2 chemical pregnancies with IVF

millmeg

0 Posts
Reply 2 chemical pregnancies with IVF Posted on: Dec 2, 2010 at 9:01pm
Dr. Braverman,

I would love to hear any suggetions you have for us. I am 32 years old, husband is 34. I was diagnosed with hypothalamic amenorrhea which landed us in the fertility clinic to conceive. My husband has a varicocele and has moderate morphology issues. Since my diagnosis of hypothalmic amenorrhea a year ago I have taken it upon myself to stop exercising (only walking) and gained 20 pounds. My BMI is now 22.8! Because of the combined issues of my husband any myself, we have attempted 2 IUI's BFN (failed to produce follicles on 2 more attempts), and then moved on to IVF upon suggestion of our RE.

IVF--1 - Stimulated with menopur and bravelle
15 eggs retrieved, 11 mature, 9 fertilized with ICSI, transferred 2 blasts (looked great) on day 5. None to freeze. HCG was 16 on first check, 0 on next. Diagnosed with chemical pregnancy.

IVF--2 - Same stimulation with menopur and bravelle
20 eggs retrieved, 16 fertilized with ICSI, 2 8-celled transferred on day 3 (said they were Grade A), none made it to freeze after 5-6 days. BFP with HCG 297 at first blood draw, but I was already bleeding. Rechecked 2 days later at 111. Diagnosed with another chemical pregnancy.

Question: What should my RE be doing next? What does it mean that I have had 2 chemicals in a row? I have a follow up appointment next week and am concerned he is going to just say it is bad luck. I feel like there is something more...........could it be a blood clotting issue or immune issue? What tests do I need to have done?

Thank you so much for your time. Any advice is appreciated greatly.
Millmeg

Dr. Braverman

2026 Posts
Re: 2 chemical pregnancies with IVF Posted on: Dec 3, 2010 at 3:55am
Hi Millmeg, first I am very sorry for your difficulties(I know I always say that , but I feel I always need to address that first). I have many thoughts on your case. First with hypothalamic amenorrhea its important that the uterine lining be well estrogenized, did you prime with estrogen prior to your cycles, I usually go for 2-3 months with at least OCs before trying a cycle in those cases.
Next the morphology issue should be investigated with a DNA fragmentation and Oxidative Stress Assay to try and guage how significant the male factor is. Although most male factors show up between day 3 and 5 making it to blast does not rule them out.
Lastly any time you fail transfer of good quality embryos you need to rule out immune and thrombophilic issues in that order, as early losses that are not genetic are more often immune related than thrombophilic. I would be happy to asses those issues for you, and I suggest you rule everything out prior to starting another cycle so you minimize your chances of another chemical. I can assist you with this if you would like, you would just need to fill out the new patient questioniarre and call for a consult.
I hope this was helpful , good Luck.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

millmeg

0 Posts
Reply Re: 2 chemical pregnancies with IVF Posted on: Dec 3, 2010 at 12:48pm
Thank you for your quick response! After my follow up appointment with my RE next week we will consider a formal consult with you. I would do this now, but we live a LONG way away!

Thanks again for your expert opinion!
Millmeg

Dr. Braverman

2026 Posts
Re: 2 chemical pregnancies with IVF Posted on: Dec 3, 2010 at 11:35pm
Good Luck. Many patients of ours are from out of state, we set up telephone consultations for them for thier convinience.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.