www.reproductivepartners.com

Hi,
I fall under the category of unexplained infertility. I have done numerous iui with no success and moved on to ivf with PGS tested embryos. i have done all the tests from HSG, Hysteroscopy to remove a fibroid more than one year ago, a sonohystergram as well as a biopsy of the endometrium lining. Everything has come back normal. First FET transfer of one PGS tested 5 day grade AA blastocysts was failed. what is the success rate for the PGS tested 5 day blastocyst of AA and AB quality? also, how often do you see repeated failed FET transfers when transferring PGS tested embryos with no knows cause to the female partner?

Unfortunately it's never a sure thing even though it seems it should be with normal PGS great quality embryos. (You did not mention your age although that's not a big factor with PGS normal embryos.)

When this happen I may recommend a mock cycle with biopsy for progresterone effect and/or Endometrial Receptivity Assay (ERA).

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

thank you. though i have heard mixed feelings about the ERA testing? I have heard that there is much evidence to support this and only about 15-20% of people actually come back with results that are positive (meaning a window that may suit the endometrial lining better). I forgot to mention my age is 36.

Don't forget this test is usually done only on women who have had repeated implantation failure and if it's a valid test one would expect a fairly high positive rate in this population.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

I am 33 yrs old, husband 39 yrs old, I had one normal pregnancy 8 years ago and we aborted it for non-health issues, after that we waited for 5 years then we wanted to start our family and it has been more than 4 years with 3 failed IUIs and 2 failed IVFs, diagnosis is unexplained infertility as all the regular fertility test are negative. The embryos from each cycle were transferred at day 3 (I have been told the eggs were not that good, however in each cycle produced 12-16 eggs each time of IVF with only 3 embryos 1st time and 4 2nd time).
Now we consulted a second doctor and he thinks it is the control of the stimulation medications and I did APA and NK activity tests and came out NK activity slightly high and for APA it is positive for AntiB2glycoprotein I Igm, and AntiB2glycoprotein I IgA.
So the second doctor plan is to go with conventional IVF with Lupron, Intra lipid injection before transfer and after positive pregnancy test and Lovenox prophylaxis dose.

I need your opinion in regards to the 2nd Doctor plan and whether there are other tests and plans we should consider.

Appreciate your time and help
Pola

We don't believe in immunotherapy in IVF.

Besides, although you call it unexplained, the problem with embryo development can explain your lack of success so far. It would seem that doing things to improve embryo quality and checking their chromosomes with PGS and freezing all the embryos before transfer to avoid negative effects of the stimulation meds would make sense.

Of course I do not know all the facts so there may be issues I am unaware of. Maybe another formal opinion would be beneficial.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Dear Dr. Wisot,
Thanks for answering my questions.
You mentioned there are ways to improve embryo/ egg quality, Beside doing the genetic testing, what are the things that could be better managed before going into 3rd IVF? How to improve the quality?
AMH is 6.5 and the hormonal levels all normal.

Appreciate your help
SP

We have found that for some couples these may improve egg/embryo quality:

Before the cycles a vitamin and antioxident regimen which can be found through our Lifestyle & Fertility page to the lifechoices page link.

During the cycle, growth hormone during the stimulation and co-culture in the lab.

I can't get more specific than that here,

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Dr Wisot,
My husband and I very thankful for your thorough messages and advice.
I will be contacting your office soon for official consultation.


Sp

Dr.Wisot,

I need your help and advice ASAP, I am still under the fertility Dr. who does the immunology treatments, he did a test called DQ alpha for both my husband and I and the results came back 100% match, he did this test recently while I am about to start my stimulation medications in few days and now he backed off on us saying there is no hope for successful implantation and we have only two options:
Sperm donor or Surrogate.
we are highly devastated and shocked, so from your opinion is that something you will also back off and not willing to treat? or you think this is not an issue and we can try a normal IVF as you mentioned before?


Please I need your help as we are about to decide to abort this trial with him.