what is the most difficult step in IVF?

sliz · December 2009

does anyone know what the hardest part is for a good outcome? like after the transfer, the implantation should be the most "robust" part of IVF right? i.e. if they can get good eggs & embies, even if you have to go through one or more cycles, you should be able to get pg eventually right?

Kiki11 · December 2009

I seem to have an implantation issue. Shortly after they implant, they fizzle out. They're not sure if it is an embryo issue or a lining issue... they're just calling it 'Repeated Implantation Failure.' Although all of the REs we've talked to have given us hope that eventually it will work for us.

flutterby918 · December 2009

Kiki11:
I seem to have an implantation issue. Shortly after they implant, they fizzle out. They're not sure if it is an embryo issue or a lining issue... they're just calling it 'Repeated Implantation Failure.' Although all of the REs we've talked to have given us hope that eventually it will work for us.

Kiki, have you had endometrial biopsy? I had one and found that I have immuno issues in the lining (NK cells) that can prevent implantation. We did (although we didn't make it to transfer last time) and will be doing again with our FET, IV intralipids. They have been shown to help with the NK cells and support implantation.

Kiki11 · December 2009

flutterby918:
Kiki11:
I seem to have an implantation issue. Shortly after they implant, they fizzle out. They're not sure if it is an embryo issue or a lining issue... they're just calling it 'Repeated Implantation Failure.' Although all of the REs we've talked to have given us hope that eventually it will work for us.

Kiki, have you had endometrial biopsy? I had one and found that I have immuno issues in the lining (NK cells) that can prevent implantation. We did (although we didn't make it to transfer last time) and will be doing again with our FET, IV intralipids. They have been shown to help with the NK cells and support implantation.

I have had an endometrial biopsy (in October) and they said it was normal. And interestingly, my RE and just about all of them in my area, refuse to use intralipids. Something about the research not supporting their use or something. I don't know. But if this doesn't work, we will probably look into some place (even if we have to travel) that does further immune testing/treatment!

flutterby918 · December 2009

Kiki11:
flutterby918:

Kiki11:
I seem to have an implantation issue. Shortly after they implant, they fizzle out. They're not sure if it is an embryo issue or a lining issue... they're just calling it 'Repeated Implantation Failure.' Although all of the REs we've talked to have given us hope that eventually it will work for us.

Kiki, have you had endometrial biopsy? I had one and found that I have immuno issues in the lining (NK cells) that can prevent implantation. We did (although we didn't make it to transfer last time) and will be doing again with our FET, IV intralipids. They have been shown to help with the NK cells and support implantation.

I have had an endometrial biopsy (in October) and they said it was normal. And interestingly, my RE and just about all of them in my area, refuse to use intralipids. Something about the research not supporting their use or something. I don't know. But if this doesn't work, we will probably look into some place (even if we have to travel) that does further immune testing/treatment!

Ok, just a thought I had. I figure in the end, it can't hurt. In the whole scheme of things, it not much more money, and basically it's just fat so there isn't any negative side effects. GL with your FET!!!

sliz · December 2009

i got pg successfully once although i lost them at 17 wks (because of intrauterine bleeding/infection)...but now that with the IVF i got good eggs and embies, a part of me wonders if the reason that i haven't gotten pg with femara/other cycles this past year had more to do with my uterine lining rather than not getting good, fertilized embryos...

i guess they will have to do at least 2 transfers and if I don't get pg, look for something else...this is the last part of the equation - our doc literally said that we make good eggs, good sperm and together good embies - i know sometimes "it just doesn't work" but if my beta is negative tomorrow, I just want to know what other options we have to look for a reason i'm not getting pg....

sescms2004 · December 2009

my clinic believes that getting genetically normal embryos is the most critical step. Even in women under 35, 60% of eggs are typically abnormal. And women w/ low reserve or high fsh can have even higher % abnormal. I have had 4 losses, and my dr. believes that the earlier they occurred, the more likely they were to have been genetically abnormal. So, even though I have low fsh, I have low reserve, and therefore poorer egg quality than most my age. My clinic believes in customizing IVF protocols to optimize your egg quality, so that is the biggest hurdle in my opinion. With an AFC of 9, I'll be lucky to get that many eggs, and know that all won't fertilize, and a small portion of those that do will make it to blasts. At this point, I just hope I have something to transfer.

BTW - are you going to test tonight??!!

flutterby918 · December 2009

sliz I wish I could tell you I had an idea of what it could be, but I am totally not sure. As you said, you sucessfully got pregnant before, so you know you can, but maybe the issue is holding onto that pregnancy. I am not sure what tests that can do to determine that. I hope and pray that this cycle works for you. I am holding out hope for my upcoming FET because neither of my 2 IVFs have gotten me anywhere yet. (((HUGS)))

Ruby_Tuesday · December 2009

I'm in the same boat as all of you. I lost my first pregnancy after interuterine bleeding (subchronic hemotoma). We don't know what prompted the bleeding. And then 3 pregnancies that obviously stopped shortly after implantation. This is my first IVF and my egg + DH's sperm look good and have created top notch embies. I'm truely afraid that these top notch embies are going to fizzle out shortly after implanting due to who knows what... I have also had a endometrial biopsy that I was told came back 'normal'.

sliz · December 2009

sescms2004:

my clinic believes that getting genetically normal embryos is the most critical step. Even in women under 35, 60% of eggs are typically abnormal. And women w/ low reserve or high fsh can have even higher % abnormal. I have had 4 losses, and my dr. believes that the earlier they occurred, the more likely they were to have been genetically abnormal. So, even though I have low fsh, I have low reserve, and therefore poorer egg quality than most my age. My clinic believes in customizing IVF protocols to optimize your egg quality, so that is the biggest hurdle in my opinion. With an AFC of 9, I'll be lucky to get that many eggs, and know that all won't fertilize, and a small portion of those that do will make it to blasts. At this point, I just hope I have something to transfer.

BTW - are you going to test tonight??!!

I don't think i will test - i am a total poas chicken - i also don't want to jinx my beta - DH might push me to do it though but i guess as long as there is no neg hpt, i can still hold out hope....

i am confused about this process too honestly - i don't understand how anyone gets pg or how i got pg...i was so hopeful after we lost the twins - i just felt it was a matter of getting me to ovulate and presto, we'd be pg again within a cycle or two - i even bucked up and lost a lot of weight and did everything to O on my own or help the meds work - instead i got several failed cycles and when i did O on my own, it was a messy cd 7 ovulation that then caused the clinic i was working with to test my AMH which came out as 0.6 even though my dx was up to then (and still is according to my RE) PCOS. When they did AFC counts the following 2 months, it was 21 and 23 total. I produced two follies on low does follistim (which is supposed to be magic for pcos people) but had a weak/early O (before they could trigger)....then i did IVF and so far produced good eggs/embryos....

half the things i read say AGE is the primary indicator of successful outcome and low amh in young patients isn't as dire as it is in older patients...other things i read said amh is indicative of egg quantity AND quality - but then how did my amh come out low and i got both good quantity and quality of eggs at ivf? ARGH....

are you using a SIRM clinic? i did like them but their success rates in dfw were lower then dr. barnett's - it was a hard choice....plus SIRM offered to retest AMH and inhibin B and also test NK cells - i guess those are options if we fail 2 cycles.....

sescms2004 · December 2009

Yes, I am at SIRM. My doc also believes age is the biggest factor, but I've been having losses since I was 31. We did find several immune issues, so at this point, we don't really know if it's egg quality or immune issues. IVF should tell us a lot, once they see the sperm & eggs combine and how our embryos might look.

If this fresh transfer didn't work for you (which I think it will!), I think that looking into immune issues would be a reasonable thing to do. The treatments are fairly simple - lovenox, intralipids, and steriods. I think you made the right choice w/ Dr. Barnett. I would probably have chosen him, as wel, if we were still in DFW.

sliz · December 2009

sescms2004 -

they did an RPL panel on me after losing the babies and there were no immune or clotting issues that came up - the one thing that my MFM didn't test for is NK cells - which SIRM seems to push but no other RE did....

sescms2004 · December 2009

Yeah, I wouldn't worry about NK cells too much, if I were you. If they were going to have an impact, it would have happened way before 17 weeks. That's great that all your RPL testing came back negative. Your prognosis sounds great!!

Ali212 · December 2009

I seem to have implantation issues as well (I'm completely self-diagnosing here but that's all I can imagine). IVF has been really smooth for me - no issues with the shots or meds, no real side effects and the ER/anesthesia doesn't bother me. I'm so-so in terms of eggs...they get 7-9 and with ICSI most fertilize but my viable embryos typically get to 2-3 when it comes ot transfer. That said, the 2-3 viable embryos my RE has transferred for all 3 of my IVFs have been 'perfect' in their words. So, I would think I would have gotten pregnant by now given the 7 perfect embryos that have been transferred...but no...so I figure it's got to be some implantatation issue.

sliz · December 2009

sescms2004:
Yeah, I wouldn't worry about NK cells too much, if I were you. If they were going to have an impact, it would have happened way before 17 weeks. That's great that all your RPL testing came back negative. Your prognosis sounds great!!

thanks - Dr. saleh at SIRM dallas was the only RE interested in testing these and he said it was because they never identified the source of bleeding and the root of the loss - the babies were healthy the entire time in utero and the ultimate loss was caused by membrane rupture on one of the twins...

not that i would ever want to experience another m/c but i have never even seen a + hpt since the loss - so i could never even be sure that the eggs/sperm were even getting together or "trying" to implant....

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