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      • My IVF Cycle Failed – What Went Wrong? Question #2 – Was I Adequately Evaluated and Prepared for IVF by My Physician?

      Dr. Geoffrey Sher Recommends

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      This is the second in a series of responses to common questions about Failed IVF Treatment. Question #2 – Was I Adequately Evaluated and Prepared for IVF by My Physician?

      Patients often ask “When is it time for me to stop doing IVF?”The answer I consistently give is that it is time to stop “when there is no remediable explanation for failure.”It is against this background that I submit that pre-cycle evaluation of a couple undergoing In Vitro Fertilization (IVF) is probably the most important step in the entire process, and becomes even more critical when it comes to evaluating a couple who has failed to conceive after undergoing 1 or more IVF attempts in the past.

      The Seed-Soil Analogy

      I have in the past stated that successful human reproduction is akin to the need when gardening, to establish an ideal “seed/soil relationship.” However, when it comes to reproduction, the “seed” is the embryo and the “soil” is the uterine lining.As with horticulture, a successful outcome requires planting a “good seed” in a “good soil.” In the case of IVF, a good seed is analogous to what we refer to as a “competent” embryo. This is an embryo that has the proper number of chromosomes (euploid) and has an optimal chance of developing into a healthy baby.A “good soil” is analogous to a receptive endometrial lining (one that will allow normal and healthy implantation to be established). So, proper (re)evaluation of a woman undergoing IVF requires a critical (re)assessment of those variables that affect embryo competency and endometrial receptivity.

      A. Evaluating the Factors That Affect Embryo Competency (The “Seed”)

      1. Age

      The woman’s age during IVF is the most important factor affecting the chromosomal integrity of her eggs.This in turn, is central to the ability of the egg to develop into a “competent” euploid embryos post-fertilization.The “competence” of an embryo is determined largely by the chromosomal integrity of its egg of origin. Only a euploid eggcan propagate a “competent” embryo and it is the age of the woman that determines the likelihood of any egg being euploid.The percentage of a woman’s eggs that are euploid decreases progressively with advancing age beyond 35.At age 30, slightly less than 1 in 2 of eggs will be euploid; at age 40 about 1 in 6-8, and by her mid 40’s, less than 1 in 10 eggs will be chromosomally normal eggs.Cells that have an abnormal quota of chromosomes are referred to as aneuploid. A “normal” (euploid) mature egg has 23 chromosomes. Anything more or less than that number makes the egg aneuploid and such eggs will invariably propagate “incompetent” aneuploid embryos which will either fail to implant, briefly implant and then be lost as a miscarriage, or (albeit infrequently) propagate a baby with a chromosomal birth defect such as Down’s Syndrome. It follows that the woman’s age must be taken into consideration when discussing the likelihood of a successful IVF outcome.

      The older the woman undergoing IVF, the more difficult it becomes to maintain an ideal ovarian hormonal environment that would favor proper egg development and thus, the greater will be the imperative to modify the protocol of ovarian stimulation in order to avoid egg maldevelopment (that is more likely to occur in an abnormal environment) and an increasing likelihood that following the hCG “trigger” (that initiates chromosomal segregation) the “mature” egg will turn out to be aneuploid (see my post on an Individualized Approach for Ovarian Stimulation).

      2. Ovarian Reserve

      Approximately 6-8 years before the onset of menopause, the number of eggs available declines more rapidly, to the point that a woman progressively develops resistance to fertility drugs.This period of diminishing ovarian reserve (DOR) is known as the climacteric and is characterized by progressively rising basal blood FSH levels as well as by declining AMH and Inhibin B levels.The climacteric usually begins in the late 30’s to the mid 40’s but it can and often does occur sooner.

      With DOR goes a change in ovarian response to hormonal stimulation and thus it becomes even more important to individualize the protocol of ovarian stimulation in such cases.

      3. Sperm Quality

      Male sperm dysfunction accounts for about 50% of infertility.In most cases, it is very difficult to reverse through medical or surgical intervention. When it comes to embryo competence, the egg plays a far greater determining role than does the sperm.However, in cases of male infertility, the contributing role played by the sperm in causing embryo aneuploidy increases significantly. There are circumstances where surgical or medical treatment can improve sperm quality significantly:

        • Some men who have blocked sperm ducts or a fluid collection around one or both testicles (hydrocele) might benefit from surgical correction, while those with a collection of varicose veins around their testicles (varicocele) might benefit from surgical or radiological occlusion of the spermatic vein(s).
      • While the egg plays a far greater determining role in embryo competence than does the sperm, in cases of significant male infertility, the role of the sperm increases significantly in this regard.

      4. Genetic/Chromosomal Factors

      Certain chromosomal and genetic abnormalities involving the man or the woman can thwart successful IVF.In approximately 1 out of 200 cases a balanced translocation (where part of one chromosome is exchanged with that of another) will cause unexplained IVF failure or miscarriage.This is worth looking for in some cases.There are also cases where there is a deletion of part of the chromosomes in the sperm or in the egg that can cause the same problem.Detection of such rare genetic events requires In certain cases where there is a low sperm count and motility, the cause may be related to understimulation of sperm production.In such cases the man might have a low blood FSH level.In such cases, treatment with medications such as low dose clomiphene or letrozole for a period of about 3 months (the sperm cycle) will sometimes result in a marked improvement in sperm function.In other cases, administration of FSH and/or LH medications over a period of 3 months can also be helpful (see my post on Enhancing Sperm Production).

      B. Evaluating Factors that Affect Uterine (Endometrial) Receptivity (“The Soil”)

      1. Thickness of the Uterine Lining

      Measured at the time of the hCG trigger, the thickness of the uterine lining is also a very important factor.A lining of less than 9mm in thickness is suboptimal, while a lining under 8mm is usually totally inadequate.It is very important to recognize this fact because, just as the roots of a plant cannot develop adequately if it is planted in a thin layer of soil, so the embryo’s root system (trophoblast) cannot take proper hold or function adequately if the lining is too thin.Today, through the administration of medications such as Viagra for the uterine lining, estrogen and anti-prostaglandins (e.g., aspirin), it is possible in many such cases to improve the lining.However, when as a result of uterine inflammation or surgical trauma to the a thin inner (basal) germinal layer of the endometrium, such treatment will often be ineffectual, necessitating the use of a gestational carrier (surrogate).

      2. Endo-Uterine Pathology

      The presence of small surface lesions that protrude into the uterine cavity can interfere with embryo implantation. These can be (and often are) missed, unless proper inspection by a hysterosonogram, hysteroscopy or an MRI is done.The use of a dye X-ray test (hysterosalpingogram) is inadequate to identify small endometrial polyps, or small fibroids (see this article on Uterine Fibroids).

      3. Immunologic Implantation Dysfunction (IID)

      This is often a cause of “unexplained” IVF failure (in about 30% of cases) and must be looked for.Here, autoimmune rather than alloimmune factors (the latter more commonly results in early miscarriage), are usually the cause.Effective treatment of immunologic infertility is available.I have personal experience with many cases where using selective immunotherapy, I have successfully treated women who previously had failed to achieve viable IVF pregnancies after more than 10 consecutive attempts (and in one case more than 20 prior IVF failures had occurred). It is important to bear in mind that resorting to the use of donor eggs does not offer a solution in cases of immunologic implantation dysfunction.

      To their own discredit, many fertility doctors have hitherto denied or even discounted the role played by immunologic factors in implantation failure and have even discredited the use of selective immunotherapy in such cases. In my opinion, in this attitude stemmed from a desire to maintain a competitive edge, since until recently, successful treatment of immunologic implantation dysfunction often required the administration of a blood product known as immunoglobulin-G (IVIg). The administration of this product was very expensive (up to $4,000 per infusion, and more than one administration was often required), and it sometimes caused unpleasant side-effects. In addition patients often expressed fear that because IVIg is a blood product, its administration might lead to the transmission of HIV and hepatitis viruses. The fact is however, that this concern was was unfounded because FDA-approved IVIg products are all screened for viral contamination and thus are safe in this regard. Against this background doctors were fearful that prescribing IVIg treatment (while others denounced it) would put them at a competitive disadvantage.

      All this changed with the recent introduction of a product called Intralipid (IL), which has largely replaced IVIg for the treatment of immunologic implantation dysfunction. The reasons for the change of heart are that unlike IVIg, IL is very inexpensive (less than $200 per infusion), is safe, and is free of significant risk or side effects and most importantly, IL is equally effective for the treatment of immunologic implantation dysfunction . Perhaps not surprisingly, the low cost and minimal risk associated with IL therapy, bolstered by an ever increasing demand on the part of IVF patients that they be assessed and selectively treated for immunologic issues, has led to a dramatic increase in the number of RE’s that now test for immunologic implantation dysfunction. In fact, many of the naysayers now strongly advocate the use of selective immunotherapy in such cases. Simply stated, enlightened self-interest has now made it popular and convenient for critics to become advocates. Be that as it may, to ignore the fact that immunologic implantation dysfunction is an important cause of “unexplained IVF failure” is, in my opinion, to deny many women the opportunity to go from “infertility to family”. (See my post on Immunologic Implantation Dysfunction).

      A few additional considerations:

      As far as the embryo is concerned, a careful evaluation of its appearance microscopically and its rate of development is vital.As an example, an embryo that fails to divide to the 6-9 cell stage of development within 72 hours of fertilization is usually “incompetent.”In the same manner, embryos that develop beyond the 10 cell stage within the same time period are growing too fast and are very often also incompetent.We and others have pointed out that embryos failing to reach the expanded blastocyst stage within 6 days of fertilization are, in more than 95% of cases, aneuploid and would not have resulted in a pregnancy anyway.Also, embryos whose cells (blastomeres) are very discordant in shape and size, or embryos that have numerous small cell fragments disseminated throughout their substance (fragmented embryos) are also far more likely to be “incompetent.” While the age of the woman plays an important role in determining embryo development, so does the protocol of ovarian stimulation.It is in regard to the latter where we as treating physicians can play a very important role.

      I have previously pointed out how individualizing the protocol of stimulation for IVF is central to optimizing the environment in which the egg develops, and hence the quality of the embryos it propagates.This is even more critical in woman with DOR, those with polycystic ovarian syndrome (PCOS) and in older women.I cannot emphasize strongly enough how important it is to assess the protocol of stimulation in all cases where there is deemed to be poor embryo quality (see my post on an Individualized Approach for Ovarian Stimulation).

      Finally, there is the issue of carefully evaluating embryos for chromosomal integrity (karyotyping).Here the relatively recent introduction of Comparative Genomic Hybridization (CGH) for egg and embryo chromosomal analysis, is a game changer.A “CGH-normal” embryo transferred into a receptive uterine environment has about a 65-70% chance of producing a viable pregnancy regardless of the age of the egg provider.Unfortunately, microscopically “good-looking” embryos – even those that make it to the blastocyst stage – are not necessarily always “competent or euploid, and this fact serves to underscore the need for CGH analysis, especially in cases where there is unexplained IVF failure.(see my post on CGH Egg/Embryo Selection)

      It is important to realize that it is often difficult or even impossible for women in their mid-40’s to produce the chromosomally normal eggs necessary to propagate euploid (CGH normal) embryo.This serves to explain why older women are less likely to conceive, even when their embryos appear to look normal under the microscope, and why the selective transfer of CGH-normal embryos should be the goal.(Please refer to the articles on the merits of embryo banking).

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      18 Responses to “My IVF Cycle Failed – What Went Wrong? Question #2 – Was I Adequately Evaluated and Prepared for IVF by My Physician?”

      1. dreams and deviations says:
        April 13, 2011 at 9:03 pm

        Dr Sher – many thanks for this informative article. I have one quick question – how do you suggest I broach the topic of screening tests to my fertility specialist who so far has not suggested any testing for me? I have 3 existing autoimmune conditions and have had 5 failed cycles so far. My last stimulated cycle resulted in the fertilisation of 13 embryos, of which 12 were frozen. Many thanks in advance!

        Reply
      2. Geoffrey Sher, MD says:
        April 14, 2011 at 11:04 am

        You are a specific case in point. There must be plausible reason why you have failed IVF 5 times. You absolutely do need a thorough re-evaluation and, ASAP. The problem is that I simply do not know how to advise you with regard to broaching this with your own RE except that you need to remember that this is about you and your partner, not about the feelings of any doctor…..So you need to be direct!

        Feel free to call 800-780-7437 and set up a free medical telephone consultation with me to discuss this in detail.

        Geoff Sher

        Reply
      3. dreams and deviations says:
        April 14, 2011 at 7:14 pm

        Thankyou Dr Sher – your response is much appreciated. If I was in the US I would definitely be making contact with you! Your advice is much appreciated and I feel better about seeing my Fertility doctor now and being direct in asking for some testing. In the meantime I will be reading your blog and tweets for more invaluable information – I am so glad I discovered them!

        Reply
      4. Geoffrey Sher, MD says:
        April 15, 2011 at 10:30 am

        You are most welcome Kirsten,

        Let me know if I can be of any further assistance.

        Geoff Sher

        Reply
      5. dsps says:
        April 21, 2012 at 2:23 am

        A friend of mine had only wonderful reviews of you and your practice. I just finished a donor egg cycle and it didn’t work. At 7 week sonogram no visible sac. I am now just waiting and again on the emotional roller coaster. I am 42 and this will be my 5th miscarriage. My donor didn’t produce well. i did the shared risk and there were only 9 follicles. I received 4 but only 3 were good enough to move forward with. one fertilized, one fertilized abnormally (they think 2 sperm got in there) and one didn’t fertilize at all. They transferred a 3 day grade bb embryo with 7 cells. My first beta was 69, 2nd 192 and 3rd 424. Needless to say I was feeling positive. when I went in for my ultrasound the nurse had a hard time finding my uterus, she actually had to fight with it. Turns out there were multiple uterine fibroids (posterior submucosal and posterior subserosal and anterior intramural) and several ovarian cysts. When I asked if these caused the embryo from not implanting correctly they said no. No one said anything to me about any fibroids when I went in for the transfer. In fact the transfer went pretty smoothly. I was in the dr office 20 min from start to finish. I thought it was strange that they didn’t let me sit there awhile because from what I read they said you would wait half hour or in chair. My lining was a 9 right before and my estrogen and progesterone levels were good. I was tested for NK after my 3rd miscarriage and was told my levels were within normal limits. i want to try donor egg again as soon as my mind and body heal but I need to know what keeps causing these miscarriages so I don’t keep putting emotion, time and money into something that will keep failing. my husband and I are at wits end. Also my husband is a Police Officer, I read that you have discounted programs for officers. Can you send me some information.

        Reply
      6. Geoffrey Sher says:
        April 21, 2012 at 9:06 am

        It sounds very much as if you have an embryo implantation dysfunction. I respectfully reserve judgement on whether the opinion given you that your NK cell activity test (the K-562 target cell test) was normal. I am not even certain that they did that test on you and you should know that if they did not, then it defies interpretation. I also cannot say whether the fibroids [played a role . To do so I need to know hat a sonohysterogram or hysteroscopy prior to IV showed. Specifically, it is important tro know whether any fibroids were encroaching upon or protruding into the uterine cavity.

        Simply stated, I think we should talk. You might also consider calling 800-780-7437 or 702-699-7437 to set up a telephone consultation with me (which is free if you reside in the U.S.A or in Canada) so we might discuss your case in detail.

        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.

        1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
        2. “Agonist/Antagonist Conversion Protocol”
        3. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
        4. “IVF success: Factors that influence outcome”
        5. “A Stepwise Approach to IVF At SIRM” (Posted on March 9th, 2012)
        6. Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
        7. “Staggered IVF”
        8. “Uterine Fibroids and IVF”
        9. “Egg Donation”
        10. “Egg Donation with St-IVF
        11. “Embryo Banking”

        Geoff Sher

        Reply
        • dsps says:
          April 24, 2012 at 12:25 am

          Thank you so much for such a quick response. Since your response I have been reading everything on your website. you have given me a little hope back. My husband and I would like to set up a phone consult with you. What information/records would you need beforehand? From what I am reading it does sound like an implantation dysfunction. My family does have a history of hypothyroid. Both grandmothers and an aunt and cousin have had their thyroids removed. I did have endometrosis that was discovered when I had a cyst removed. I never had any pain from it. Doctor said it was very mild. I have never been diagnosed with hypothyroid although I did believe I had issues with my thyroid on numerous occasions because of being extremely fatigued, trouble losing weight and my hair falls out and is all over the bathroom floor. Blood tests always showed within normal range. I look forward to setting up time to speak with you.

          Reply
      7. Geoffrey Sher says:
        April 24, 2012 at 2:36 am

        Please call 800-780-7437 or 702-699-7437 ASAP and they will give you all the information ne34eded.

        Geoff Sher

        Reply
      8. Lisa says:
        November 30, 2012 at 4:21 pm

        Dear Dr,

        I have had 4 cycles of natural modified IVF in the UK – 1 embyo each time – The first 3 was top grade embyos and 1 was poor – none implanted. I have also had 5 cyles of IUI with no success. This cycle I started taking DHEA to try and improve quality and had the “scatching” procedure in preparation for my next cycle but when I went for my first ultrasound I only had two very small follicles and the cycle was abandoned.
        I am now 45 so time may have run out but I feel as if I have had no guidance with my treatment- each time I just do the same thing – and have almost been prescribing my own treatment. Having read your articles I wonder if the DHEA has affected my follicle growth as I have never had a problem wth producing follicles each month. I have now stopped taking it. My question is should I have tests for my immunity or is there anything i should I be doing anything else that my clinic is not suggesting? L

        Reply
        • Geoffrey Sher says:
          November 30, 2012 at 5:52 pm

          Hi Lisa,

          Although I do not agree with the use of DHEA, I doubt this is your issue. Rather it is the biological clock because at 45 the chance that the egg fertilized is chromosomally normal is about 1:20. You really need to consider egg donation at this stage.

          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.

           “Egg Donation” “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)
           “IVF success: Factors that influence outcome”
           “Staggered IVF”
           “Embryo Banking”
           “Egg Donation”
           “Gestational Surrogacy”

          Consider calling 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.

          Geoff Sher

          Reply
      9. Rachel Stephenson says:
        March 31, 2013 at 2:52 pm

        I have just had 2 failed ivf in the last 6 months i am 25 years old i have pcos my first ivf i had a day 5 transfer with 1 early blast and 1 morula 14 eggs retrived 9 felized nothing to freeze 2nd ivf 13 eggs retrieved 8 fertilized had 3 day transfer with 2 top quality grade A eggs no pregnancy both cycles what should i do now could it be a immune problem. your help very much appreciaated

        Reply
        • Geoffrey Sher says:
          March 31, 2013 at 6:31 pm

          I really think we should talk as there is more information I need. This could be a stimulation issue (often relevant in PCOS) or a hitherto undiagnosed 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. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

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

          . “PCOS”

          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)

          I recommend that you call 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
          • Rachel Stephenson says:
            April 28, 2013 at 3:26 am

            Thank-you for your advise you said you needed more information i have pcos my bmi is 20 so do not have a weight issue i have been ttc 8 years my fsh is 7.1 and LH is 37 which I am lead to beleive is extremely high . I did long protocol down regging bcp and then stimms for 10 days did not go into ohs took metformin to twice daily starting one month prior to ivf . im 25 years old thank-you for taking the time to reply back .

            Reply
            • Geoffrey Sher says:
              April 28, 2013 at 6:07 pm

              Rachel,

              I think I can help here but we would need to talk. Please 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. Namit says:
        April 13, 2013 at 5:04 pm

        Dear Dr Sher,
        I have had two failed IVF cycles in the last six months At present I am 37 years old, We had been trying for two years without success before going for IVF. My husbands sperm count was 39 million with reduced motility and My FSH was 5.3, LH 5.1, Oestradiol 108 and Prolactin 512,before our first cycle. We were told that we could possibly conceive naturally but due to prolonged period of not conceiving, we were referred for IVF
        In the first cycle Buserelin and Menopur were used, long proctocol. In this cycle I hyperstimulated with over 30 follicles. 24 eggs were collected, split between IVF and ICSI. 3 of IVF and 9 of ICSI fertilized. I was put on Cabergoline due to Oestradiol level of 24,000.
        2 balstocysts were transferred on day 5. In this cycle My hsubands sperm count was 80 million with good motility.this cycle was not successful. I was advised that the egg quality was not good.
        In view of my over response, borderline prolactin levels and slight increase in hair growth on chin.
        It was thought I might have PCOS.
        I was put on Metformin 500 mg tid. I also took DHEA for 2 months. stopped DHEA before starting next cycle.
        In the last cycle which was last month the short protocol of Cetrotide and Menopur was used in order to avoid hyperstimulation.
        In this cycle 22 eggs were collected.only about 10-12 were mature and 7 fertilized with ICSI. the quality this time was poorer and on day 3 two embryos ,6 cell and 5 cell were transferred. Unfortunately this cycle failed as well. In this cycle the egg and embryo quality became poorer rather than improving.
        We do not know how to proceed forward now. I would really appreciate if you could please offer any help or advise

        Reply
        • Geoffrey Sher says:
          April 13, 2013 at 8:25 pm

          It sounds very much like typical PCOS. As you probably are aware, with this condition there is already a high level of ovarian male hormone production as well as often an underlying egg issue. The last thing you need in my opinion is additional male hormone (DHEA). Also, the protocol used must keep LH down-regulated and that wont happen , until (too) late in the stimulation cycle when an antagonist is only commenced 6-7 days after the stimulation starts. In my opinion, you could benefit from 2-3 months of a birth control pill (to keep LH low) prior to the stimulation. Then I might recommend a long pituitary down-regulation protocol with low dose recombinant FSH (Puregon, Follistim or Gonal F) in readiness for “Prolonged coasting” (see below). This I believe should optimize egg the potential for good quality eggs/embryos.

          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. “Polycystic Ovarian Syndrome and IVF”

          4. “Ovarian Hyperstimulation Syndrome”

          5. “Prolonged Coasting”

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

          Geoff Sher

          Reply
      11. Arshia says:
        May 2, 2013 at 7:47 am

        Hi,

        I am 33 yr old. I did 3 IUI’s and my first IVF in April’13. All failed.My RE says i have unexplained infertility.
        During my IVF cycle everything was going great.My eggs, sperms and fertilization was great.Response to the drugs was good and out of 23 eggs retrieved 7 fertilized and 1 blastocycst transfered on day 5 which was having around 100 cells and 4 are freezed.My RE said i had a very good chance of pregnancy with just one embryo transfer…but i got my number low on my first HCG beta was just 12 and then hormone level dropped.My RE informed there won’t be a pregnancy anymore and i need to stop my progestrone…
        At this point i am very confused and stressed. Could you suggest what i should do next.
        I did read about Immunologic factor, Embyro glue, and other testings on IVF authority.

        Many thanks!

        Reply
        • Geoffrey Sher says:
          May 2, 2013 at 9:53 am

          Arshia,

          I suggest you read my most recent blog, posted on this site a few days ago…relating to this very issue. Then if you wish…call 800-780-7437 and set up a Skype consultation with me.

          Geoff Sher

          Reply

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      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 #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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      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 #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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