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.
My partner has 31% antisperm antibodies. We just had a miscarriage at 5 weeks and 5 days. Could it have been caused by my antigens attacking the “early embryo, resulting in its destruction by phagocytic immune cells (i.e., phagocytic antibodies).”
I’m not sure how to word that I copied from your article. We went in for a scan two days after I bled moderately for a day and half and they couldn’t find anything in the uterus and my HcG levels were 11.
I’d had a severe headache a week before and very tender breasts. Just trying to give you all my symptoms.
We are going to try again but I want to rule out the possibility of another miscarriage as much as I can. My question really is could the antibodies be the cause of miscarriage at 5 weeks and 5 days. Or doesn’t Helen earlier if that’s the cause?
Thank you so much!
Missy and Antony
I doubt the antibodies had anything whatsoever to do with the miscarriage.
Geoff Sher
i am 48 years old with adenomyosis, I want to go through IVF with donor egg. my bones are weak we cannot shrink the adenomyosis with Zoldex. what are the change of me having a successful pregnancy? Any recommendation?
thank you
Adenomyosis is a condition where endometrial glands develop outside the uterine lining (endometrium), within the muscular wall of the uterus (myometrium). Definitive diagnosis of adenomyosis is difficult to make. The condition should be suspected when a premenopausal woman (usually>25 years of age) presents with pelvic pain, heavy painful periods, pain with deep penetration during intercourse, “unexplained infertility” or repeated miscarriages and thereupon, when on digital pelvic examination she is found to have an often smoothly enlarged (bulky) soft tender uterus. Previously, a definitive diagnosis was only possible after a woman had her uterus removed (hysterectomy) and it this was inspected under a microscope. However the use of uterine magnetic resonance imaging (MRI) now permits reliable diagnosis. Ultrasound examination of the uterus on the other hand , while not permitting definitive diagnosis, is a very helpful tool in raising a suspicion of the existence of adenomyosis.
Criteria used to make a diagnosis of adenomyosis on transvaginal ultrasound:
•Smooth generalized enlargement of the uterus.
•Asymmetrical thickening of one side of the (myometrium) as compared to another side.
•Thickening (>12mm) of the junctional zone between the endometrium and myometrium with increased blood flow.
•Absence of a clear line of demarcation between the endometrium and the myometrium
•Cysts in the myometrium
•One or more non discrete (not encapsulated) tumors (adenomyomas) in the myometrium.
Since there is no proven independent relationship between adenomyosis and egg/embryo quality any associated reproductive dysfunction (infertility/miscarriages) might be attributable to an implantation dysfunction. It is tempting to postulate that this is brought about by adenomyosis-related anatomical pathology at the endometrial-myometrial junction. However, many women with adenomyosis, do go on to have children without difficulty. Given that 30%-70% of women who have adenomyosis also have endometriosis…. a known cause of infertility, it is my opinion that infertility caused by adenomyosis is likely linked to endometriosis where infertility is at least in part due to a toxic pelvic environment that compromises egg fertilization potential and/or due to an immunologic implantation dysfunction (IID) linked to activation of uterine natural killer cells (NKa). Thus, in my opinion all women who are suspected of having adenomyosis-related reproductive dysfunction (infertility/miscarriages) should be investigated for endometriosis and for IID. The latter, if confirmed would make them candidates for selective immunotherapy (using intralipid/steroid/heparin) in combination with IVF.
Surgery: Conservative surgery to address adenomyosis-related infertility involves excision of portions of the uterus with focal or nodular adenomyosis and/or excision of uterine adenomyomas. It is very challenging and difficult to perform because adenomyosis does not have distinct borders that distinguish normal uterine tissue from the lesions. In addition, surgical treatment for adenomyosis-related reproductive dysfunction is of questionable value and of course is not an option for diffuse adenomyosis.
Medical treatment: There are three approaches.
•GnRH agonists (Buserelin/Lupron) which is thought to work by lowering estrogen levels.
•Aromatase inhibitors such as Letrozole have also been tried with limited success
•Inhibitors of angiogenesis: The junctional zone in women with adenomyosis may grow blood vessels more readily that other women (i.e. angiogenesis). A hormone known as VEGF can drive this process. It is against this background that it has been postulated that use of drugs that reduce the action of VEGF and thereby counter blood vessel proliferation in the uterus could have a therapeutic benefit. While worth trying in some cases, thus far such treatment has been rather disappointing
•Immunotherapy to counter IID: The use of therapies such as Intralipid (or IVIG)/steroids/heparin in combination with IVF might well hold promise in those women with adenomyosis who have NKa.
Fortunately, not all women with adenomyosis are infertile. For those who are, treatment presents a real problem. Even when IVF is used and the woman conceives, there is still a significant risk of miscarriage. Since the condition does not compromise egg/embryo quality, women with adenomyosis-related intractable reproductive dysfunction who fail to benefit from all options referred to above…(including IVF) might as a last resort consider Gestational surro resort consider Gestational surrogacy.
If you are interested in my advice or medical services, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com. You can also apply online at http://www.SherIVF.com.
Also, my book, “In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD
Hi Dr.
8 days after embryo transfer i had brownish discharge and it continues until day 10 then it turns red in day 11 (today) and the bleeding increases. Is it my period coming? Should i just continue with my progesterone pills? The test is 5 days ahead. Thanks for your advise.
It is hard to say. Unfortunately you will need to allow this to play itself out. Wait for the blood test and try not to stress out. That only will make matters worse.
Good luck!
Geoff Sher
Hi Dr Sher, I am experiencing hot flushes/flashes since switching from lupron to 1/2 dose cetrotide. Is that a normal side effect? I have never had this side effect on the usual ivf protocols.
It is nothing to be concerned about…in my opinion. Talk to your RE about it!
Geoff Sher
Hi Dr Sher, i was on a lupron cycle and my RE overlapped the last 2 days of the BCP with lupron. Then I stopped BCP and continued on lupron 10iu and period arrived after 7 days. Is that overlap of lupron with BCP (for 2 days) enough or is the fact that I continued lupron for another 7 days and started stims 2 days after period arrived sufficient?
I think it is OK, Jo!
Good luck!
Geoff Sher