Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Undergoing IVF Treatment.Diagnosed As Unexplained Infertility. What Could Be The Reason?
Question: We (Husband-36, WIfe-33) live in the U.S. (Boulder, CO) and have been undergoing IVF treatment since XXXXXXX 2011 at Colorado Center for Reproductive Medicine (which is considered be one of the top fertility centers in the US based on their success rates).
So far we have performed four IVFs in the past 1.5 years, but haven’t been successful.
We were supposed to be ideal candidates, but at this point diagnosed as unexplained infertility.
Test results:
1. No male issues (good sperm count, motility, morphology, no Antisperm Antibody): all normal
2. No female issues (no uterine polyps, fibroids, Hysteroscopy clear, good hormone levels of FSH, LH, AMH, Estrogen, prolactin, TSH: 1.5, AFC: 14-17,
3. Beta integrin proteins present
4. Karyotyping on both of us-normal.
5. All communicable tests are normal (HIV, STD, Hep-A, Hep-B).
6. Tubes open, checked w/ HSG.
7. Antiphospholipid antibodies-normal
We have not yet performed the following tests (because our RE doesn’t think that they are necessary):
· Immune testing (e.g. NK Cells, Matching DQ Alpha, etc.)
· Blood Clotting tests (Thrombophilia)- But we have done APA which is normal
· No laparoscopy- So don’t know whether we have Endometriosis (according to our RE, this shouldn’t be an issue as we have beta integrin proteins)
However, some of the issues we have seen are:
· Irregular periods (we believe mainly due to tendency of taking stress/tension),
· Blood flow to uterus not perfect (seem to get affected w/ stress)
· Sub-clinical hypothyroidism (taking 25 mcg Levothyroxine 1/day)
Our IVF History:
1. IVF 1: Fresh Tx of 2 of Day 5 blastocysts (4AA, 4BA)-BFN
2. FET 1: 2 Day 5 Blasts (3BB, 3BB): Miscarried at week 7 (according to RE mostly due to abnormal embryos)
a. Blood flow to uterus normal, Lining ~10 mm
3. FET 2: 2 genetically normal day 5 blasts (4BB, 4BB) (they perform comprehensive chromosomal testing where all 23 pairs of chromosomes are tested)- BFN
a. Blood flow to uterus was significantly hampered (PI of >5 on both ovaries 5 days before ET), tried to correct it through vaginal Viagra from 5 days before ET till the day before the ET.
b. Lining ~8-8.5mm
4. FET 3: 2 genetically normal blasts (Day 6 5AA and Day 5 5AB)-Biochemical (Betas: 117, 143, 69)
a. Blood flow was somewhat hampered, used vaginal Viagra for about 2 weeks, stopped 5 days before ET.
b. Used estrogen estrace since 5 days before
5. Basically, I respond well to stimulations, produce high quality, genetically normal Day5 or Day 6 blasts. But end up either with no pregnancy at all, or miscarriage or biochemical pregnancies.
a. Avg. various parameters per cycle:
i. Eggs retrieved: 17-22,
ii. Fertilization: 11-17,
iii. Blastocysts Formation: 5-7
iv. Genetically Normal Embryos w/ CCS: 3-4
We would like to seek your opinion on the following questions:
1. What may be the reasons that are hampering our chances?
o We have failed IVFs w/ chromosomally normal Day 5 blastocysts.
2. What additional tests would you recommend we should perform? Are we missing any important parameters?
3. Could potentially undiagnosed Endometriosis be causing this?
4. Could the toxicity of vaginal Viagra might have led to implantation failure and miscarriage during our last 2 transfers when genetically normal blasts were transferred?
a. 3rd transfer: Viagra was given till 1 day before ET- BFN
b. 4th transfer: Viagra was stopped 5 days before ET- BFP/chemical, Betas: 117, 143, 69
c. 2nd transfer: No Viagra, BFP, miscarried at 7th week (mostly due to abnormal embryos). This may indicate that uterus may seem to be working fine as long as blood flow is adequate.
5. Is there any specific Indian origin male or female issue that we may be overlooking?
6. What do you recommend we do for our next transfer?:
a. We have 4-5, day 5 chromosomally normal blastocysts. We would like to do the ET soon.
b. Shall we do anything different?
Could please Dr. Malpani answer my question?
So far we have performed four IVFs in the past 1.5 years, but haven’t been successful.
We were supposed to be ideal candidates, but at this point diagnosed as unexplained infertility.
Test results:
1. No male issues (good sperm count, motility, morphology, no Antisperm Antibody): all normal
2. No female issues (no uterine polyps, fibroids, Hysteroscopy clear, good hormone levels of FSH, LH, AMH, Estrogen, prolactin, TSH: 1.5, AFC: 14-17,
3. Beta integrin proteins present
4. Karyotyping on both of us-normal.
5. All communicable tests are normal (HIV, STD, Hep-A, Hep-B).
6. Tubes open, checked w/ HSG.
7. Antiphospholipid antibodies-normal
We have not yet performed the following tests (because our RE doesn’t think that they are necessary):
· Immune testing (e.g. NK Cells, Matching DQ Alpha, etc.)
· Blood Clotting tests (Thrombophilia)- But we have done APA which is normal
· No laparoscopy- So don’t know whether we have Endometriosis (according to our RE, this shouldn’t be an issue as we have beta integrin proteins)
However, some of the issues we have seen are:
· Irregular periods (we believe mainly due to tendency of taking stress/tension),
· Blood flow to uterus not perfect (seem to get affected w/ stress)
· Sub-clinical hypothyroidism (taking 25 mcg Levothyroxine 1/day)
Our IVF History:
1. IVF 1: Fresh Tx of 2 of Day 5 blastocysts (4AA, 4BA)-BFN
2. FET 1: 2 Day 5 Blasts (3BB, 3BB): Miscarried at week 7 (according to RE mostly due to abnormal embryos)
a. Blood flow to uterus normal, Lining ~10 mm
3. FET 2: 2 genetically normal day 5 blasts (4BB, 4BB) (they perform comprehensive chromosomal testing where all 23 pairs of chromosomes are tested)- BFN
a. Blood flow to uterus was significantly hampered (PI of >5 on both ovaries 5 days before ET), tried to correct it through vaginal Viagra from 5 days before ET till the day before the ET.
b. Lining ~8-8.5mm
4. FET 3: 2 genetically normal blasts (Day 6 5AA and Day 5 5AB)-Biochemical (Betas: 117, 143, 69)
a. Blood flow was somewhat hampered, used vaginal Viagra for about 2 weeks, stopped 5 days before ET.
b. Used estrogen estrace since 5 days before
5. Basically, I respond well to stimulations, produce high quality, genetically normal Day5 or Day 6 blasts. But end up either with no pregnancy at all, or miscarriage or biochemical pregnancies.
a. Avg. various parameters per cycle:
i. Eggs retrieved: 17-22,
ii. Fertilization: 11-17,
iii. Blastocysts Formation: 5-7
iv. Genetically Normal Embryos w/ CCS: 3-4
We would like to seek your opinion on the following questions:
1. What may be the reasons that are hampering our chances?
o We have failed IVFs w/ chromosomally normal Day 5 blastocysts.
2. What additional tests would you recommend we should perform? Are we missing any important parameters?
3. Could potentially undiagnosed Endometriosis be causing this?
4. Could the toxicity of vaginal Viagra might have led to implantation failure and miscarriage during our last 2 transfers when genetically normal blasts were transferred?
a. 3rd transfer: Viagra was given till 1 day before ET- BFN
b. 4th transfer: Viagra was stopped 5 days before ET- BFP/chemical, Betas: 117, 143, 69
c. 2nd transfer: No Viagra, BFP, miscarried at 7th week (mostly due to abnormal embryos). This may indicate that uterus may seem to be working fine as long as blood flow is adequate.
5. Is there any specific Indian origin male or female issue that we may be overlooking?
6. What do you recommend we do for our next transfer?:
a. We have 4-5, day 5 chromosomally normal blastocysts. We would like to do the ET soon.
b. Shall we do anything different?
Could please Dr. Malpani answer my question?
You have gone well into the detail of the subject. The most common cause appears to be the stress in the absence of any other identifiable cause. In India we do diagnostic laparoscopy and Hysteroscopy as routine before IVF. You may do Thrombophilia screen and NK cell test. the treatment of NK cells if present is uncertain and inadequate. There is no genetic difference in IVF success rates. We routinely advise meditation destressing antioxidant medications along with low dose of steroids aspirin and progesterone.Emdometriosis is treated only if its a large ovarian lesionore than 2.5cm. cautery of mild endetriosis does not improve conception rates. Use of Viagra is relatively recent and more needs to be seen. Please relax as much as possible this time. We have seen patients conceiving without treatment after 9 cycles of failed IVF. So it's essential to maintain adequate coital freq say every 2-3 days atleast. Best wishes
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. XXXXXXX for your reply.
-Which antioxidant medications would you recommend?
- Do you know of any correlation between clotting issues and recurrent IVF failures? We have not found out yet whether I have any clotting issues yet, hence we decided to do the thrombophilia panel.
-Could you please let us know how would the low dose steroid help in our case?
Regards,
XXXXXXX
-Which antioxidant medications would you recommend?
- Do you know of any correlation between clotting issues and recurrent IVF failures? We have not found out yet whether I have any clotting issues yet, hence we decided to do the thrombophilia panel.
-Could you please let us know how would the low dose steroid help in our case?
Regards,
XXXXXXX
Brief Answer:
follow up answer
Detailed Answer:
There are a lot of medications. Most commonly used is with lycopene.A popular brand in India id Lycored taken twice a day.
There is no definite evidence if thrombophilias pevent implantation , they generally cause pegnancy failure (poor embryo Growth) But the fact remains that ASA is commonly used by most after embryo transfer.
Best wishes
follow up answer
Detailed Answer:
There are a lot of medications. Most commonly used is with lycopene.A popular brand in India id Lycored taken twice a day.
There is no definite evidence if thrombophilias pevent implantation , they generally cause pegnancy failure (poor embryo Growth) But the fact remains that ASA is commonly used by most after embryo transfer.
Best wishes
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
