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      • My IVF Cycle Failed – What Went Wrong? Question #19: Why Do I Keep Having Chemical Pregnancies and Miscarrying?

      Dr. Geoffrey Sher Recommends

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      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 embryo abnormalities which are usually (but not invariably) related to chromosomal irregularities (aneuploidy). These most commonly result from the egg being abnormal, rather than the sperm. In the remaining 20-30% of cases, the cause is dysfunctional implantation which can result from anatomical (lining), immunologic, or molecular biochemical abnormalities.

      Since egg and embryo aneuploidy occur so frequently as a component of normal reproductive performance, it follows that early pregnancy loss is likewise a part of normal reproductive performance. Moreover, since chromosomal irregularities of the egg increase with age, embryo aneuploidy will likewise increase correspondingly as the woman gets older. The fact is that even in young women, at least 20% of embryos are lost due to implantation dysfunction. Depending upon how early this occurs, it would manifest as either a chemical pregnancy (a positive pregnancy test without ultrasound evidence of a developing conceptus) or later as a miscarriage (loss of an established pregnancy).

      Furthermore, the incidence of early pregnancy loss rises dramatically as women age beyond 40 years, such that by the mid 40’s it can be greater than 50%. Such chromosomal early pregnancy losses occur sporadically, so that a woman might have a baby, lose one or two, and then have another healthy pregnancy. In other words, they rarely occur repeatedly.

      In contrast, early pregnancy loss due to implantation dysfunction (i.e., a non-receptive uterus) tends to be recurrent because unless treated successfully, the cause of the miscarriage remains ever present. In summary, while miscarriages most commonly occur as a result of chromosomal embryo abnormalities, these rarely present as recurrent losses (more than 2 in a row). Thus, when they do, it is important to rule out embryo implantation problems before proceeding to another IVF attempt.

      Women who experience repeated IVF failures thus need to be evaluated thoroughly for both embryo competency and implantation dysfunction before and/or in the course of their next IVF attempt. Implantation problems should be evaluated before proceeding to the next IVF cycle. The tests needed include:

      1. Evaluation of the anatomical integrity of the uterus. This necessitates performance of a sonohysterogram (saline sonogram), a hysteroscopy or a pelvic MRI (rarely is it necessary to go this far). A hysterosalpingogram (HSG), also known as a Dye X-ray, is inadequate because it involves injecting a radio opaque substance into the uterine cavity which can obscure small lesions due to scarring, polyps or fibroids protruding into the uterine cavity.
      2. Assessment of endometrial thickness. This can be determined by ultrasound examination around the time of normal ovulation or can be determined based on endometrial thickness as measured in previous cycle. A lining of greater than 9mm in thickness is ideal. Less than 8mm is poor and between 8 – 9mm in thickness is intermediate. In my opinion, embryos should not be transferred into a uterus where the lining measures less than 8mm. The administration of vaginal Viagra (sildenafil) suppositories for at least 72 hours prior to the hCG trigger will often dramatically improve a “thin lining”.
      3. Autoimmune and alloimmune causes of immunologic implantation dysfunction should be assessed. Since both types are ultimately linked to Natural Killer Cell activation, you can start by doing a Natural Killer Cell activity (NKa) test using the K562 target cell test and only proceed to more detailed evaluations if this turns out to be abnormal. Read my prior post on immunologic factors that affect implantation and immunotherapy that can reverse such problems.
      4. Testing of molecular and biochemical factors in the endometrium. There has been a growing interest in measurement of various endometrial biochemical and molecular factors as a method to assess implantation potential. Frankly, I personally do not share enthusiasm for such tests because to my knowledge there is little concrete evidence of efficacy. Besides, treatment of suggested abnormalities remains obscure and unproven.

      Recent advances in egg and embryo karyotyping (chromosome testing) using Comparative Genomic Hybridization (CGH) and related technologies have markedly improved our ability to identify “competent” chromosomally normal embryos for transfer. This requires biopsying the egg or the embryo and testing the DNA using CGH. When the embryo is tested, a biopsy can be done on either day 3 or day 5 (blastocyst stage). Whether it is done on day 3 or day 5, embryo transfer must be deferred until a subsequent treatment cycle (Staggered-IVF) so as to allow enough time for the results of the testing to become available. In such cases, the embryos can be frozen via vitrification (ultra rapid freezing) and stored for subsequent dispensation.

      Aside from the above, there are other far less common causes of embryo incompetency (e.g., unbalanced embryo chromosomal translocations) and implantation dysfunction (bacterial and parasitic infections, etc.).

      There is nothing more stressful to patients and to caring physicians than dealing with repeated early pregnancy losses following IVF. There is also no greater imperative than to carefully identify the underlying cause, without which successful treatment is far less likely.

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      18 Responses to “My IVF Cycle Failed – What Went Wrong? Question #19: Why Do I Keep Having Chemical Pregnancies and Miscarrying?”

      1. kjk says:
        September 23, 2011 at 2:00 pm

        Hi Dr. Sher,

        I'm 31 yrs old and have had 5 failed IVFs (3 fresh, 2 FET) with history of recurrent pregnancy loss and biochemical pregnancy. 3 confirmed pregnancies via ultrasound including 1 heartbeat were all on my own(before 8 weeks). 2 biochemicals were with IVF, 1 on my own.

        I'm being treated for immune issues-have used intralipid treatments and now being treated with Neupogen, thrombophilia issues with Lovenox and uterine lining issues with Viagra, Neupogen, Metformin.
        In two years, I've transferred over 8 grade AA blasts and a couple of grade AB blasts. My lining is always grade A triple layered but always between 8-9 mm. In between cycles I've had hysteroscopies and most recently I had a Laporoscopy to investigate the uterus and endometriosis. That provided to be conclusinve with some mild abdominal scarring from a past surgery and less than mild endometriosis to be of no concern. I've also had 4 D&Cs.;

        I'm being told that I produce great quality embryos and that my lining is ideal but not perfect because of the thickness.

        Do you find a need in testing the embryos with CGH to rule out unknown chromosome issues, an endometrial biopsy to test for bacterias, further study of my uterine cavity? I'm literally at a loss.

        Thank you for your time.

        Reply
      2. Geoffrey Sher, MD says:
        September 23, 2011 at 4:18 pm

        Hi kjk,

        Your case is very interesting. I might be able to help!

        Something is being overlooked here. It sounds like a complex implantation dysfunction. We should discuss! Please call 800-780-7437 or 702-281-7437 and set up a telephone consultation.

        In the meanwhile please read the articles posted on this site relating to: 1. An Individualized approach to ovarian stimulation for IVF; 2) IVF success: Factors affecting outcome; 3) Immunology (posted on May 10th and on May 16th 2011 and 4) Staggered IV.

        I look forward to talking to you.

        Geoff Sher

        Reply
      3. Ravi says:
        May 24, 2012 at 3:34 am

        Dr Sher my DQ alpha genotype is 0301,0505 and my husband’s is 0401,0501
        Do we have a 50 percent match?

        Reply
        • admin says:
          May 24, 2012 at 4:17 am

          There the 0505 and O501 DQ alphas match (4,1). Thus this is a partial DQ alpha match which is only significant if, in addition the NK test (K-562 target cell test) shows activation.

          Please read the article I posted on May 10th, 2011 elsewhere on this blog.

          Geoff Sher
          800-780-7437

          Reply
      4. Marcia says:
        July 22, 2012 at 11:00 pm

        Hello Dr. Sher,

        I have PCOS and am currently 34yo. My husband and I had a Fresh IVF when I was 30. We have had (1) Fresh Cycle that resulted in a blighted ovum at 8wks and (1) frozen cycle that resulted in a chemical pregnancy at 6wks.

        We have 3 frozen embryo’s remaining and are trying to decide which option would be the best at acquiring the family we so desire. Should we do another frozen cycle with me as the carrier, have a friend of ours carry w/ our frozen embryo’s, or should we do a cycle with donated embryo’s.

        Which do you feel would give us the best outcome? And, what do you feel may be the reason for my recurrent losses?

        Thanks in advance!
        Marcia

        Reply
        • Geoffrey Sher says:
          July 23, 2012 at 5:16 pm

          First, you need to be evaluated for an implantation dysfunction: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.

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

          Geoff Sher

          702-892-9696

          Reply
      5. P says:
        August 30, 2012 at 10:16 am

        Dear Dr Sher,
        I have had 4 early pregnancy losses and after some general testing my RE concluded that there is no problem on general blood, genetic, sperm, uterin cavity testings and that the issue is probably the quality of my egg. He put me on clomid for one cycle and now suggests that I do injections for super ovulation with IUI. I am relatively fertile as shown by my 4 losses in the last 9 months (all losses biochemical between week 4 and 6). My immunologist (who I saw for hives I get during these pregnancies) ran a more comprehensive test and found I have anticardiolipin IgM of 45 and prolonged ATPP test but no antilupus antico antibody. My immunologist diagnosed me with APS and said I should go on heparin as soon as I have a positive test. My RE is not worried about this and thinks I should only take baby aspirin (I was on baby aspirin during two losses). I have postponed the injectable cycle for this month as I didn’t feel confident that my RE has a proper game plan to keep me pregnant should it occur and didn’t want to spend 5000 dollars just to have another biochemical pregnancy. I know you can’t diagnose me without seeing and testing but unfortunately I am in Canada and would love to hear your advice on what to do. I feel like I need a second opinion on this.
        Thank you in advance for your help!

        Reply
      6. Kerri says:
        March 6, 2013 at 7:45 pm

        Dr Sher,
        I am newly 40 and have just had a chemical pregnancy from a FET of an array CGH tested 5 day normal embryo. I have been pregnant twice before, once from our first IUI at 37 (miscarried 7w3d after intermittent heartbeat), and once about 6 months ago from a surprise natural pregnancy (D&C revealed triploidy) Following the first miscarraige and subsequent failed IUI’s an office hysteroscopy revealed both endometritis and a slight uterine septum. The RE attempted to resect the septum but was unable to do so. She left it intact believing it was too slight to make a difference. I had one failed fresh IVF with an antagonist protocol (9 eggs retrieved, 6 fertilized, transferred three 8,7, and 6 cell embryos, none to freeze) Following the failed cycle, I did both the Endometrial Function Test through Yale and the E-tegrity test (to test for Beta- 3 inhibin). Both revealed normal uterine receptivity, but the EFT showed continued presence of endometritis. We moved on to a new RE, who was insistent on and successful with resecting the septum and clearing up the endometritis.

        My FSH when we started at 37 was 6 and was actually 3.4 about 6 months ago (thought this was a 1 day not 3 day fSH level) My AMH was 3.21 when we started and 2.02 about 6 months ago. I am also positive for MTHFR for one copy of C677T mutation and one copy of the A129C mutation.(treated with Lovenox and extra folgard) After my most recent pregnancy, we attempted an IVF with Follistim and bravelle but I only produced 4 follicles (despite an AFC of 36) so we converted to IUI. We tried a modified Cornell Estrogen priming protocol (Microdose Lupron, Gonal F, Menopur) for this most recent IVF and I did much better (21 eggs retrieved, 16 mature, 9 fertilized, 7 made it to blast) Of those, only 1 was CGH normal. My lining was triple stripe. My RE believes its possible that the embryo was compromised due to the biopsy and this may be why it didn’t survive beyond implantation.

        At this point, we plan to try the Estrogen Priming Protocol again since I responded so well and hope for at least one more normal embryo. Do you agree with my RE’s guess that the stress of the biopsy was too much for my embryo? Are we missing something? Would you recommend a different protocol to improve egg quality? While I got a lot of eggs, it doesn’t make sense that they were so poor given my normal FSH range. Do we need to switch to donor eggs since we only had one CGH normal embryo? Any ideas would be much appreciated!

        Reply
        • Geoffrey Sher says:
          March 6, 2013 at 9:56 pm

          We really do need to talk. I suggest strongly 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) with me so we can discuss your case in detail.
          Geoff Sher

          Reply
      7. G says:
        April 3, 2013 at 10:53 am

        I am quickly approaching 42 years old, have 3 children with out issue on 1st attempt(at 33, 35, 39) and have had 3 chemical pregnancies in the past 7 month, again on 1st attempt to get pregnant. I took progesterone suppositories from CD21 for the second one, and baby aspirin & folgaurd for entire cycle + progesterone at day 27 for the most recent one, but all have lasted only to 4 – 4/12 weeks along. I felt early pregnancy symptoms with all 3. My cycles are typically 26-27 days, and ovulation (OPK, cervical mucus &BBT) is usually between CD 12-13. I frequently have strong ovulation cramps. My menses is usually very heavy, with clots,and strong cramping and occasionally spotting before & after. My husband & I had genetic karyotyping done, and rpl panel by my ob. I have the C MTHFR mutation, but my homocysteine levels were normal. I had one test of anticardiolipin that was 13, but a repeat 6 weeks later was negative. ANA, & thyroid antibodies were normal. A sonogram to detect 1st chemical pregnancy showed endometrial linig 11mm. I have had polyps & fibroids in the past (small) & my Ob/gyn has suggested in past adenomyosis? We do not want to do IUI or IVF, & would like to know if we have overlooked something that may not be related to egg quality. Thank you.

        Reply
        • Geoffrey Sher says:
          April 3, 2013 at 1:36 pm

          Absolutely you have overlooked 2 things. The first is the effect of age on egg/embryo quality and the need accordingly to individualize ovarian stimulation protocols. Second the issue of possible implantation dysfunction (see below.

          I think I can help but you would need to communicate with me .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 meanwhile, 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. “Staggered IVF”

          10.“Embryo Banking”

          11. “Egg Donation”

          Geoff Sher

          Reply
      8. Nikki says:
        April 5, 2013 at 9:32 pm

        I was diagnosed with PCOS when I was 17 years old. I am now 27.. my husband and I have been trying to have a baby for a couple years now. I have been on chlomid 50mg 1 daily from days 3-7 of my cycle. my husband has frequent sperm analysis done and his sperm is perfectly fine. My periods were never regular and my infertility doctor prescribed me PROMETRIUM to induce a period.. It worked but my cycles were so long. So I decided to stop that and I started acupuncture August 2012 to present. It regulates my period and I begin getting positive ovulation tests. So to our surprise, the month I didn’t take chlomid I conceived. :)

        In February I had a Positive pregnancy test .. Then then miscarried at 4w6days due to a chemical pregnancy . I ja an U/S and A sac wasn’t found and I didn’t have a tubal… we are very heartbroken. we want to try again right away but my husband works away from home .. So it’s even hard for him to be home when he needs to be. My fertility doc has now increased my chlomid to 2 pills daily ( 50 mg per pill) and we are thinking of doing IUI and freezing my husbands sperm so it can be used when he’s not home. I’m not sure if we need to go this route or not??????

        I’ve had HSG often.. Everything looks fine.. I get ultrasounds for antral follicule count every couple months and blood work every month to see if I’ve ovulated.

        It’s been very stressful and we are hoping to become pregnant right away without having a miscarriage again. what do you think is the best idea for us where he works away from home. I’ve heard frozen sperm isn’t as good as the fresh sample for IUI.

        any advice is appreciated . Also, do u suggest metformin? I’ve read up about it.

        Thanks so much
        Nikki

        Reply
        • Geoffrey Sher says:
          April 6, 2013 at 8:42 am

          I think you are doing what you need to do right now. However, if this is not successful you might need to consider IVF. See below.

          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. “PCOS”

          4. “Intrauterine insemination”

          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. “Clomiphene Stimulation”

          Good luck,

          Geoff Sher

          Reply
      9. Anna says:
        May 3, 2013 at 2:32 pm

        Dear Dr. Sher,
        I have been reading all your comments and am hoping you can give me some insight in my situation.
        10 yrs ttc
        4 iui’s failed
        1st IVF 5 eggs retrieved, 2 transferred on day 3
        beta #1 30 bleeding started day after-chemical
        1 frozen blast transferred-bfn!
        IVF #2 7 eggs retrieved 2 transferred on day 3
        beta #1 50 bleeding started same day-chemical
        1 frozen blast – bfn
        Ivf #3 5 eggs retrieved 2 transferred on day 3
        beta#1 39 bleeding next day-chemical
        no frozen
        My Re says its a matter of finding the right embryo and wants us to start IVF#5. I am so confused…
        We used Lupron Gonal F menopur and estrace progesterone suppositories and baby aspirin each time and the last cycle we added Lovenox and prednisolone.my lining is always above 10 and the embryos we transfer are always great quality. The last IVF being of excellent quality. So what is going on? Or is it actually just a matter of finding the right egg? I am 31 and have always had regular periods altho light but have never gotten pregnant on my own.

        Reply
        • Geoffrey Sher says:
          May 4, 2013 at 10:34 am

          This is HIGHLY suspicious of an embryo implantation dysfunction. 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. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

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

          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
      10. Isla says:
        May 5, 2013 at 9:43 pm

        Hi Dr Sher.
        I am nearly 33 years old and I am beginning to get very desperate.
        I have had 17 failed embryo transfers from 3 egg collections as well as 2 iui.. 6 of these embryos were from a pgd cycle so we know they were good quality. I have had hcg and progesterone with each cycle as well as clexane to thin the blood and prednisolone. I have had 6 chemical pregnancies and one ectopic treated with methotrexate. Each time I am pregnant I get a clear fluid discharge, no odor, not thrush from 3 days post transfer until when I get my period. No one seems to know what this is but I suspect this might help to figure out what is wrong. I am generally healthy in the normal weight range, no alcohol, smoking, minimal caffeine. Have also had acupuncture as well as Chinese herbs. I have a past history of mild asthma and graves disease with stable path for the last few years on ptu one tablet every 3 days. Laparoscopy revealed mild endometriosis which was removed from pouch of Douglas. I am emailing from Australia as I just don’t know what else to do. We have spend close to $100,000 on treatment and still have four embryos remaining from the last collection. I would be very grateful for your opinion :(
        Isla.

        Reply
        • Geoffrey Sher says:
          May 6, 2013 at 9:01 am

          Hi Isla,

          Yours Please go to the home page of 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. “Endometriosis”

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

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

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

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

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

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

          Geoff Sher

          is a textbook example of what most likely is an “implantation dysfunction.

          Reply

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      Understanding Immunologic Implantation Dysfunction Part 2: A Rational Basis for Selective Intralipid & IVIg Immunotherapy in IVF
      ALLOIMMUNE VS. AUTOIMMUNE DYSFUNCTION Alloimmune Implantation Dysfunction Every human being has two DQ-alpha genes. One is contributed by the father and the other by the mother. In a small percentage of patients undergoing IVF, paternal-maternal DQ-a... more
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      Understanding Immunologic Implantation Dysfunction Part 1: Setting the Stage for Selective Immunotherapy with Intralipid and IVIg
      It is an unfortunate reality that many IVF programs attach little importance to factors that affect embryo implantation in general, and immunologic implantation dysfunction (IID) in specific (see below). Perhaps the lack of attention given to evaluat... more
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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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      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 #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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