Recurrent implantation failure with PGD tested embryos from donor

Amber

1 Posts
Reply Posted on: Aug 18, 2015 at 2:58pm
Dear Dr. Braverman,

I am in the following predicament which I would like to hear your thoughts about:

My husband is 35 years old and I am 36 years old. We started fertility treatments almost two years ago, originally because my husband had minor motility issues with his sperm. I got pregnant on my first IUI but it was ectopic. After additional IUI's that failed, I did several IVF cycles, only one of them resulted in a transfer of a 5 day embryo that almost became a blastocyst. I was diagnosed as a poor responder to the meds with an egg factor. We switched doctors and found out that in a matter of two months, my AMH levels dropped from 1.4 to 0.5. I decided to move on to an egg donor. We did an egg donor cycle with a 23-year old donor. The cycle produced 10 blasts: 3 day 5, 5 day 6 and for some reason, they froze 2 more from day 7. We did PGD on the embryos and only one, day 6 blast came out chromosomally abnormal. I did one transfer of a day 5 blast graded 4AA, the lining was 10.5, with a triple layer lining pattern. This transfer failed despite being given 80% success chance. We were told that we should consider this "bad luck" and that that is why the chances are not 100%. A week before the second transfer, the doctor told me that he had consulted with his colleagues and that they think I have an arcuate uterus, the mildest degree possible. Please note that this was the first time in my life ever hearing about me having this condition. I was treated under numerous doctors, did two hsg’s, saline ultrasounds, etc. and was never told that I have an arcuate uterus. I know it is a normal deviant but the doctor still said that if the coming transfer fails, he would want me to do a surgical hysteroscopy to repair this. After the first failed transfer, I raised the issues of Thrombophilia and immunological dysfunction with my doctor. He explained that he wrote about and studied immunological dysfunction, that it is a very controversial area, that the immunological dysfunction tests are not accurate and that the tx is not empirically established or was shown to be effective. He said that there are some doctors making a lot of money of this issue. The second transfer failed as well. I transferred 2 embryos: one day 5, graded 3AA and one day 6, graded 4BB.

I am in a loss of words. I have a feeling that the arcuate uterus issue is just an explanation that was given to us because there are no other apparent explanations for this. We spend close to 100k over these fertility treatments and I know that surgical hysteroscopy will perhaps address a morphological issue ( which I don’t understand how come was only “discovered” now). However, if an arcuate uterus is a normal deviant, why should it be surgically fixed? A surgical hysteroscopy does not address immunological dysfunction issues or Thrombophilia. I am afraid that the surgery will cost a lot, I might end up using all of my remaining 4 embryos (excluding the ones from day 7) and still end up having to undergo another egg donor cycle, or maybe even gestational surrogacy or adoption. Is it time for me to seriously consider surrogacy? What are the costs associated with doing am immunological dysfunction test panel? Are the treatments really ineffective? What are the side effects that occur with immunotherapy?Buy the way, my doctor told me that I might as well take the treatment directly rather than to take these tests as he said that these tests will indicate that I have a problem for sure, so I might as well save the expensive tests cost. Could there be a situation in which these good embryos from this donor just do not work well for my body and if I switch donors it will suddenly implant? Buy the way, I am treated by a colleague of one of the doctors that is written down here as a doctor who consulted or collaborated with you at the Fertility and Surgical Associates clinic in Thousand Oaks Califonia. I would really appreciate to hear your thoughts about our desparate situation. Thanks much!

Dr. Braverman

2016 Posts
RE: Recurrent implantation failure with PGD tested embryos from donor Posted on: Aug 21, 2015 at 9:57am
This is clearly an immune related issue. Best is to fill out a consult request from our website and we will schedule a free consult with yout to discuss your case , Im sure I can give you answers and offer treatments. I completely disagree with taking treatments without tests as you will knot know the correct medications, correct doses, and correct frequencies with out knowledge of what the problem is . This advice is usually given by those wthout the ability to correctly interpret these tests.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.