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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?

      Dr. Geoffrey Sher Recommends

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      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. Nowhere is this concept more apparent than when it comes to IVF.

      Most of the factors that affect IVF outcome are not even properly defined as yet, let alone solutions having been found. Thus, when confronted with IVF failures, it is important for patients to have a working knowledge of the factors that influence outcome.

      I like to equate successful IVF with what happens when a seed is planted in soil; a good outcome is predicated on a “competent” seed being planted in a receptive soil. With IVF, the seed is the embryo, and the soil is the uterine lining. It follows that the transfer of a good quality embryo into a non-receptive uterine lining, or an “incompetent” embryo transferred to a receptive uterus won’t yield a successful outcome. Thus, the variables that influence IVF outcome are those that influence egg/embryo “competence” and those that affect endometrial receptivity. And when IVF fails, it is almost always due to one or more such variables being abnormal.

      It so happens that in at least 70-80% of cases, it is embryo “competence” (the seed) that will determine IVF outcome. In the remaining 20-30% of cases, it is endometrial receptivity. IVF failure will manifest as failed fertilization, arrested embryo development, failed implantation or pregnancy loss (early or late).

      Research has shown that the majority of eggs are chromosomally abnormal (aneuploid) from the get-go, and are thus “incompetent”. Such eggs will invariably produce incompetent embryos that cannot propagate a healthy pregnancy. As women get older, the incidence of egg aneuploidy increases dramatically from about 1 in 2 in younger women (under 35) up to at least 9 out of 10 by the mid 40’s. That is precisely why it becomes more difficult to conceive with advancing age and why the miscarriage rate also increases correspondingly.

      Outside of the effect of age, the protocol of ovarian stimulation can also impact egg “competence”. Older women (over 39 years), women with diminished ovarian reserve, and women with polycystic ovarian syndrome (PCOS) tend to have high biological Luteinizing Hormone (LH) activity which results in increased ovarian male hormone (androgen) production. This can compromise egg development and increase the risk of aneuploidy, and thus negatively impact reproductive performance. That is precisely why it is so important to minimize this LH/androgen effect by individualizing the protocol of ovarian stimulation in such cases, and to time the administration of hCG precisely.

      When it comes to implantation dysfunction there are primarily 3 factors to be considered. The first is the anatomical integrity of the uterine cavity. In other words, there should be no surface lesions protruding through the endometrial lining. Such lesions (polyps, scarring, fibroids) will create a local reaction that will compromise embryo implantation.

      The second is that the uterine lining must be thick enough to allow for adequate proliferation of the embryo’s root system. Linings thinner than 9 mm at the time of egg retrieval (or at the initiation of progesterone administration in embryo recipient cycles) are suboptimal, and an endometrial thickness of < 8 mm is grossly inadequate. Personally, I do not even transfer embryos in such cases, preferring to freeze and bank them for future dispensation at a time that the uterine lining has been restored through hormonal therapy and vaginal Viagra suppositories.

      Third and finally, there is the issue of immunologic acceptance by the endometrium of the implanting embryo. Details regarding immunologic implantation dysfunction can be found elsewhere on this site.

      Hopefully, the above information will explain why and how IVF fails and indeed also how it is possible to experience several failures in a row without necessarily anything having been done wrong. But when this happens it is important to evaluate and address all the disparate variables that can affect egg/embryo “competence” and uterine receptivity before moving to another attempt. Simply stated, the time to stop IVF is when there is no remediable explanation for failure.

      The most distressing of all is when patients are encouraged to just simply keep on trying until IVF becomes successful. It is almost unconscionable for doctors to lead patients on in this way. Unfortunately, as an example, due to either arrogance or ignorance, a patient will be told by a doctor that he/she simply does not believe in immunologic factors as being influential in IVF outcome.

      My advice in such cases is to respectfully request that the physician describe the workings of implantation immunology and then explain what it is about the concept of immunologic implantation dysfunction that he/she disagrees with. Most will not be able to do so for a simple reason – namely that reproductive immunology is a highly complex subject, possibly being even more complex than ART itself – and most reproductive endocrinologists do not take the time to understand it properly, preferring to present platitudes rather than solutions.

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      27 Responses to “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?”

      1. MKRoberts says:
        September 7, 2011 at 6:33 pm

        I'm getting ready to start my 2nd cycle of IVF in November. My RE has a great success rate 65%, but unfortunately I landed in the 35%. Anyhow, I'm 29 with mild endo and husband (28) has 6% morphology (Kruger strict). We tried a ganirelex antagonist protocol. 24 eggs retrieved, 20 mature, 17 fertilized with ICSI, none made it to blasts or froze and they had significant fragmentation. We transferred 2 day 5 morulas and obviously this didn't work. We are switching to a long lupron protocol and my RE is looking into using a bromocriptine-rebound cycle as well. I feel like after having 17 embryos fail to make it to blast, we are pretty hopeless. What do you think?

        Thanks for any input!
        MK

        Reply
      2. Chickachick says:
        September 8, 2011 at 12:37 pm

        Dear Dr. Sher – I really appreciate your blog. I'm one of those 40+ women who has lots of technical questions and your blog answers many. When we get to the ivf phase of our journey, I will definitely keep your practice in mind. Thanks for the straight talk. :)

        Reply
      3. Geoffrey Sher, MD says:
        September 8, 2011 at 12:55 pm

        You are very kind!

        Thank you so much!

        Geoff Sher

        Reply
      4. brooke says:
        September 9, 2011 at 1:43 pm

        …"The most distressing of all is when patients are encouraged to just simply keep on trying until IVF becomes successful. It is almost unconscionable for doctors to lead patients on in this way. Unfortunately, as an example, due to either arrogance or ignorance, a patient will be told by a doctor that he/she simply does not believe in immunologic factors as being influential in IVF outcome…"
        Ummmmm were you sitting in my RE's office recording what she said to us after our 3rd, 4th and 5th pregnancy loss between 3.5-5 weeks??
        This is exactly why I called Dr. Peters and will only proceed with SIRM from here on out- I was simply disgusted by my RE's ignorance AND arrogance.

        Reply
      5. Geoffrey Sher, MD says:
        September 9, 2011 at 3:54 pm

        What can I say except thanks for sharing!

        Geoff Sher

        Reply
      6. HopefullHubby says:
        November 27, 2012 at 10:08 pm

        Hello Dr ,
        During Egg Retrival : endometrial thickness of 8.5MM

        11/09 : ET Done

        11/18 : 1st Beta HCG : 86
        The morning of the 1st Beta we took a HPT and it came back Negative.

        11/20 : 2nd Beta HCG : 218
        The morning of the 2nd Beta we took a HPT and it came back Positive.

        11/26 : 3rd Beta was 6 days from the 2nd Beta : 2385
        UltraSound done and we didnt see an Gestational Sac.
        The docs requested for another Ultra Sound from another centre and also briefed us about ectopic pregnency , we went there in the evening and same result , there was no gestational SAC inside or outside the uterine walls.

        11/26 : Black Discharge along with some blood during the night , a little heavier than spotting and lower than periods.No pain or cramping any where , discomfort due to ultrasound scan though.

        11/27 : 4th Beta was 7days from the 2nd Beta : 2024 .

        No clue whats going on !

        Is this a Chemical pregnency , Can it be Ectopic …can it be determined this early ?

        Is a Reduced Beta mean that it was not Ectopic and we have lost the pregnency ?

        Reply
        • Geoffrey Sher says:
          November 28, 2012 at 7:37 pm

          It could be either a chemical pregnancy or a tubal (ectopic pregnancy). You need to be on the lookout for sudden abdominal pain, Rt shoulder tip pain and light headedness. Your beta should be repeated every 2-4 days to make sure it is dropping and only when it is zero can you be complacent. Your Re should repeat an examination and ultrasound in a week.

          Please keep me in the loop!

          Good luck and G-d bless

          Geoff Sher

          My next webinar in about 1 week will be on this very topic. Go to the home page of http://www.haveababy.com and sign up for it. It will be enlightening …I promise.

          Geoff Sher

          Reply
      7. pinky says:
        December 9, 2012 at 4:10 pm

        Hello my name is merry and i had a failed ivf cycle. My age is 40 years and i had 4 follicles good size 15mm, 16mm, 16mm, 17mm and the other 7 smaller size follicles. My doctor gave me 350 units of gondal F for 13 days and on 13th day i had ultrascan and my follicles were sizes, 15, 16, 16 and 17mm. my doctor told to take an extra day of gondal F so that my follicle size increases, but after taking one more day they did not increase. My nurse told to take another day gonadal F because the doctor is not available on sunday for egg retrival. So i took another day gonadal F. finally i took 2 days extra Gonadal F with out increasing the size of the follicles. Ultimately my embryos arrested on day 4, so failed ivf. can you please tell me what is the reason for the failure of ivf

        Reply
        • Geoffrey Sher says:
          December 9, 2012 at 11:06 pm

          It seems clear that you have diminished ovarian reserve. In such cases the use of a very strategic and individualized protocol of stimulation is central to proper egg development. Remember, ultimately it is mostly egg quality that determines embryo “competency”.

          Go to the home page on this blog and from there (via the search bar), find the article I wrote on November 22nd 20o10 entitled “An Individualized Approach to Ovarian Stimulation for IVF”.

          If you wish, call 800-780-7437 and set up a telephone or Skype consultation with me so we can discuss your case in detail.

          Geoff Sher

          Reply
          • pinky says:
            December 10, 2012 at 7:03 pm

            Hello doctor sher,
            I can not do skype consultation or on telophone because I live in Australia. My actual age is 41.6 years. I am thinking to go for second IVF cycle. please give me your advice whether to do second ivf cycle or not.
            I am a pcos patient with thin BMI is 22.5 regular menstrual cycle. i am on metformin 1000mg per day. regular ovaluation cycles. I am trying to concieve from the past 2 1/2 years only. I found my partner very late in my life. I concieved naturally last year but miscarried at 6 weeks.
            can you give your advice to go for second ivf or just try naturally.

            Reply
            • Geoffrey Sher says:
              December 10, 2012 at 9:29 pm

              Sorry Pinky,

              I simply do not know enough about your case to advise you whether to try again.

              However, if you were here, I would probably recommend “Staggered IVF” with “embryo banking” as an option. See below!

              Go to http://www.IVFauthority.com and when you get to the home page find the “search bar”, type in the following subjects into the bar 1. “Staggered IVF” 2. “Embryo Banking” and “Egg Donation”.

              Geoff Sher

              Reply
      8. Hopeful says:
        February 8, 2013 at 10:16 am

        Hello Dr Sher
        Thanks for the very informative sessions. Just went through our 6th failed ivf cycle. At the 4th cycle after pgd (and after switching clinics and RE) we found derangement in all the embryos. We didn’t do a transfer in this cycle as we opted for the first time to try to go to blastocysts. All embryos arrested. The RE suggested that it is a sperm issue considering that we had to do a TESE each cycle. For the 5th and 6th cycle we used donor sperm. I did all test possible including HSG, laparoscopy, all blood tests seem within range, healthy uterus etc. However the RE is bewildered as although we do have good looking blasts at day 5 / 6 with good grades, these blasts grow at an irregular progression. It got explained to us that some of the embryos look as if they arrest in day 2 or day 3 and then all of a sudden pick up speed and make up for lost time. And for this to happen twice in a row we think it is more than a coincidence. Have you encountered anything like this? For the last cycle we put in 3 grade A blasts. We have another 3 blasts frozen which we have sent for CGH but this is going to be purely a diagnostic test. At a loss what to think. I’m at 32 years old. Could it be an egg issue? Our RE does not believe that it has to do with immunological issues even though I have not tested for them. Looking forward to receive your insight. Thanks

        Reply
        • Geoffrey Sher says:
          February 8, 2013 at 1:08 pm

          At 32Y it is unlikely that you have an egg issue. Also (subject to a thorough review of your husband’s sperm parameters and an SCSA (see the article on SCSA elsewhere on this blog) that using your husband’s sperm should be off limits. To me the focus should be on the protocol for ovarian stimulation.

          Indeed, sometimes embryos that develop slowly in the first 2-3 days suddenly take off and develop to blastocysts but in my experience if such blastocysts are derived from day 3 embryos that were <5 cells divided, they do not do well and are often aneuploid. The blastocyst CGH tests being done will be very revealing in this regard.

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

          5. “IVF success: Factors that influence outcome”

          6. “Staggered IVF”

          7.“Embryo Banking”

          Consider calling 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.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
      9. Palak says:
        February 11, 2013 at 7:22 am

        Dear Dr.Sher,
        My age is 29 and My husband is 31. We are trying to conceive for more than 2 years. I had 2 failed IUI with clomid. With one IUI, I got pregnant but it was diagnosed as ectopic pregnancy. My husband’s morphology is only 1% and so we tried to do 1 fresh IVF cycle, which also failed. My doctor has transferred 1 blastocyst embryo on 5th day of grade 3AA. We still have 1 frozen 6 day embryo. I am going to schedule an appointment with my doctor. But I need your opinion about what points I should discuss with my doctor. What could be the reason for failure of my 1st IVF. My doctor also did Saline sonogram and Hystroscopy to see into my uterus and the report was normal. Even I have hsg done which sows my tubes are open. Please suggest me what other test I should do before going to frozen embryo transfer.
        Thank You,
        Palak Shah

        Reply
        • Geoffrey Sher says:
          February 11, 2013 at 9:49 am

          tHANK YOU!

          The chance of a baby,with 1 blastocyst (not-genetically tested), even at your age is only about 1:3. You therefore may just have been unlucky.

          Contact me with the FET outcome.

          Good luck!

          Geoff Sher

          Reply
      10. Sarah says:
        February 13, 2013 at 6:53 pm

        Dr. Sher,

        We would like to get your opinion on what to do next. My husband and I have been trying to get pregnant for the last 2.5 years. I am 34 and my husband is 35. All tests and bloodwork to date have been normal (HSG, saline sono, AMH, sperm analysis and DNA fragmentation). We’ve had 4 failed IUIs. We just completed our first IVF cycle (12 eggs – 7 fertilized by ICSI, 4 fertilized naturally). We transferred 1 blast and froze 2 more. The result was negative. Given that we have never had a positive pregnancy test should we look into implantation disorder or just go ahead with FET?

        Thank you.

        Reply
        • Geoffrey Sher says:
          February 13, 2013 at 7:15 pm

          I am so impressed with the manner in which patients are wising up. Clearly if it is not likely to be the embryo it most likely is endometrial receptivity, i.e., endometrial thickness , uterine cavity contour or immunologic implantation factors. My bet is that it is the latter. I think you might benefit from my input so I invite you to call 800-780-7437 or 702-699-7437 to arrange a Skype (or telephone) consultation (free of charge to those who reside in the United States or Canada) 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.

          In the interim go to http://www.IVFauthority.com . When you get to home page, 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”

          I look forward to helping you in your quest to have a baby.

          Geoff Sher

          Reply
      11. Cristina Berna says:
        February 19, 2013 at 6:58 am

        Dear Dr. Sher,

        I love all the complete information you give.
        I am 41.10 months. I have multifollicular condition, never had issuses with my ovaries, still regular period, thick lining in uterus.
        IVF # 1 failed transfer. 8 embryos tested array cgh. Biopsy on DAY 3 after fertilization.RE says biopsy on polar body of egg( I don´t understand if after fertilization it is an embryo not an egg?)
        Should I go next time for a more individualized protocol with mild IVF instead?

        Reply
        • Geoffrey Sher says:
          February 19, 2013 at 10:18 am

          Of course (for reasons described in this blog) the method of ovarian stimulation used is an important consideration…especially in older women and those with diminished ovarian reserve. However, failure to succeed following the transfer of chromosomally normal embryos (CGH-tested) is a definitive indication to look for a possible implantation dysfunction (often immunologic). 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. “Staggered IVF”

          10.“Embryo Banking”

          You should seriously consider calling 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.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
          • Cristina Berna says:
            February 19, 2013 at 1:00 pm

            Dr. Sher,

            Thank you so much for your quick answer!!!
            I didn´t write all the details properly. The transfer didn´t happen because they told me all embryos had chromosomal abnormalities. Apparently a biopsy was performed on a polar body on the embryo on day 3, retrieving only maternal DNA, and an array cgh was performed. On the basis of the results the embryos were discarded. I am trying to get information about the test and the results so far without any luck.
            Without the information I feel very uncertain. May I call you next week? is there any time more convenient for you? I am currently living in Madrid but in July will be moving to NYC.
            Thank you again for your kindness!!!

            Reply
            • Geoffrey Sher says:
              February 19, 2013 at 4:23 pm

              Consider calling 8702-699-7437 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 Sher

              Reply
      12. Stephanie says:
        February 25, 2013 at 8:33 pm

        Dear Dr. Sher, this is the most informative website in this area I have found. Thank you so much. I was wondering if you think I could have an egg quality issue based on these 1st IVF failure stats:

        Age – 35, DH – 33
        Sperm normal, all my tests came back normal except elevated TSH and disagreement if I might have sublinical PCOS (all my blood glucose came back normal.

        Was on BCP for a month, ending with crossover Lupron
        75IU of Follistem, 75IU of Menopur, 5 ml Lupron

        Triggered when had 2 mature follicles, 8 at 16, 1 at 14

        13 eggs retrieved, 12 fertilized, 2 (early stage) blastocysts (were supposed to be further along by day 5), said 1/2 day behind were transferred BFN.

        Nothing to freeze…

        Just wondering what this could be possibly pointing too…

        thx so much for your perspective

        Reply
        • Geoffrey Sher says:
          February 26, 2013 at 6:44 am

          Of course, the protocol of stimulation is central to any IVF cycle and even all the more so if you indeed have PCOS. Another important consideration is whether you are on course to develop hypothyroidism because in most cases this condition is due to an autoimmune cause. And in such cases, regardless of vwhether there is or is not manifest clinical hypothyroidism, about 50% will also have a concommitant immunologic implantation problem linked to NK cell activation.

          isPlease 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. “Thyroid Autoimmune disese and IVF”

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

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

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

          7. “IVF success: Factors that influence outcome”

          If for any reason this cycle does not pan out for you, you might consider calling 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.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
      13. Sharon says:
        March 5, 2013 at 1:42 pm

        Hi Dr Sher

        I just came across your website and have spent hours reading through it, it’s excellent and full of information. Thank you.

        I would be grateful if you could advise on my situation

        Age of myself and husband 31
        AMH 10, on Eltroxin and Metformin (due to high HBA1C – dont have PCOS). Sperm normal apart from 45% motility, DNA fragmentation 20%

        ICSI #1, Long protocol, 300 Gonal F with Luveris, 9 eggs, 8 fertilised, 2 early blasts transferred day 5. Negative result. Nothing to freeze

        ICSI # 2, Long protocol, 225 Gonal F with Luveris, 8 eggs, 5 fertilised, 1 blast and 1 morula transferred day 5. Negative result. Nothing to freeze

        I was on full immune support, Clexane, steroids, Intralipds (borderline anti nuclear antibodies and slightly high CD19+5)and we are still getting negative result. We have been told eggs and sperm look good, embryos look good so don’t know where to go from here. Do you think we could have a quality issue? Could we have issues with chromosomes or compatibility?

        Thanks so much in advance for your help

        Reply
        • Geoffrey Sher says:
          March 5, 2013 at 6:23 pm

          I really think I could help you but we would need to talk. 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. “Staggered 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
      14. Anxious says:
        March 17, 2013 at 7:04 am

        Dear Dr Sher,
        How long should one wait between IVF cyles. My first cycle failed and was wondering when I could start again.
        Thanks

        Reply

      Leave a Reply

       
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      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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      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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      IVF: Coping With the Emotional Roller Coaster Ride
      Procreation – and with it the ability to achieve immortality by living on through one’s children – is one of the most insatiable human needs. This strong natural urge exerts tremendous pressure on couples unable to have a baby. And ... more
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      DQ alpha/HLA Sharing: Does It Always Lead To Reproductive Failure?
      It is not unusual for couples who share DQ alpha/HLA similarities to first give birth to a healthy baby only to subsequently develop infertility, recurrent IVF failure or recurrent pregnancy loss. Such couples find it hard to comprehend how after hav... more
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      Dr. Geoffrey Sher Recommends

      CGH Embryo vs. Blastocyst vs. Cleaved Embryo
      IVF Success Rate Reporting – Are We There Yet?
      Please join me on Wed, February 6 at 8:30pm Eastern for a live webinar where I’ll discuss this topic in detail and take your questions. For more information or to register, click HERE ————- I have, for many years, tak... more
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      IVF Success Rate Statistics: The Time Has Come to Revise the Present Reporting System
      IVF programs currently report their outcome statistics in a number of categories: a)      Number of IVF cycles initiated in a given year b)      Number of single and multiple pregnancies that occurred c)      Number of cycles that res... more
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      Mother Gives Birth Using Daughter’s Eggs: Was It “Ill Conceived”?
      I wish to share a very interesting case with you; one that I’m pretty sure will meet with the approval of some and evoke criticism by others. Before I even tell you about it, let me say that I and my team thought long and hard before going ahead wi... more
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      IVF Authority - Dr. Sher's Blog
      Gender Selection in IVF: What Is Its Place?
      Couples have for centuries sought to influence the gender of their offspring. More than seven centuries ago the ancient Chinese developed a birth calendar said to be able to predict gender on the basis of when conception occurred. Later, the ancient ... more
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      Acupuncture and IVF: Does it Improve Success?
      Acupuncture involves the insertion of thin needles into the skin along so-called meridians (energy channels). It has been used in China for centuries to regulate and treat many health disorders including ailments involving the female reproductive sys... more
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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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      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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      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 #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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