Repeated failed IVF with PGS tested embryos


5 Posts
Reply Posted on: Dec 2, 2016 at 4:28am
Hi Dr Braverman. Thank you for taking the time to read through all our questions and give us your advice! I have had numerous transfers of PGS tested embryos resulting in an ectopic pregnancy and a chemical pregnancy (my lining on 4 transfers was between 6mm-7mm on the day of progesterone). We are lucky to have some frozen embryos left so I am due to do the ERA (endometrial receptivity test) next month to check the genetic markers of my lining on the day the embryos would be transferred. I know my lining is a major issue but we needed to rule out immune issues also (all of my standard immunes were clear) I had some higher level immune bloods done recently in the Reproductive Immunology Associates lab in America. The results were as follows:

NK562 Test

Native State 10.2 – Abnormal NK Cell Activity (>10 abnormal) No stimulation with IL-2 therefore suppression with Intralipid recommended. (there was no suppression with IVIG and mild stimulation with IL-2)HLA Panel:


DQ Alpha: 1.2, 2.0

DQ Beta: DQ2, DQ6(1)

HLA A: A3, A30(19)

HLA B: B7, B13

HLA C: Cw6, Cw7

HLA DR: DR7, DR15(2)

DRB4 DRB5 presentHusband

DQ Alpha: 3.0, 3.0

DQ Beta: DQ3, DQ3

HLA A: A2, A2

HLA B: B27, B44(12)

HLA C: Cw5, Cw7


DRB4 presentOther Tests Completed:

Karotyping – Normal

APA – Negative

ACC IGG – Negative

Thrombphillia Screen – Negative

MTHFR – Heterozygous C677T (will be on Clexane)

Protein C – Negative

TPO – Normal

TSH – 2

Prolactin – ranges between 18 – 23ng/ml (take Dostinex 4 weeks prior to each transfer)

All other bloods normal (FBC, Vit D etc)

From what I can see we have 1 partial match on HLA C but I do not know how significant it is? Also my husband seems to have a lot of the same genetic markers, is this normal? I am also due to have a laproscopy in January to check for endometriosis and we are due to then have another transfer in February so I would love to hear your thoughts. Do you think it is most likely my lining that is the issue? We did have 2 transfers were my lining was just over 8mm on the day of progesterone but I was on no immune support for those transfers. Thank you for reading my message!

Dr. Braverman

2026 Posts
RE: Repeated failed IVF with PGS tested embryos Posted on: Dec 2, 2016 at 6:03am
You have not had enough immune testing performed to reach a conclusion. Based on your HLA this is not an incompatability issue. I do suspect that there might be a mitochondrial issue and yes it could be secondary to endo. But then there may also be other immune issues associated with endo that may also be coming in to play. If Im correct the embryo (although PGS normal) sitll might not work. I would also advise if you are going to look for endo , only a specialist in endo surgery (not an RE) should perform the procedure, if all is not identifield and excised you do not get the full benefit. You have genetic markers that we see in patients with these issues, but I would need a much broader workup to recommend your correct therapy. Feel free to fill out a consult requeist on my website and we can schedule a free phone call or SKYPE to review your case in detail.
Braverman Medical Team
Braverman Reproductive Immunology P.C.


5 Posts
Reply RE: Repeated failed IVF with PGS tested embryos Posted on: Dec 2, 2016 at 6:55am
Thank you so much for your reply Dr. Braverman! I will be seeing one of the top endometriosis doctors for my surgery in January so I am in good hands with that. The reason I am having the operation is because I have cysts on my ovaries for 1 year now (all of my fresh cycles were done before the cysts appeared) which my RE thinks is endo, also my sister has endo. I had a lap 5 years ago and none was found at that point but we need to rule it out again. When you say mitochondrial issues do you mean with the embryos? From my understanding embryos with this high DNA won't implant? This makes me very nervous :-( my main issues is, we have 6 top quality frozen embryos left and we just can't afford to move them to another clinic as the cost is huge. Also our doctor in the IVF clinic does not like to work with other doctors so I feel we are stuck in a very bad position and I am so anxious over it. Is there any other blood tests you would recommend for me to have? I will be having intralipids/steroids as part of our next protocol also. If it turns out the issues is mitochondrial, would that mean it's likely all of the 5 embryos won't implant or could

some of them be ok? I thought my lining was the main issue as we have had so many cycles cancelled due to a thin lining!

Dr. Braverman

2026 Posts
RE: Repeated failed IVF with PGS tested embryos Posted on: Dec 2, 2016 at 8:06am
ok so at least you have the endo issued covered by going to a top excision specialist. The only testing that is viable is the testing we perform. If I would help you , you are correct your doctor would have to allow this. Yes even with PGS tested embryos if the mitochondria are affected they will not be successful most of the times. Giving Intralipids and prednisone without a complete workup is simply guess work and while it may be successful it is "blind" therapy. Our new data shows that Intralipids may not be effective if patients Free Fatty Acid profile is not correct and if correct may not need intralipids.
Braverman Medical Team
Braverman Reproductive Immunology P.C.


5 Posts
Reply RE: Repeated failed IVF with PGS tested embryos Posted on: Dec 8, 2016 at 5:59am
Thank you Doctor Braverman, I am waiting to speak with my IVF doctor to see if he will agree to let me consult with another doctor so fingers crossed! I have been reading all your blogs on mitochondria issues and I was wondering are there any signs that the embryos may be affected? My FSH/LH/AMH and ovarian reserve are all normal for my age, I always respond very well to the meds getting a good number of embryos and about 80% blast rate. We have almost a 100% fertilisation rate, our embryos divide perfectly and are always 'top AA grade'. I am not obese and I do not have PCOS. I was 35 at the time of embryo collection. The only thing I seem to 'fit' is the fact I may have endometeriosis on my ovaries however I do not know if this was even there at the time I had the fresh cycles. In your experience with mitochondria issues, is there a 'pattern' you would look for to suggest there may be issues and taking all the above into account, do you still think this could be an issue for us? I look forward to hearing from you again!

Dr. Braverman

2026 Posts
RE: Repeated failed IVF with PGS tested embryos Posted on: Dec 8, 2016 at 6:39am
Your embryo history does make it less likely and this could simply be an immune issue that needs treatment. We would not know without a complete workup.
Braverman Medical Team
Braverman Reproductive Immunology P.C.