Special Circumstances

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1. I have done five cycles of IVF and on three occasions my pregnancy test was negative while two cycles showed a low positive that never progressed to a pregnancy. What is wrong?
   
   When sperm meets egg, creating an embryo, an individual, genetically different from the mother, is nurtured within the uterus until delivery. Fortunately, the maternal immune system responds in a protective way in the majority of pregnancies. In some pregnancies, the implanting embryo elicits an aggressive response and this abnormal response can result in failure to implant, very early loss as in a chemical pregnancy, first trimester miscarriage or even placental insufficiency and decreased fetal growth in the second and third trimester.
   
   Patients who conceive without any assistance, but have recurrent pregnancy loss, were the first studied by Dr. Alan Beer and other reproductive immunologists. In these patients, autoantibodies like phospholipid or thyroid antibodies and specialized lymphocytes like natural killer cells may damage the delicate vessels and blood supply of the early placenta, causing clotting in the vessels and pregnancy loss.
   
   Certain patients who have recurrent loss or repeated failure with IVF treatment, may have abnormalities within this system of autoantibodies and natural killer cells that can be identified and treated prior to initiating another IVF cycle. This testing and treatment is controversial and is considered experimental because there are as yet, no large prospective randomized studies to prove efficacy. For additional information check http://www.repro-med.net/.
2. Can fibroids interfere with IVF?
   
   Fibroids are benign tumors consisting of fibrous tissue and muscle which grow in the uterus. The significance of fibroids relates to not only their size but also their location. Even small fibroids located inside the cavity of the uterus where embryos need to implant, may interfere with success and need to be removed. Fibroids that do not encroach on the cavity of the uterus are generally not significant unless they are larger than 5 cm in diameter and also if there are many fibroids causing significant uterine enlargement.
3. I am 34 years of age and have been told that I have premature ovarian failure. My periods stopped completely about two years ago and my FSH level is 55. Can you help?
   
   For reasons that we do not completely understand, your ovaries have stopped producing eggs prematurely. This may be because you started out with less than the average number of eggs or something in your system has caused your body to use up your allotted store of eggs sooner than is average.
   
   If your FSH has remained elevated on a number of repeat tests, then the diagnosis of premature ovarian failure is probably correct and your options include living child-free, adoption or in vitro fertilization using the egg from another woman preferably under 30 years of age.
   
   You can use the eggs of a friend, a family member, or you can recruit a donor through one of the agencies that we work closely with. Once you have chosen a donor, you will both be screened for infectious diseases as well as psychologically and we will then synchronize both of your cycles using the birth control pill. The egg donor will be given fertility medications and your uterus will be prepared with natural estrogen and progesterone and we will then harvest the eggs, fertilize them with your husband's sperm and then transfer embryos to your uterus during a short procedure no different from a pap smear or intrauterine insemination.
   
   If your egg provider is under 30 years of age, the chances of a successful birth can be as high as 60% per fresh transfer procedure.