Recurrent implantation failure

lindsey

2 Posts
Reply Posted on: Jun 14, 2013 at 8:01am
Dear Dr Braverman,

I have had 4 fresh DE cycles (a chemical on the 4th), and 3 FET DE cycles. Then my husband and I moved onto DD, as there have been some sperm issues. We have just had a FET embryo adoption cycle which was also negative.

I have had 3 hysteroscopies and 1 laparoscopy (no issues); have no bacterial infections; have had minor NKa activity occasionally (and treated as appropriate), and have on/off high TNFa (but still only early 30s at highest). I do not respond well to synethic estrogen, as tested by some of these cycles, so have to have natural IVF donor cycles (where I get a good lining).

I used Gcsf injections on 1 DE fresh cycle (the chemical) plus FET cycles (2 DE and the 1 DD cycle), where I had no HCG readings.

In total I have had 15 OE, 23 DE and 4 DD embryos transferred (total 42) but still only one chemical.

What are we missing?

Dr. Braverman

2004 Posts
RE: Recurrent implantation failure Posted on: Jun 14, 2013 at 8:12am
You are missing a complete and correct immune workup, you cant make a diagnosis with what yo have had done to date. At a minimum you need a complete HLA analysis on both you and your hsuband. (see my recent blog). I would be happy to assist you with this. you can send in a contact form from the website and we can arrange a telephone or SKYPE consult.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

lindsey

2 Posts
Reply RE: Recurrent implantation failure Posted on: Jun 14, 2013 at 9:10am
Thank you for your response. I have had A LOT of tests; I did not list them all...

We have had HLA-DQ testing; I am 0102, 0301 and my husband 0102, 0201. When we tested LAD in '11 my T cells IgG+ was 18.3% and B cells IgG+ was 89.5%. After 2 x LIT in March this year those results were 15.2% and 14.0%. We decided to move to double donation after this, to try and eradicate another potential issue.

I have had HLA KIR testing and I understand I am AA Haplotype as I only have the 2DS4 activating receptors (so missing 2DS1, 2DS2, 2DS3, 2DS5 and 3DS1).

I have not had the other HLA tests; is this relevant if we are using double donation?

Thank you in advance.

Dr. Braverman

2004 Posts
RE: Recurrent implantation failure Posted on: Jun 14, 2013 at 9:14am
Yes we would stil need the full HLA on both of you, need to assess what may have happened with previous attempts with your husband as well . There is no information at all from simply looking at DQalpha not sure why that is still done.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

Dr. Braverman

2004 Posts
RE: Recurrent implantation failure Posted on: Jun 14, 2013 at 9:15am
Also LIT based on LAD is not appropriate. It should be based on HLA status only as the LAD tells you nothing about the "type" of antibody you have and in most cases LIT is incorrectly prescribed. (see my blog).
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.