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