Multiple "unexplained" implantation failures


1 Posts
Reply Posted on: Jan 16, 2015 at 7:27am
Hi Dr. Braverman,
I am looking for advice on next steps for treatment. I am 32 and my husband is 35. We have been trying to conceive for 4 years and had one early pregnancy loss, conceived naturally shortly after we started trying. Since then, nothing. Our infertility work ups were "normal". I have hashimotos treated with daily synthroid. Hysterocopy removed a couple of small polyps, not seen on any previous ultrasounds. I have symptoms of endometriosis but have never had a laparoscopy. (Deemed unnecessary as have always had good response with IVF and good quality embryos). I have somewhat irregular cycles and typically several days of spotting leading up to my period (even on medication regulated cycles, eg. Medicated FETs, except when switched to PIO).
We have had 3 failed IUIs, 2 fresh IVF cycles/transfers (negative betas) and 4 failed FETs (also negative betas). All transfers have been with "good quality" day 5 blasts (in the 6 transfers, we have transferred a total of 10 blasts). We have never had PGS/PGD on the embryos. RPL blood panels were negative. We both have normal karyotyping. Other than that, we haven't had any other immune testing done, however, my current RE has included immune protocols to treat any potential immune issues (given my Hx of hashimotos and repeat implantation failure). Treatments have included neupogen shot prior to transfer, medrol, intralipids, and fragmin. Also have had endometrial biopsy prior to all frozen transfers. Prior to my last transfer, I went through the testing for endometrial receptivity array (ERA) and the results suggested a displaced window of implantation, or "non-receptive/ pre-receptive" on P+5 (day six of PIO administration). Repeat test at P+ 6 with the same protocol gave a "receptive" result. Our next transfer following the same protocol as I had during the "receptive" ERA test also gave a negative result (but I must note with this transfer we did not use any immune therapies as we did not know if they would affect the ERA results).

I am at the point where we have only one frozen embryo left and am ready to throw in the towel if this last transfer fails. Is there anything else we can do to give ourselves the best shot at success with this last transfer? Or, in any future cycles if we decide to continue with ART?

Dr. Braverman

2026 Posts
RE: Multiple Posted on: Jan 16, 2015 at 7:42am
I am very sorry for your difficulties. The best thing you could do if you only have one embryo left , is to get a diagnosis first then tailor the treatment to yoru diagnosis. Most of the errors that are made wtihout the complete testing are with the doses and fequency of the medicaitons. I would be happyt to assist you , please fill out a consult request from our website and we will schedule a free 10 mintue consult with me to reveiw your case and how I can help you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.