they transferred three embroyos,…bt the 4th ivf again failed …..now I do not know what to do….I read a lot about ur success rate,I really want your help I’m down,deppressed bt nt willing to loose hope

          Reply
          • Geoffrey Sher says:
            February 8, 2013 at 1:01 pm

            Hi Iram,

            I really think I can help you. However there are so many things that we should discuss regarding your case that I suggest we have a Skype consultation after I have reviewed your records carefully. Please call 702-699-7437 to set this up.

            First there is the issue of strategically developing an ideal protocol for stimulation (see #’s 1,2 & 3 below). Second there is the fact that IVF cannot be done if you have endometriomas. These must be treated in advance of doing IVF (see 4 &5 below). Then (and I believe this to be the most significant omission in your case), the likelihood that you have an immunologic implantation dysfunction (IID) that occurs in 30% of women with endometriosis, regardless of its severity or grade (see #s 6 & 7 below). .

            Please go to the home page of 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. “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. Endometriosis and IVF”

            5. Sclerotherapy of ovarian Endometriomas”

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

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

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

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

            10. “IVF success: Factors that influence outcome”

            Regards,

            Geoff Sher

            Reply
            • Iram says:
              February 11, 2013 at 3:07 am

              Thanks a lot for your detailed response,I will definitely set up a Skype call soon,in the meanwhile I do think I might be suffering from IiD,is there any test I can do to check if I’m suffering frm this specific disease…If so can u let me know if this test can be done in Pakistan and what is the name of the test,or such test are only done at SIRM

              Reply
      8. mel says:
        February 21, 2013 at 11:14 am

        Dr. Sher,

        Please note that I posed a question above re:laporoscopy, I have decided not to have surgery and have taken your suggestion to be tested for the NK Killer cell. As I live in Europe, I will have the array done with RIA in Californica per your recommenation. However,on the lab requistion paper NK Killer with IVIg test is checked rather than the NK Activity Array.
        I spoke with a biologist at RIA today and she explained that the NK Killer with IVig is more thorough.

        I am perplexed and don’t know what test I should have done.

        Please advise.

        Many thanks

        NB: I am 37, 6 years TTC, endometriosis, hormone imbalance, IVF resulted in ectopic pregnancy, failed FET)

        Reply
      9. mel says:
        February 21, 2013 at 12:10 pm

        Great, thank you. So (forgive my ignorance with all this testing), the array with IVIG will give enough information and the other is not needed?

        Is there anywhere I can find information that will explain the testing more in depth in order to help me gain more understanding.

        Thank you again!

        Reply
      10. mel says:
        March 8, 2013 at 8:51 am

        Hi again Dr Sher,

        So I have my results back from RIA for the NK Killer Assay with IVIG, but am having troubling interpreting the results:

        Basically this is what it says:

        INTERPRETATION:
        Normal NK Cell Activity
        Stimulation with IL-2
        No Suppression with IVIg
        =======================================================

        and

        INTERPRETATION:
        Normal NK Cell Activity
        Stimulation with IL-2
        Suppression with INTRALIPID
        =======================================================

        In a nutshell what does this mean? I think it is the stimulation/suppression piece that has me confused.

        Many thanks for your insight

        Reply
      11. rsham says:
        April 4, 2013 at 12:03 am

        Im 29 yr old Indian female living in Dubai, TTC for 4 yrs and diagnosed with severe endometriosis. The endometriotic cyst in right ovary was removed (incl adhesions) by laproscopy in April 2011 from India.Ovulation study was done after that for 4 months ( with clomid). However, I was not ovulating (lufs) in any of the cycles even with the ovulation trigger injections (ovutrille). Then in November 2011, the cyst recurred in the left ovary. Hormone levels seemed very bad. (FSH – 8.10miu/ml, LH – 3.22miu/ml, ESTRADIOL (E2)- 49.06pg/ML dated 6/11/2011) Doctor put me on Lupride depot for 6 months (injected on 6/11/2011) and he advised me to do ICSI in March. Meanwhile he aspirated my cyst twice in Jan and Feb and had done AMH test on 22/01/2012 and its value was 0.03ng/ml. Since the AMH was very low he didn’t give us much hope. Still, he said we will try and chance was only 5% for getting good egg.

        Started with icsi injections in March, but dropped the cycle due to poor follicle growth (still in lupride).
        We switched to Ayurvedic treatment in India. I was admitted to hospital (on 2/4/2012) to do the treatment for 1 month. I had repeated AMH test after the Ayurvedic treatment and the value was 4.00ng/ml, which was not at all matching with the previous value (0.03). So I did it again from a different lab and the value was 5.10ng/ml.
        I have been taking ayurvedic medicines since April, 2012 and throughout my cyst hasn’t grown (current cyst size is 2.7 X 1.6 cm). As per scan, doc says ovaries are adherent to the uterine margins and not sure of the fallopian tube function. I was not ovulating all these while, however now I have ovulating.

        Now we are consulting Dr. Pankah at Conceive, Dubai. As per labs my AMH is now 1.4ng/ml and IRT is on the border line. So he has put me on Co-Q10, DHEA,Gluphage.

        Planning to do ICSI this month. I really need your help on this. Kindly, advise me.

        Reply
        • Geoffrey Sher says:
          April 4, 2013 at 5:29 am

          Endometriosis can profoundly affect egg/embryo quality as well as implantation potential and Endometriomas must be removed (surgically or through sclerotherapy). Aspiration is inadequate.

          I suggest you read all the articles below carefully and then consider setting up a Skype consultation with me.

          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. “Endometriosis and IVF”

          9. “Ovarian endometriomas”

          10. “Sclerotherapy of ovarian endometriomas”

          11. “Staggered IVF”

          12. “Embryo Banking”

          11. “Egg Donation”

          Consider calling 702-699-7437 today 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
      12. suzy says:
        May 15, 2013 at 12:58 am

        that’s interesting about endometrioma removal. My specialist aspirated one of mine at egg retrieval, threw in some antibiotics and then didn’t mention it again. They obviously don’t think they are an issue? (But then they dont test for killer cell dysfunction either in New Zealand).

        Reply

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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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      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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      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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      Case Study: Pelvic Tuberculosis, Hypothyroidism, and Immune Implantation Dysfunction
      About 18 months ago I saw an Asian Indian couple who presented with a very interesting history. The female partner (whom I will refer to as DB) had regular menstrual cycles and normal ovarian reserve, was ovulating regularly and had a fertile male pa... more
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      Dear Dr. Sher: A Healthy Baby Followed by Multiple Miscarriages
      This is the second in a series of posts taken from questions that have been submitted to me via email, website, or discussion boards.  This question is from a patient who had a healthy baby from her first pregnancy, but then went through a period of... 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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