2 Failed IVF Cycles

STL34

6 Posts
Reply 2 Failed IVF Cycles Posted on: Apr 13, 2011 at 8:44pm
Dr. Braverman:

I have two failed IVF cycles. My first had two good expanded blasts transferred on day five. There was no HCG present when tested at 6 and 8 days past 5dt. My second I had two blasts that had not yet expanded (one good and one not as good) and a thawed expanded blast that was from IVF --1 transferred. Again, there was no HCG present when tested at 6 and 8 days past 5dt.

My diagnosis is diminished ovarian reserve, endo and positive for several APAs. I also have an autoimmune type of arthritis with my current diagnosis (it has changed a few times over the years) being ankylosing spondylitis. While I have occassionally tested ANA+, I haven't for a while (March 2011 tested negative). I have been on sulfasalazine for this condition for a couple of years. I was on humira, but stopped it before IVF --1. After IVF --1 failed, I started Humira again and remained on it for IVF --2. My husbands SAs were good except the high resolution SA showed 3% morph. The DNA frag test was fine. For IVF --1, I did a long lupron protocol with HGH and dexamethasone (.75 mg). I did an intra lipid 20% infusion about 7 days prior to ER. I started Lovenox and baby aspirin after retrieval. I had 4 eggs retreived and 3 fertilize. All three were good expanded blasts by day 5. For IVF --2, I did a version of antagonist where half doses of ganirelix were started two days before stims, I also did estrogen suppositories, HGH and dexamethasone. I did an intra lipid 20% infustion about 8 days prior to ER. Lovenox was started with stims and baby aspirin was started after retrieval. I had 6 eggs retrieved, 4 mature and 3 fertilize. On day 5 I had two blasts that had not expanded (1 good and 1 not so good). I was on 300 ius of FSH meds during both IVF cycles. I stimmed 7 days and coasted a day before triggering for IVF --1. I stimmed 8 days with the last day being at half dose before stimming on day 9 with IVF --2.

Since my second failed IVF, I have had more testing that shows that APAs that weren't previously tested were high and those previously tested were still high. All of the IgM variety. I also tested positive for lupus anticoagulant and heterozygous for MTHFR. I was on over the counter B vitamin supplementation before both of these IVF cycles because of the sulfasalazine. However, after the MTHFR diagnosis, they switched me to two folgards a day.

I am gearing up for IVF --3. It will be another long lupron protocol. I started estrace last week and because of the clotting issues also started Lovenox.

I just feel like there is a piece of this puzzle missing. Is there anything else I should do? Is thore more testing that I need? Could the intra lipids or humira be hurting my chances of success?

I am OOP for all of this, so we are getting close to the end of the road for us financially (possibly also emotionally). I had a 2nd HSG done in March 2011 that showed 2 blocked tubes. So, we may not have hope if this cycle doesn't work!

Thank you in advance for any advice/information you can provide.

Dr. Braverman

2016 Posts
Re: 2 Failed IVF Cycles Posted on: Apr 13, 2011 at 10:12pm
Its very improtant during your treatments to follow all of the immune parameters so that you can asnswer the questions that you have posed. Are the doses and frequency of my treatments too little or too much. I think many people over look the question you have asked, can the treatments themselves be the cause of the problem, and in my experience the answer is yes. you certainly do have immune issues, its just the randomness of the treatments that Im concerned about.
I would be happy to go over your entire case wtih you , I understand you are at the end of a long journey and I would like to try and piece it all together for you. Call my office and ask for Kim she will be happy to set up a telephone consultation with me.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

STL34

6 Posts
Reply Re: 2 Failed IVF Cycles Posted on: Apr 15, 2011 at 3:09pm
Is there concern with being on humira during IVF cycles? I am on it to treat my ankylosing spondylitis. Since I stopped NSAIDs (I was on indomethicin) before we started TTC, I had been in more pain and experiencing even more joint stiffness (particularly in my back and neck). That is why I started the humira. We had been TTC for a year without results when I started humira. I was told that it could be used while trying to conceive where NSAIDs could not. I was concerned about it possibly having negative effects and that is why I stopped it a month before ET in IVF --1. But, I experienced more back/neck pain and stiffness, particularly around ET and when I was on bed rest. So, my doctor and I decided I wouldn't try stopping it during my next cycle.

I will talk to my husband about setting up a telephone conference. I will need him to be on board, but I think he might be. My other concern is how long it would take to do the testing and come up with a plan. I will start lupron around May 12 for what may be our last IVF cycle.

Dr. Braverman

2016 Posts
Re: 2 Failed IVF Cycles Posted on: Apr 16, 2011 at 4:29am
Decsions about Humira must be based on your current TNF levels, dropping your inflammatory cytokines too low may pose a significant issue as well. You clearly have an immune cause related to your losses and in many cases intralipids is not the correct choice, in fact the choice of treatment should be based on a full immune parameter. With your history we really need to review your treatments and modify your workup. I hope you are able to call me. Good Luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

STL34

6 Posts
Reply Re: 2 Failed IVF Cycles Posted on: Apr 21, 2011 at 9:13pm
I have a telephone consult set up with you for next week. As you may recall, I will be doing possibly my last IVF cycle in May with Lupron starting May 12. I was told there would still be enough time to do testing and everything with the call next week. I asked about whether it was okay for me to still be on Humira when we do the testing and was told you would let me know during our telephone consult. The problem is that it takes Humira a month to leave the system (according to my rhuematologist) and I am supposed to do my scheduled injection tonight. So, if I need Humira out of my system for the testing, I can't do my normal injection and get the testing completed before my IVF cycle (even without doing this injection, there still might not be enough time). What should I do?

I do one 40 mg Humira injection every other week for my ankylosing spondylitis. Thanks.