| I often have patients who come to me from other | | | | proved useful in IVF as well. You might want to |
| clinics after having failed IVF multiple times. I also | | | | suggest this to your doctors. This regimen is |
| have patients of my own who need to do IVF | | | | unproven and controversial, however. Another |
| multiple times due to implantation failure and we jump | | | | suggestion would be to transfer at day # 3 instead |
| through whatever hoops we need to to get them | | | | of going to blastocyst. On the third day, embryos |
| pregnant. | | | | generally are between six to eight cells. |
| Sometimes patients think they have a luteal phase | | | | Blastocyst culturing means letting the embryos go to |
| defect. First of all, despite the fact that a patient | | | | blastocyst, usually five days in the incubators. We |
| may have had a luteal phase defect in the past, the | | | | have the ability to keep the embryos two additional |
| use of progesterone after egg retrieval is to treat | | | | days in a culturing material before implantation in the |
| for possible luteal phase defect. Therefore, you | | | | uterus. During this additional culture period, the |
| cannot have a luteal phase defect with your IVF | | | | embryos continue to grow to become "blastocysts". |
| cycles, and this is NOT the reason for the | | | | Blastocyst culturing is not perfected and I still believe |
| implantation failure. Something else must be going on. | | | | that the uterus is a much better culture media and |
| The quality of the embryos can be part of the | | | | incubator that the lab. Other disadvantages include |
| problem but I have had terrible looking eggs implant | | | | the fact that some patients, especially older patients, |
| into patients and they end up pregnant. Genetic | | | | may have no embryos develop to blastocyst and |
| abnormalities within the embryo may the culprit and | | | | thus lose the opportunity for a transfer. Another |
| PGD or pre implantation genetic diagnosis can be | | | | reason is that the number of embryos for freezing |
| used to select out for this, although it is not currently | | | | and the survival of embryos after thawing will decline, |
| recommended by many specialists due to the fact | | | | potentially lowering the overall successful outcome of |
| that the embryo may be damaged resulting in a failed | | | | a future single stimulation/egg retrieval treatment |
| cycle. | | | | cycle. |
| Implantation failure is a difficult problem because we | | | | Also keep in mind that pregnancy rates are very clinic |
| are not able to distinguish all the processes required | | | | dependent. There is a wide variety of pregnancy |
| for implantation, and there are not tests to help. The | | | | rates between clinic, and the rates can very much be |
| only current test available, b-Integrins, don't help | | | | influenced by the laboratory environment, the |
| because the treatment is to use more progesterone. | | | | physician skill doing the transfer and the stimulation |
| I would do that any way. | | | | and culture protocols. One option might be to try a |
| My approach to patients with implantation failure is to | | | | different clinic. I recently changed my clinic location |
| add the following medications: | | | | and our pregnancy rates are much better than |
| 1. Aspirin 81 mg per day beginning at the start of the | | | | before because we were able to build a better |
| cycle. | | | | facility. Our facility is a stand-alone center with a very |
| 2. Heparin 2000 units twice per day beginning at the | | | | high-tech laboratory environment. For instance, we |
| start of the cycle. | | | | have a large Hepa air circulation unit that utilizes only |
| 3. Medrol 16 mg daily until transfer then 8 mg from | | | | outside air and not recirculated air from within a |
| that point until positive pregnancy, then stop. | | | | multi-story office building. The air within the surgical |
| 4. Increase progesterone to 50 mg injection plus | | | | suite and embryology lab is expelled 24/7 with new |
| Endometrin 100 mg twice per day vaginally. The | | | | air that is super-filtered reentering the environment. |
| injections starts on the day of the retrieval and the | | | | In other words, every detail, from the medication |
| suppositories start the day after the transfer. | | | | protocol, to the ability of the reproductive specialist |
| This regimen covers most immune responses that | | | | to transfer the embryos skillfully all the way to the |
| might prevent implantation, as well as, any micro-clots | | | | air quality within the embryology laboratory, all can |
| that form at the site of implantation. It is used mainly | | | | have a play in whether or not you have implantation |
| in patients that have recurrent miscarriages, but has | | | | success with In Vitro Fertilization. |