26 Responses to “My IVF Cycle Failed – What Went Wrong? Question #15: Might My Mental State Have Played a Role?”

1. Lmynatt says:

   August 16, 2011 at 3:16 pm

   Very good Blog post! During my IVF cycle in Feb, I recall hearing many of the "don'ts" that you've listed! Ugh! After hyper-stimming, I sort of felt helpless, and unfortunately had a super early miscarriage. So thank you for this! It helps and makes me feel a little less guilty, and that my miscarriage wasn't my fault!!

   Reply
2. Geoffrey Sher, MD says:

   August 17, 2011 at 1:40 am

   Thank you most kindly. Glad it helped!

   Good luck!

   Geoff Sher

   Reply
3. mum2oneds says:

   August 17, 2011 at 3:24 am

   Thank you Dr Sher for this entry. I have learned new interesting facts esp in the first paragraph.

   Reply
4. Geoffrey Sher, MD says:

   August 17, 2011 at 3:06 pm

   You are most welcome.

   Geoff Sher

   Reply
5. thebunlessoven says:

   August 18, 2011 at 4:38 am

   It's so important for women going through IVF to know these things.
   There are already countless pressures and stresses laid upon us during a cycle – the panic of responsibility for every smallest thing can't be good!

   Reply
6. Geoffrey Sher, MD says:

   August 18, 2011 at 12:38 pm

   I concur!

   hanks for taking the time to comment!

   Geoff Sher

   Reply
7. Wantababy says:

   June 8, 2012 at 5:09 am

   Message: I just had 2 failed ivf cycles with 2 cgh normal blastocyst. I have a reciprocal balanced translocation hence the need for ivf/cgh. My doctor says I have no uterine or immunological abnormalities except for a mild case of hasimoto’s. I got pregnant twice naturally but had miscarriages at 8 weeks in both cases. I\’m 28 years old and my husband is 41 and prefect. I don\’t know the way forward right now. I need help.

   Reply
   • Geoffrey Sher says:

     June 9, 2012 at 3:04 am

     Of course, the translocation is an issue but I do not believe that CGH is the best way to diagnose this.FISH is far more reliable. Notwithstanding this, 2 CGH normal blasts were transferred and thus your negative outcome bears explaining. Clearly there is something else at work here and that something is almost certainly an implantation dysfunction. What seems to have been overlooked here 50% of women with autoimmune hypothyroidism (Hashimoto’s disease) will have “activated” uterine natural killer cells (NKa) the presence of which virtually precludes successful implantation. In my opinion, that is precisely what you likely have as a cause for “unexplained” failure” in spite of transferring “competent” embryos. perhaps even more importantly, NKa would set you up for repeated failures in the future, regardless of embryo quality (even if you used donor eggs/embryos…which is totally unnecessary in your case). Unless/until this issue is addressed correctly by selective immunotherapy with steroids and intralipid (IL) you will likely keep on “spinning your wheels”. But please bear in mind that it is NOT the concentration of NK cells in your blood that matters, rather it is measurement of NK cell activation and this requires using the K-562 target cell blood test which cannot be adequately measure by most Reference Laboratories. In fact there are only about 4 or 5 reproductive immunology reference labs in the U.S.A that can do the K-562 test reliably. Call my office at 800-780-7437 and get the phone # for Reproductive Immunology Associates (RIA) in Van Nuys, CA or Reprosource, Boston MA and call them to set up doing this test. Go to an article elsewhere on this blog and read on “Thyroid Autoimmune Disease and IVF Outcome. Also carefully read 2 articles on immunologic implantation dysfunction that I posted on May 10th and May 16th 2011. Other articles also worth your while reading on this blog include:

     1. “IVF success: Factors that influence outcome”
     2. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
     3. “A personalized, stepwise approach to IVF at SIRM” (posted March,9th, 2012)
     4. “Staggered IVF”
     5. ” Embryo selection: The critical factor in IVF outcome”

     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.

     Geoff Sher

     Reply
     • Wantababy says:

       June 12, 2012 at 6:51 am

       Thank you so much Dr Sher for this interesting insight. My RE did the panel testing (including NK cells) for me before we started the IVF treatment but I’m not sure whether this particular NKa testing was done. I have scheduled a consultation with you this thursday and I’m really looking forward to discussing further with you. Thank you so much!!!

       Reply
       • Geoffrey Sher says:

         June 12, 2012 at 10:36 am

         You are most welcome. I look forward to talking with you.

         Geoff Sher

         Reply
8. Jenny says:

   November 7, 2012 at 2:49 pm

   Dear doctor

   I am experiencing secondary infertility. I have been trying for three years for a 2nd. My amh is 1.4 and initially in my first ivf my fsh was normal. In my second ivf it was elevated.

   First round of ivf we only had two eggs both fertilized but no transfer. The second cycle there was one egg and we cancelled it. I have been given dhea and recommended one more go. My specialist has explained we are not good candidates for ivf.

   I have acupuncture weekly and am otherwise very healthy, ovulate and have good lining in second half of my pregnancy.

   What do you think?

   Thankyou

   Jenny

   Reply
   • Geoffrey Sher says:

     November 7, 2012 at 5:50 pm

     Dear Jenny,

     Your blunted response is weird because although you have a reduced AMH, it was not so low as to fully explain your poor response to COS. I somehow question whether the protocol used might be the cause of this.

     Either way, we should talk. So please call 800-780-7437 or 702-699-7437 to arrange a telephone or Skype consultation (free of charge to those who reside in the United States or Canada). While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice. Then go to http://www.IVFauthority.com and when you get to the home page find the “search bar” in the right hand column. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.

      “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
      “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
      “Agonist/Antagonist Conversion Protocol”
      “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
      “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
      “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)

     Sincerely,

     Geoff Sher

     Reply
9. Lindsey says:

   January 14, 2013 at 8:58 am

   Dr. Sher,

   My sister had Leukemia when she was in her teens and her Fallopian tubes were removed. Needless to say, she can not get pregnant on her own. Last year, we tried IVF. I was 24 and perfectly healthy. The doctors were so optimistic. Up until I went in for the surgery, they told me I was going to have a lot of eggs to give to my sister. Shortly after they started the procedure, they stopped. I was told that I had many follicles but that they were empty, they were only able to get 3 eggs?? My sister is afraid to try IVF again in fear of it not working again and also in fear that she took my “last eggs”. I have seen other doctors and they are telling me I am still a healthy, fertile, 25 year old. Could I have been overstimulated?? Just trying to find answers so that we can try IVF again and go in open minded! Thank you so much for your time.

   Reply
   • Geoffrey Sher says:

     January 14, 2013 at 5:14 pm

     This is usually a result of the protocol of stimulation and/or the timing of the hCG shot. At 24Y it is almost certainly not an egg quality issue.

     I would need a lot more information to be more specific.

     If you wish to discuss with me, call 800-780-7437 and set up a phone or Skype consultation (free to patients in the U.Sa/Canada).

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

     Reply
10. uzma zeeshan says:

    February 1, 2013 at 4:30 am

    dear doc i am 26 year old and married for 2 years.i have a history of Dysfunctional uterine bleeding since puberty and as the bleeding used to continue for 2 months in a row so doc started giving me Duphaston that regulated my cycle.i have been on Dience 35 as well and then later the periods gap settled t0 10 days.. After every ten or 11 days i used to bleed for 7 days … so doc again put me on period regulating pills. I got married in 2011 and after four months i reported pain.on TVS an ovarian fibroma was detected and Laproscopy was done.and Fibroma was removed and the report said that tubes are patent.Then later i was put on clomid 5mg to induce ovulation but it didnt benefit me. my FSH is 4.46miU/ml ,my Estradiol is 172.4 Pg/ml ,LH 3.50 miU/ml ,Prolactin 12.84 ng/ml and Testosterone is 0.115 ng/ml and my AMH level is 17.03 prnol/l,Insulin level is 10.12 and my
    TSH is 3.69 uU/ml. Then I was put on stimulation with Menogon for timed intercourse but it didn’t benefit either and then doc ordered a Hystersalpingogram which could nt be carried out because the doc found a polyp that was touch to bleed. It was removed by Hysteroscopy and the results showed that the uterus was normal and free floating too. Then on the basis of AMH test report the decision of ICSI was taken
    now i am writing the histroy given to me by my doctor
    Uzma has a history of ovarian tumor removal,poor ovarian reserve and one time stimulation with Menogon for timed intercourse. Husband semen analysis was normal.was given Progluton for period regulation.On day 2 of cycle U/S showed anteverted uterus of normal size 7.7cm x 2.93cm. Thin endo 2.2 mm,Rt ovary accessible with moderate antral follicles and Lt ovary slightly small with 4 antral follicles. Antagonist Protocol for controlled ovarian stimulation was used. I was given 375 IU of Merional for 4 days. U/S on 6th Sep 2012 showed Endometrium triple line of 7.9mm. Rt ovary 4 follicles between 13-15mm, Lt ovary 2 follicles12-13 mm.
    I was again Advised Merional 450IU for further 4 days and Inj Cetrotide .25mg for 4 days. U/S on 9 sep showed Endometrium Triple line of 8.2 mm. Rt ovary 4 follicles between 16-17mm,Lt ovary 3 follicles 14-15mm. was given HCG and ovum pick up was planned 36 hrs later.
    10 eggs were recovered. Husband’s semen analysis showed 2.5 ml volume, 119×10 6/ ml count with 84% motility and 5% morphology (strict Kruger’s criteria).
    10 MII oocytes were
    injected, 7 fertilized and 6 cleaved. On day 2, 4 embryos were 4 cells G1 and 2 embryos 4
    cells G1-2. On day 3, 1 embryo was 8 cells G1, 4 embryos 8 cells G1-2 and 1 embryo 8 cells
    G 2. On Day 5 there were 4 full blastocysts and 2 early blastocysts. 1 hatching and 1 full
    blastocyst were transferred. ET was easy.
    No remaining embryos was frozen.
    She was advised luteal support with 8% Crinone + Estradiol Valerate 4 mg daily.
    i got pregnant however after 6 weeks i miscarried.started having brown discharge and then bleeding
    the BHCG was also not doubling in 48hrs.
    my doc planned another ICSI attempt in March 2013. However my mother in law took me to another doc yesterday and he said that the protocol used was not correct. Till the time my FSH is fine ,AMH test values dont matter. Thirdly the endometrium lining was not upto the mark and even the pregnancy support medication given of 8% Crinone and Estradiol Volerate 4mg was not right….

    According to him i should start taking Glucophage pills and get a Hysterosalpingogram done to check for tubes ( although Laproscopy findings say that tubes are patent ) and he said i should go for IUI .
    Based on my history you please guide me that was the protocol followed was right ?

    Reply
    • Geoffrey Sher says:

      February 1, 2013 at 9:39 am

      Without access to detailed records I can only say based upon FSH/E2 and AMH that you do not present as someone with DOR. In fact I am surprised that you do not over-stimulate. I would want to examine the details of your protocols. You might well have a variety of PCOS.

      I am also suspicious that you might have an immunologic implantation dysfunction. Your TSH is high-normal and this could point to a possible sub-clinical hypothyroid state that might not present yet. I think this should be investigated through measurement af antithyroid antibodies, NK cell activation (by the k-562 target cell test) and an antiphopholipid antibody panel.. These should be tested in a qualified reproductive immunology reference lab.

      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. “Thyroid autoimmune disease and IVF”

      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. “PCOS”

      10.“ICSI”

      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
      • Uzma says:

        February 1, 2013 at 12:30 pm

        Thanks for your reply. What is DOR ? i didnt over stimulate because on TVS doc tells that the ovarian activity is diminished. The ovarian Fibroma has regrown .. and doc say i do not have PCO…
        should i go for ICSI or IUI based on my reports and was 8.2 mm endometrium lining thick enough ? and was the support protocol of Crinone 8% and estradiol volerate 4mg right ?
        lastely when laproscopy report says that tubes are patent then why do i need a Hysterosapingograpy to check the tubes ?

        Reply
        • Geoffrey Sher says:

          February 1, 2013 at 1:11 pm

          DOR means diminished ovarian reserve. Your FSH/E2 and AMH suggests the contrary. As I said, with those values I would have expected an “hyper” rather than a “hypo” response to stimulation and thus I am queering the exact protocol of stimulation you were on. The surgery for removal of the fibroma of the ovary should not impact response based upon these parameters.

          If your RE does not think you have PCOS why are you on Metformin?

          An ideal lining measures >9mm but 8.00mm-9.00mm can suffice. It represents a “gray line”.

          Geoff Sher

          Reply
11. Uzma says:

    February 2, 2013 at 12:58 pm

    on my AMH the reference ranges are in prnol
    optimal fertility :40.04 – 67.9
    satisfactory fertility: 21.98 – 40.03
    low fertility: 3.08 – 21.97
    very low/undetectable:0.0-3.07

    My AMH value is 17.03 prnol/l does not it lie in the low range ?
    At the end of the refrence ranges its written that levels greater than 67.9 prnol/l are suggestive of PCO or granulosa tumors.
    Secondandly i have consulted numerous doctors and they all say that \i dnt have PCO as i dnt have any apperant PCO symptoms .. neither on TVS it shows PCO and had i been having PCO then on this hi stumulation i would have produced 40-50 eggs rather than this Hypo response.
    told u that my mother in law took me to this new doc who without even checking me or doing a scan said that i might be having PCO and asked me to start taking Glucophage…..

    Please Ans me that if the laproscopy report says that tubes are patent then why has the doctor asked for a hysterosapingogram ? since one year now my periods are always delayed …. after 2 months time or even once i had them after 3 months … and on TVS the doc tells that she doesnt see the ovarian activity as if the ovaries are going towards premature ovarian failure…..

    I am so confused at which doctor to trust and whether go for ICSI again or not

    Reply
    • Geoffrey Sher says:

      February 2, 2013 at 6:17 pm

      Thank you for correcting me, I thought your AMH was in pg/ml. …my mistake. It does alter my assessment with regard to you potentially being a high responder and the need to investigate for PCOS. The rest stands.

      Good luck!

      Geoff Sher.

      Reply
12. Uzma says:

    February 3, 2013 at 1:35 am

    thanks doc.. so based on my FSH ,E2 and AMH now what do u think should i go for IUI or another ICSI reatttempt ?
    and u didnt reply that if the laprsocopy result says that my tubes are patent then why doc wants to have an Hysterosalpingogram done ??? thirdly should i take DHEA or not ?
    thanks for your guidance.
    GOD bless You

    Reply
    • Geoffrey Sher says:

      February 3, 2013 at 10:54 am

      I could understand a hysteroscopy to re-examine uterine contour…but if all was normal with laparoscopy, I do not know why an HSG is recommended. You must discuss this with your RE.

      I do not recommend DHEA because it metabolizes in the ovary to testosterone, too much of which I believe to be detrimental to egg development. (see “Nutritional Supplements in IVF…elsewhere on this blog).

      At 26 with what you have presented here and with normal sperm, I might try a few medicated IUI attempts before ICSI.

      Geoff Sher

      Reply
13. Uzma says:

    February 21, 2013 at 7:13 am

    why my blood test on day 2 of cycle shows a normal FSH of 4.7 value .. however my AMH is 17.03 prnol.. why such opposite results ?

    Reply
    • Geoffrey Sher says:

      February 21, 2013 at 7:43 am

      I think you mean that the AMH level was 17 pmol/L. If so, this is satisfactory and in keeping with your FSH of 4.7MIU/ml

      Geoff Sher

      Reply
14. Angela Bingham says:

    March 4, 2013 at 2:51 pm

    Hello Dr Sher
    I am really struggling because I was diagnosed with herpes 1 and 2 last summer. I have been struggling with infertility for 11 years, have had many failed IVF cycles although do have a son conceived naturally 8 years ago. I am 45. On my last IVF cycle (with donor eggs) I was on suppression therapy for the herpes. I managed to get pregnant for the first time with IVF but then miscarried at 7 weeks. I had stopped taking the acyclovir at 3 weeks. I did have a very minor outbreak of herpes about 3 days before th miscarriage. Now I am not sure whether the acyclovir or the herpes outbreak caused the miscarriage or if it was a coincidence. I don’t know what to do for the best on my next cycle whether to take acyclovir or not. I am so confused. I just want to do the right thing but don’t know any more what that is and noone seems to have any information about herpes because it has such a stigma attached to it. Please help. So desperate for a little brother or sister for my little boy. ange

    Reply
    • Geoffrey Sher says:

      March 4, 2013 at 5:58 pm

      Neither herpes nor acyclovir therapy explains your situation of having conceived once and thereafter not being able to conceive even with IVF and DE. Rather, this suggests to me a hitherto undiagnosed implantation dysfunction. I would not be at all surprised if you were to find that you have an alloimmune implantation dysfunction. I suggest you read my second to last blog (www.IVFauthority.com) on this very issue that is associated with DQ alpha and HLA matching between you and your husband. Also, read 2 articles I posted in May 2011 on the same blog.

      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.

      Geoff Sher

      Reply