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repeated IVF failure

By: J.Hijjawi, alhayat ART center, AMMAN,JORDAN 23 March 2005

Question: I have 42 yo woman who had 13 attempts of IVF, all failed. I supervised attempt no.13,on flare microdose decapeptyl and menogon 375iu she responded very nicely (10 days stimulation,and peak E2 2600pgm). At OPU, I got 9 MII oocytes, all ICSIed and 5 good quality embryos (3GI,2GII), transfered after assisted laser hatching, and again no pregnancy. She is pushing and asking for one more trial. The cause of infertility is idiopathic, normal karyotype for her and her husband, normal uterine cavity at hysteroscopy, normal immunonolgy studies. In islam egg donation is not allowed. Shall I go for trial no.14 as she requests??.

Replies (9) Write a reply... I think you can test the endometrial thikness before fresh ET if ok you can transfer half of the embryos and keep the other half for FET if not ok you can keep all embryos cryopreserrved till you have good endometrial preparation by FET cycle I hope this helps you but it is beleved that it may not be the resone for these faliars osama deabes - 27 May 2005 Some of the options We have had pregnencies after the age of 42.You need to counsel the patient for chromosomal anomalies(age related). If she agrees options are Early cleaved Embryos D-3 transfer Blastocyst transfer/AH PGD Frozen Embryo Transfer. Dr.Kundavi&Thomas - 26 April 2005 We had a similar situation before. A lady had about 10 times of IVF. We did three times. Every time, she produced about 10 beautiful embryos and we transfered 3-4 but never got pregnant. However, the last cycle, she produced 20 eggs and had 12 embryos at 8-cell stage at Day 3, and 6 at 5-6 cell stages. We decided to transfer half of her embryos and freeze half. So we transfered 9 embryos: 6 at 8-cell stage, and 3 at other cell stage. She was pregnanct and delivered one healthy boby. She was 42 years old (if I did not make mistake). Now she is thinking to transfer another 9 frozen embryos. Wei-Hua Wang - 20 April 2005 In such cases the reason most probably a chromosomal abnormality. I think better to go to pgs" preimplantation genetic screening" before ET. ANAS - 17 April 2005 These could be some of the options 1. Blast ET 2. PGD of D3 embryos and ET on D5 3. CryoET on either natural cycle or FET 4. Co-culture 5. Natural cycle IVF tevfik yoldemir - 12 April 2005 I believe this is not the end of the story. I would strongly advice to go for blastocyst culture. The last SART report (and also the previous 2 SART reports) have shown at least 12% difference between D3 & Day 5 transfer for those above 41 years old. I disagree with the reply of the absence of pregnancies afor 42 years old and above. A center in Cororado achieves over 25% in this group!! Dr Hosam Zaki - 09 April 2005 AS STRICT MUSLIMS WE ALSO NEVER DO DONOR PROGRAMMES. BUT WE HAD BIRTHS AT THE AGE OF 43 ONE CASE, AT 42 TWO CASES & AT 41 A FEW MORE.APART FROM BLAST TRANSFER I WOULD SUGGEST TO TRY FROZEN TRANSFER,AS THE UTERINE RECEPTIVITY IS MUCH SUPERIOR IN FET CYCLES. DR.ASHRAF - 09 April 2005 Being an IVF Scientist for many years, I wonder why you have not tried to culture the embryos to Blastocyst stage for ET. If there is any choromosomal/DNA defects in sperm (S/A could be normal),the development of Blastocyst will be ceased in many cases. If you have decided to treat her again, blastocyst ET may help you to find more information on embryos. I select patients for Blastocyst ET's on failure of pregnancies with 4 or more good grade embryos. Also our pregnancy rate is very high for blast ETs. Shantal Rajah - 31 March 2005 In the literature i have not come across a single pregnacy at the age of 42 and above.obviosly at that age most of the embryos produced will be abnormal in any case. In view of that info i would discourage her. Hope this helps Regards GH Mohamed Dr GH Mohamed - 24 March 2005