Repeat chemical pregnancies

maryevelyn

1 Posts
Reply Posted on: Feb 19, 2013 at 12:49pm
Hello Doctor,Someone suggested I get in touch with you for advice on how to proceed. I am currently 34 and my husband is 38. This is our history.My husband and I tried on our own to conceive for 10 years with no luck. Never a late period or any other indication I had gotten pregnant. I had routine blood tests several times and was always told everything was 'normal'.First IUI with stims resulted in a great response, but no pregnancy. A cycle of medicated timed intercouse did result ina pregnancy, but it was ectopic. HSG showed everything was fine.MY RE used baby aspirin and folbic as standard protocol.my first IVF, I was on repronex only and 16 eggs were retrieved. ICSI was used and 14 fertilized. we transferred 2 blasts and froze 6 others. My first beta on 9dp5dt was 45. Second beta on 13dp5dt was 46. I was advised to stop meds and wait for miscarriage. A week later I went to the ER for pain which I though was ectopic and found a baby in my uterus with a heartbeat. Our daughter was born via c-section in May 2010.When she was 10 months old we did our first FET of 2 day 6 blasts. Chemical pregnacy (first beta was 24 I think).I asked for a hysteroscopy, and an endometrial biopsy before our next FET. I was also put on Lovenox (in addition to the BA and folbic). My embryos did not thaw well, so all 4 remaining were transferred. Also a chemical pregnany with a first beta of less that 20 ( I think).We decided to do one last fresh cycle. A polyp was found and we did a d&C and polypectomy prior to starting stims. My protocol was changed and I was on only Follistim. My E2 did not rise appropriately and by day 5 or 6 they were scrambing to 'catch me up' and I ended up being on around 600 untis of follistim + 4 vials of repronex a day. After trigger my E2 actually dropped. 15 embryos were retrieved, 8 fertilized and only 3 made it to blast. They were poor quality and all three were transferred. Another chemical. First beta was 8. Again, I was on BA, Lovenox, folbic (and I added fish oil).Since we are military and had spent considerable funds we decided to give Walter Reed a shot. They discovered a hydrosalpinx in my left tube and decided to remove both tubes as my previous ectopic was in my right. The doctor said that other than my tubes, everything looked great. No endo or scar tissue.This time (January 2013), I stimmed very well on 150U of gonal F and 75U of menopur. E2 rose well and was 3000 at trigger. 14 eggs were retrieved, 11 fertilized and on day 3 9 were growing well. A family emergency required us to do a day 3 transfer and we did a 10 cell and a 14 cell (which concerned me). All 7 continued to make blast, but only 3 were freeze quality. Once again, a beta of 4.5 indicated a chemical pregnancy.I should add that I used pregnancy tyests every cycle and would watch the hcg rise and then fall so I knew that when the beta was taken the hcg was already on the decline.Also, this last cycle my husband was told that he has viscous semen and an agent had to be added to liquefy it.So, my dilemma is this:I do not want to continue transferring embryos to a hostile uterus, but walter reed does not support the use of intralipids, immune testing, or surrogacy.I was able to convince a doctor at walter reed to order an rpl panel (minus the b2-glycoprotein (they dont do that test here)) and karotyping. Of course the karotyping won't help since our embryos are frozen at blast, but I am hoping for some explanation.I am concerned that I may have an immune issue that is causing the constant chemical pregnancies, but I am not sure what to do about it.
Me(34) DH(38)
TTC#1 11 years
FSP IUI #1 6/08 BFN
Stimmed TI 11/08 - Ectopic
IVF #1 08/09 DD
FET #1 TX (2) D6 blasts-Chemical
FET #2 TX (4) D6 blasts Chemical
IVF#2 Nov 11 TX (3) Day 5 Blasts - (2) 2BB
(1) 3AB - Chemical
Hydrosalpinx - removed both tubes
IVF#3 Jan 13-TX (2) 3d grade 2 (1) 10 cell (1) 14 cell - Another freaking CHEMICAL

Dr. Braverman

2026 Posts
RE: Repeat chemical pregnancies Posted on: Feb 21, 2013 at 6:31am
there are quite a few reasons for your difficulties and you really need a complete and correct evalutation. I know that is hard to do at Walter Reed , Ive had several patients from there. Feel free to call my office for a free 10 minute discussion and we can review your case and I can give you my thoughts.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.