Ask Our Doctors – Archive
Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.
Hi dr Sher
As i read your blog about IID( Immunologic Implantation Dysfunction) you said ‘At first we believed that treatment with heparinoids, baby aspirin and steroids would be sufficient to deal with these problems. We later learned that aspirin was ineffectual, heparinoids alone were of limited value, steroids were only selectively effective and that down-regulation of NKa required repeated intravenous gamma-globulin (IVIG) or Intralipid (IL) infusions, combined with corticosteroid therapy.
So what is the effective treatment pre and post FET if we have active NK cells that triggers miscarriages/ implantation dysfunction?
Regards,
Robbyn
Intralipid/steroids started 10-14 days prior to ET and continued until pregnancy is ruled out or in the event of success, ..to the 10th gestational week. If there are APA the heparinoids are added and if it is an alloimmune implantation dysfunction (DQ alpa/HLA matching of partners) the continue the IL therapy to the 22nd week at 2-4 weekly intervals.
Good luck!
Geoff Sher
Hi
Do I try again, and what protocol, my clinic will just say try the same again, as you did get pregnant. I’ve just suffered my second chemical pregnancy at 5.5 weeks following my 5th ivf cycle. My history, is I had a healthy baby girl in 2015 following my first ivf cycle in 2014, using buserlin to down reg and 150 iu daily gonal f stims. From that cycle when I was 32 years old I got 23 eggs which I shared half, so from the 12, 7 fertilised with ICSI (male problems is our issue nothing wrong with me, husband has low everything) a few made it to blast day 5 but only 2 were good quality 2 x 4AB. One transferred and is my daughter the other was froze and later following FET in 2017 become a MMC at 13.3 weeks.
I did another fresh cycle prior to the FET in sept 2016, but used 150 menopur instead of gonal f, got 14 eggs (egg shared again) from the 7, 4 fertilised, one transferred day 5, grade 3BB – BFN.
Went back to gonal f for my 3rd fresh 2017 21 eggs, 18 fertilised, only 2 poorish quality left by day 5, 3BC and 3CC, chemical pregnancy, at 4.5 weeks. My 4th fresh cycle we went back to menopur, 13 eggs, 6 fertilised, did a day 3 transfer of 2x good 8 cell top grade one compacting embryos, others did make it to blast but not good enough to freeze, this was another chemical slightly later one than the first. Embryologist said this time my eggs were ‘sticky’ which made ICSI a little difficult and why only 6 fertilised.
Does it sound like I’ve now got a egg quality issue, would you recommend a different protocol, I seem to get pregnant most of the time and get a decent number of eggs, but don’t seem to keep the pregnancy. My lining is always about 16mm, I haven’t had blood checks done since I first started in 2014 are there any you recommend looking at my previous cycles? Between ivf cycles I do not have any issues with my periods etc. Is there anything you recommend that could improve egg quality if that could be the issue, or anything my husband can do?
Hi Dr Sher,
Would you recommend an ERA or endometrial biopsy test before embarking on a FET after a failed fresh cycle? Also, would you recommend PGS testing of frozen embryos? I am 30
There are needless to say many different opinions regarding the value of ERA. I personally am not a believer in the value of ERA and only do such testing upon the instance of my patients.
Geoff Sher
Hi There,
Just completed first round of IVF, Husband and I are both 28 years old. Initially my husband and i qualified because he has very poor quality sperm and very low count. Subsequently found out that i have PCOS with an AMH of 78! Which is pretty high as i understand. I was on 150 Gonal F and Orgalutran. First scan i had about 10 follicles on each ovary that were measurable however there were a lot more in there, i was on a freeze all cycle due to OHSS chance. My blood levels were quite high and i had shortness of breath before egg collection so they bumped my collection forward 1 day. Subsequently i had 31 eggs collected, 22 of them were mature. The embryologist mentioned something once he had collected the eggs, saying some of them were discoloured (browny tinge) with brown specks in them, he said they looked like they were ‘overcooked’. From the 22 eggs collected overnight our numbers dropped down to 5 and we were lucky enough to get 3 that made it to freeze. 1 AA quality and 1 AB quality (both were frozen on day 5) and 1 BB (frozen on day 6). I was just wondering, could protocol have an effect on my egg quality? (i am assuming discolouration in eggs and brown spots is not a good sign). Also if my egg quality is that bad then how did i manage to get 3 embryos in the end? Initially i think everyone thought those embryos were not going to make it as far as they did. The nurse said with the dramatic drop in numbers they said if i got 2 embryos to freeze they would be very happy with the results. I have spoken to many support groups and have found no one with ‘overcooked’ looking eggs or eggs with brown spots. People have had discolouration however not brown either grey or off white.
I will look forward to your thoughts.
Thanks in advance.
Hello Dr Sher,
Could you please tell me why with autoimmune ID, IL is only done x2 in total, and not continued until the 24th week of pregnancy like with alloimune ID? I have autoimmune ID and I’m so afraid of stopping IL upon confirmation of pregnancy, because all my past miscarriages have occurred around the 13th week of pregnancy.
Thank you
The effect of the IL infusion lasts around 6 weeks. Once the pregnancy has advanced beyond 12 weeks, the baby appears not to be at risk in such caaes.
Geoff Sher