Welcome to IVF Authority - World Renowned Resource for IVF Information

Welcome to IVF Authority Blog

Search by Topic

Search by Date

<< Back to IVF Page

Using Agonists and Antagonists in IVF: An Opinion

Dr. Geoffrey Sher Recommends

Loading ...

Phone:
702-892-9696

Fax:
702-892-9666

Pin It

The main objective in controlled ovarian stimulation (COS) is of course, to safely optimize egg quantity without compromising quality. For this to be achieved, COS must of necessity strike a balance in the administration of the pituitary gland-derived hormones, luteinizing hormone (LH) and follicle stimulating hormone (FSH).

When it comes to influencing IVF outcome, the protocol selected for COS is the most critical decision that the treating fertility doctor can make. There is no more a standard protocol applicable to all IVF candidates than there is a standard height or weight for any individual. Each woman should be independently evaluated for the optimal COS protocol. Such an assessment should take into account the woman’s age, her ovarian reserve (as assessed by basal blood FSH, LH, estradiol and in many cases also the AMH), her previous response to ovarian stimulation, and the cause of the infertility. This article seeks to establish a rational basis for how the interaction between pituitary gonadotropins (follicle stimulating hormone [FSH] and luteinizing hormone [LH]) and agonists/antagonists can affect egg/embryo quality and ultimately impact IVF outcome.

How LH and FSH promote follicle growth and egg development: LH causes the connective tissue (theca/stroma) that surrounds the ovarian follicles to produce and release androgens (male hormones)…mainly testosterone. These androgens are then transported to the (granulosa) cells that line the inner ovarian follicles, where FSH then causes the conversion of (predominantly) testosterone to estradiol. As a result, the follicles grow, blood estrogen levels rise, and eggs undergo the developmental change (ovogenesis) necessary to allow proper preovulatory maturation triggered by the LH surge or by the administration of human chorionic gonadotropins (hCG).

While some androgen-testosterone is an essential prerequisite for normal follicular development, estradiol production and ovogenesis, an excess of androgens can overload and exhaust granulosa cells, overtax egg development and ultimately lead to egg chromosomal irregularities (i.e., aneuploidy). Upon being fertilized, aneuploid eggs invariably propagate embryos that are aneuploid and “incompetent” (i.e., incapable of developing normally). Such aneuploid embryos will invariably either arrest during development, fail to implant in the uterus, miscarry, or develop into chromosomally compromised offspring (e.g., Down Syndrome).

Long agonist pituitary down-regulation protocols: Within a few hours of administering an agonist (e.g., leuprolide, Buserelin, Nafarelin, Synarel), most LH is promptly expunged from pituitary gland reservoirs. The result….high blood LH concentrations, and consequential release of large amounts of androgens (mainly testosterone). The continued administration of agonists will ultimately exhaust pituitary LH reservoirs such that within a few days, blood LH concentration will decline, and over-production of ovarian androgens will thereby be avoided.

Long pituitary down-regulation protocols involve the administration of an agonist over four or more days prior to initiating ovarian stimulation with FSH-containing gonadotropins (e.g., Follistim, Gonal-F, Puregon). These protocols take advantage of this LH-depleting effect such that by the time COS with gonadotropins is initiated, the blood LH will be low enough to avoid over-production of ovarian androgens and thereby help protect follicle and egg development.

Short (flare/microflare) agonist protocols: This type of protocol involves commencing agonist administration at the time that FSH-gonadotropin therapy is initiated. This will usually result in a high (excessive) concentration of androgens bombarding follicle- granulosa cells from the very onset of COS…to the ultimate determent of egg/embryo “competency.” Since older women, those who have diminished ovarian reserve (DOR) and those with polycystic ovarian syndrome (PCOS) tend to have exaggerated pituitary LH production and/or activity leading to overgrowth of androgen-producing ovarian theca/stroma (hyperthecosis), they are the ones who are most susceptible to the adverse effects of agonist-induced, exaggerated LH-testosterone production caused by short (flare/microflare) protocols. Thus, in my opinion, it is prudent to avoid using this protocol, especially in such vulnerable individuals.

Antagonist protocols: There is another group of drugs that rapidly blocks the release of gonadotropins (FSH/LH) by the pituitary gland. These so called antagonists (e.g., Ganirelix, Cetrotide, Orgalutron) are traditionally administered starting 6-8 days after the initiation of controlled ovarian stimulation (COS). I believe that this might be all well and good with COS in younger women that have normal ovarian reserve and in whom LH activity is not excessive. However, the initiation of an antagonist LH blockade starting as late as 6-8 days after COS is started fails to protect early developing follicles and eggs from the potentially ravaging effects of over exposure to LH-induced ovarian androgens. Thus, in my opinion, it is preferable to commence antagonist therapy at the point that COS with gonadotropins is initiated, rather than starting a week or so thereafter.

Clomiphene and Letrozole: Similarly, since fertility drugs such as Clomiphene (Serophene/Clomid) and Letrazole (Femara) also cause increased release of pituitary LH, they are, in my opinion, best avoided in the IVF setting.

LH-containing menotropins: For the same reasons , the use of gonadotropins such as Menopur, that have a considerable amount of LH activity should in my opinion be limited in IVF, especially when it comes to older women, those with DOR and women who have PCOS. I submit that it is at all times preferable to predominantly use FSH-dominant, recombinant DNA-derived Follistim, Puregon and Gonal-F than to use LH-containing menotropins.

11 Responses to “Using Agonists and Antagonists in IVF: An Opinion”

PS says:

March 11, 2013 at 11:37 am

Age 37-38 I’ve had horrible response to the antagonist protocol with few follicles and uneven size. Responsed ok to first microflare but required huge doses of fsh (600 x 11 days), 5 eggs retrieved. Later continued same microflare with half dose of fsh with menopur, got 9 eggs (8 fertilized)
Repeated again with slightly less fsh and menopur, retrieved 17 but only 8 fertilized. Has to freeze at day 3 due to high e2 of 7500, 4 thawed but three were quite fragmented.
Other than control of high testosterone/dhea level, no other change.
What thought on such variability

Reply
- Geoffrey Sher says:
  
  March 12, 2013 at 12:37 pm
  
  Frankly, I do not use “flare protocols” because inevitably they result in an elevated LH-induced testosterone level. See below.
  
  Please go to the home page of this blog, (www.IVFauthority.com). When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  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
lucy says:

April 12, 2013 at 2:22 pm

Hello Dr. Sher,
I’ve been trying to get pregnant since I was 33 – now I’m 36. Husband is 44 (no previous kids) Spermogram is NORMAL. We’ve NEVER been pregnant.
High prolactin controlled by 2.5mg bromocriptine daily since 2012 (13.7 in April 2013)
7 failed IUI (3 with Clomid and Ovidrel; 4 only with Ovidrel)
FSH = 8 in March 2011; FSH = 13.7 in Dec 2012 AMH = 0.53 in Dec 2012
IVF#1 failed (March 2013) with 11 follicles> 4 eggs> 2 embryos (8cells – average quality; 4cells – low quality; both transferred on day 3) PROTOCOL: Birth Control Pill for 19 days, 200mcg Naferelyn (twice a day) for 12 days, 300 IU Puregon and 300 IU Menopur for 12 days; and triggered with 0.5 ml Ovidrel. PLUS: 40mg Enaxoparin after egg collection (clotting problems); Dexamethazone for 12 days during stimulation and Methylprednisolone for 4 days after egg collection.
Since I have noticeable low ovarian reserve and I had low response to medications I visited different clinics to know what could be my best option for IVF #2
1) Same clinic as IVF#1 – same protocol as IVF#1 – what is new: Dr. is considering Intra-lipids and 5mg Prednisone from day 1 of stimulation to the 1st trimester of pregnancy (suspecting embryo rejection problems); 1 IU growth hormone (Saizen) for 30 days from the day 1 of contraceptives; trigger with 2 injections of ovidrel instead of 1. QUESTIONS: is Prednisone and Dexamethazone together too much cortisone? Is cortisone plus intra-lipids too much? They prescribe this after a test showing 13% Natural Killer Cells. Is this the highest dose of hormones?
2) Going to Antagonist protocol – I was said in one clinic that I may respond better to this protocol. WHAT DO YOU THINK?
3) Natural IVF Cycle – I was said that since I had low response to hormone stimulations, then I should try just Natural IVF. WHAT DO YOU THINK?
4) Egg donation – SHOULD I TRY WITH MY OWN STILL?
Thanks in advance Doctor for any advice we are so confused, too many information, tired of negative results. No unlimited money to try all of the options.

Reply
- Geoffrey Sher says:
  
  April 12, 2013 at 3:01 pm
  
  You definitely have diminished ovarian reserve and this in combination with protocols that do not control ovarian LH-induced testosterone, in my opinion wont be optimal. I think your choices are 1) Aggressive stimulation on an agonsist/antagonist conversion protocol (LA-8), followed by selective embryo banking of CGH-normal blastocysts over several cycles versus ..2) IVF with egg donation. In either case, it would be advisable to also evaluate for possible autoimmune/alloimmune implantation dysfunction from the get-go.
  
  Please go to the home page of this blog, http://www.IVFauthority.com . When you get there, look for a “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  8. “IVF success: Factors that influence outcome”
  
  9. “Staggered IVF”
  
  10.“Embryo Banking”
  
  11. “Egg Donation”
  
  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
Emma says:

April 13, 2013 at 2:41 pm

Dear Dr Sher,

I am very intrested in your opinion. I will be doing the long protocol soon with the buserelin supression. Because of this, by the time i start my stimulation meds my LH will be close to zero as value so this will avoid over-production of ovarian androgens. In this case will i still need to have a half dose menopur (37.5) starting day 3 of meds or because the LH is already very low I can start menopur 75 on day 1 or 3 of stims?
I am 35 years old with normal ovarian reserve and a normal responder to meds ( day 3 FSH is 6 and AFC 17 )

Thank you very much,
Emma

Reply
- Geoffrey Sher says:
  
  April 13, 2013 at 8:12 pm
  
  Your LH will of course be suppressed with the Buserelin…but not totally. The Menopur adds a little LH (needed) from day 3 of stim and that is quite adequate.
  
  good luck!
  
  Geoff Sher
  
  Reply
Emma says:

April 13, 2013 at 8:32 pm

Thank you so much Dr Sher! Will you suggest adding on day 3 menopur 37.5ui or go with a vial of 75ui.
Usually I stim for 9 days and I will be on 200 ui puregon.

Kind regards,
Emma

Reply
- Geoffrey Sher says:
  
  April 14, 2013 at 2:03 pm
  
  75 is OK!
  
  Geoff Sher
  
  Reply
Jay says:

June 2, 2013 at 6:26 am

I am 33 years old, with an AFC of approximately 25. I get pregnant with un-medicated IUIs (3/4 attempts), but have lost all pregnancies around 8 weeks (1 chromosomally normal embryo, 2 with aneuploidies). I may have PCOS (based on a large number of follicles and elevated DHEAS), but everything else is bang normal. My LH is low (2.5 ng/ml) on CD3, and seems to rise normally, peaking on only on the day of the surge.

Despite my limited success at IUIs, my first IVF (with the microflare protocol and menagon) was a disaster: 11 eggs, 4 M2s, and 1 day 5 embryo 3AA grade embryo that failed to implant in my surrogate.

I am going back for another round of IVF; I’m switching to low-dose follistim, but I’m conflicted about when to start the antagonist. I see your point about a high LH level being bad, but I’m also concerned about a possibly deleterious effect on egg quality if LH is completely absent. From all indications, it does not appear to be high in the early days of my natural cycle.

I’m curious about how entirely the antagonist suppresses LH production. Is there a little occurring anyway? If taking LH separately with the follistim and the antagonist, what dose do you recommend?

Reply
- Geoffrey Sher says:
  
  June 2, 2013 at 9:07 am
  
  LH activity will not be completely absent if you add a little Menopur from day 3 of stimulation…forward. Of greater concern is the possibility of a hitherto undiagnosed implantation issue.Please go to the Home page of this blog, http://www.IVFauthority.com. When you get there, look for the “search bar” in the upper right hand corner. Type the following subjects into the bar, click on it and it will take you to all the relevant articles posted there.
  
  1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
  
  2. “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
  
  3. “Agonist/Antagonist Conversion Protocol”
  
  4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
  
  5. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
  
  6. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
  
  7.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
  
  I invite you to 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
Jay says:

June 9, 2013 at 12:23 am

Thank you so much for your feedback. I am a little puzzled as to why you think an implantation issue may be indicated in me; I’ve managed to get pregnant 3 times (out of 4 unmedicated attempts), and one of those times was with a embryo with Trisomy 4, which makes one think that my uterus is extremely receptive. There was a study which explored this concept recently: http://www.ncbi.nlm.nih.gov/pubmed/22848492

Additionally, in my IVF cycle, my one day 5 embryo was transferred to my surrogate.

Nonetheless, I’d love to arrange a consultation, I will be in touch.

Reply

Complete DQ alpha Match *Without* Natural Killer Cell Activation

Background: “Joanne”, a 36-year-old lady with normal ovarian reserve, had undergone three IVF procedures in a prior ... Read more

Loading ...

Join Me June 26 for a Webinar on Endometriosis & Fertility

Endometriosis is one of the most widespread conditions affecting women's fertility. Of the approximately 6 million women in ... Read more

Loading ...

Updated Edition of My Book Has Been Released

I'm happy to announce that after several rounds of major revisions, re-writes, and additions, the 4th edition of my book "In ... Read more

Loading ...

Gestational Surrogacy in a Woman Born Without A Uterus (Rokitansky Syndrome)

Background: Mary, 30 years of age and married to a fertile male partner, presented to me about four years ago with primary ... Read more

Loading ...

Top Search Terms for In Vitro Fertilization

Dr. Geoffrey Sher Recommends

Embryo Quality & Embryo “Competence” – Part III – Testing the Seed

This is the third and final post in three part series on embryo quality. In the prior two posts, I outlined the intrinsic/physiological factors and the clinical factors that can impact embryo “competence”. In this post, I will discuss the rol... more

Loading ...

Embryo Quality & Embryo “Competence” – Part One: Planting a Good Seed

“At 45 years of age the incidence of aneuploidy is likely to be nine in ten.” Several weeks ago, I posted an article about endometrial receptivity and its effect on IVF success. This, as I noted, was the “Soil” component of the “See... more

Loading ...

The Needle vs. the Dish: Should ICSI Be Used in All IVF?

The introduction of Intracytoplasmic Sperm Injection or ICSI has made it possible to fertilize eggs with sperm derived from men with the severest degrees of male infertility. What’s more, pregnancy rates achieved by this method of fertilization are... more

Loading ...

Embryo Implantation: What Farmers Can Teach us About Growing Healthy Babies

I often refer to the conception process in terms of a “seed/soil” relationship. Just as a plant can’t grow and thrive without first assuring that both seed and soil are good, neither can a pregnancy be successful without both the seed (e... more

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

Acupuncture and IVF: Does it Improve Success?

Loading ...

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

Loading ...

Understanding Immunologic Implantation Dysfunction Part 1: Setting the Stage for Selective Immunotherapy with Intralipid and IVIg

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

Complete DQ alpha Match *Without* Natural Killer Cell Activation

Background: “Joanne”, a 36-year-old lady with normal ovarian reserve, had undergone three IVF procedures in a prior relationship. The indication had been “bilateral tubal occlusion.” The reason why all three IVF attempts had failed ... more

Loading ...

Gestational Surrogacy in a Woman Born Without A Uterus (Rokitansky Syndrome)

Background: Mary, 30 years of age and married to a fertile male partner, presented to me about four years ago with primary amenorrhea (i.e. she had never menstruated) and wanting to have a baby. She was born with a condition called Rokitansky syndrom... more

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

Karmann and Ryan’s Journey – My Approach to Their Treatment

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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?

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...

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

Loading ...