The question
I’m currently on a short antagonist with a fresh cycle, following my egg retrieval the doctor noted she could see triple layer endometrium but there was no triple layer detected in the most recent scan so mentioned as she didn’t have a reference point maybe consider freeze all embryos. Lining was at 9mm at time of egg collection though.9eggs collected,5fertilised. 34 with low AMH (5.4) and mild endometriosis. Had a laparoscopy 4months ago which confirmed mild endo, none detected on my uterus but my fallopian tubes and ovaries were covered in scarring. I had sepsis originating in my uterus 2weeks post C-Section 3years ago so doctor believes this scarring is relating to this infection rather than endometriosis. I also had a hysteroscopy 10 months ago and biopsy of endometrium all of which came back clear.
Can I go ahead with a fresh transfer or should I freeze all that make it to day 5 and do a frozen transfer on my next cycle? What can be done to show a triple line, my understanding is my actual thickness is ok?
Answer from Dr. Geoffrey Sher
Yes you can go ahead. However, please be aware that 30% of women with endometriosis (regardless of severity, havd an immunologic implantation dysfunction (see below) which needs treatment.
Geoff Sher
Contact my Office manager..for appointment: Concierge@sherivf.com
- ENDOMETRIOSIS AND IMMUNOLOGIC IMPLANTATION FAILURE.
Patients with endometriosis have immunologic abnormalities. The most significant of these involve the presence of harmful antibodies known as antiphospholipid antibodies (APA) which are in the bloodstream of about 66 percent of women with endometriosis. In about half such cases (i.e. about 1/3 of all cases of endometriosis…regardless of severity) the immunologic implantation is profoundly aggravated by the presence of activated (i.e “toxic”) Natural Killer cells (Nka) in the uterine lining (endometrium). These NKa attack the invading trophoblast cells (developing "root system" of the embryo/early conceptus) as soon as it tries to gain attachment to the uterine wall. In most cases, this results in death of the embryo even before the pregnancy is diagnosed and sometimes, in a chemical pregnancy or even an early miscarriage. . As such, many women with endometriosis, rather than being infertile, in the strict sense of the word, often actually experience repeated undetected “mini-miscarriages”. Treatment requires prior and specific identification of all 18 sub-types and their gammaglobulin isotypes. Unfortunately, only a handful of Laboratories in the United States are capable of adequately testing for APAs. But it probably not APAs that cause infertility in endometriosis patients. Rather it is the co-existence of toxic or activated NK cells (Nka) that attack the early embryo’s root system as soon as it tries to attach to the uterine wall that causes the problem. The presence of APAs probably represents a marker which identifies those endometriosis patients who have immunologic problems requiring immunotherapy Women with APA's experience improved IVF birth rates when mini-dose heparin is administered from the onset of ovarian stimulation with gonadotropins until the 8th week of pregnancy.
Heparin therapy alone, only benefits APA+ women who do not have positive blood tests for Nka while women who test positive for Nka require intralipid/steroid therapy.
General information only, not medical advice for your own situation. For that, book a consultation.