If you’ve undergone in vitro fertilization (IVF) and didn’t achieve a successful pregnancy, you may be wondering why. It’s important to know that IVF outcomes can be unpredictable, but there are factors that can affect your chances. Let’s explore some common reasons for IVF failure in simpler terms.

1. Age: A woman’s age is a significant factor in IVF success. Generally, women under 35 have a higher chance of getting pregnant through IVF, around 35-40% per embryo transfer. However, this success rate decreases as women get older. For women in their mid-forties, the success rate drops to under 5%. This decline is mainly because the quality of eggs decreases as women age, affecting their ability to develop normally.

1. Egg/Embryo Competency: Apart from age, the quality and competency of embryos also affect IVF success. The quality of eggs and embryos is influenced by a woman’s age. However, for older women or those with fewer eggs, the specific IVF protocol used to stimulate the ovaries becomes crucial. A more aggressive approach may be needed to maximize the chances of success. Previously, it was thought that the uterus was better for embryo development than the lab environment. So, early-stage embryos were transferred to the uterus based on their appearance. However, we now know that embryos that have progressed further in development are more likely to be successful. Embryos that don’t reach the blastocyst stage within 5-6 days after fertilization are considered less competent and not suitable for transfer. Additionally, Preimplantation Genetic Sampling / Testing (PGS/T) allows us to check the chromosomes of embryos. This technique helps select the most competent embryos for transfer, especially for older women, those with fewer eggs, repeated IVF failures, and recurrent pregnancy loss.

1. Number of Embryos Transferred: Some people believe that transferring more embryos increases the chances of success. While this may have some truth, it’s essential to know that if the problem lies with the ovarian stimulation protocol, transferring more embryos won’t solve it. Also, transferring more embryos doesn’t fix issues related to embryo implantation dysfunction, such as anatomical or immunologic problems. Moreover, multiple embryos can lead to higher-order multiple pregnancies, which pose risks. To minimize these risks, it’s generally recommended to transfer a maximum of two embryos, or even just one, especially when using eggs from young women.

1. Implantation Dysfunction (ID): Implantation dysfunction is often overlooked as a cause of unexplained IVF failure, especially in young women with normal ovarian reserve and fertile partners. Failure to identify and address these issues can result in repeated IVF failures. If transferring competent embryos repeatedly fails to result in a viable pregnancy, implantation dysfunction should be considered. The most common causes include:

1. 1. Thin Uterine Lining: When the lining of the uterus is too thin, it can affect the embryo’s ability to implant and grow.
   2. Surface Lesions in the Uterus: Polyps, fibroids, or scar tissue in the uterus can interfere with embryo implantation.
   3. Immunologic Implantation Dysfunction (IID): Sometimes, the immune system can mistakenly attack the embryo, preventing successful implantation.
   4. Endocrine/Molecular Endometrial Receptivity Issues: Hormonal or molecular issues in the uterine lining can impact the embryo’s ability to attach and develop.
   5. Ureaplasma Urealyticum (UU) Infection: This infection in the cervical mucous and uterine lining can lead to unexplained early pregnancy loss or IVF failure. Both partners should be tested and treated if positive to prevent transmission.

Certain causes of infertility are difficult or impossible  to reverse, e.g.; advanced age of the woman, severe male infertility, and immunologic implantation dysfunction associated with certain specific genetic factors.

Understanding the common factors contributing to IVF failure can help you have informed discussions with your doctor and make decisions for future attempts. Factors like the number of embryos transferred and implantation dysfunction play significant roles. While success cannot be guaranteed, knowing these factors can guide you in maximizing your chances and addressing potential issues.

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ADDITIONAL INFORMATION:

I am attaching online links to two E-books which I recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

1.From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) “

https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

• If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or go to concierge@sherivf.com .
• Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!

Yes! I am afraid this is a negative result!

GS

________________________________________________________________

ADDITIONAL INFORMATION:

I am attaching online links to two E-books which I recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

1.From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) “

https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

• If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or go to concierge@sherivf.com .
• Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!

Thank you!

I am referring your inquiry to Dr Drew Tortoriello, Medical director at Sher Fertility Solutions-New york. I have no doubt that he will reach out to you.

FYI am attaching additional information to this response.

Geoff Sher

______________________________________________________________________

ADDITIONAL INFORMATION:

I am attaching online links to two E-books which I recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

1.From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) “

https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

• If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or go to concierge@sherivf.com .
• Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!

After 1 year of unsuccessfully trying to have a baby, it is time to have a basic infertility evaluation. And the urgency increases the older the woman is.  

A: Preparatory Tests done on the woman:

• Tests for Ovarian Reserve: On the third day of spontaneous or progesterone withdrawal menstruation, blood is drawn to test for ovarian reserve. This requires testing for blood concentrations of  estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) and for anti-Mullerian hormone (AMH).
• A hysterosalpingogram (HSG): This is performed within a week of the cessation of menstruation. This out-patient procedure involves injection of a radio-opaque dye which outlines the Fallopian tubes allowing the diagnosis of tubal blockage. To a lesser degree, it permits the detection of surface lesions inside the uterine cavity.
• Hysterosonogram (HSN) : When IVF is planned this procedure is done early in the menstrual cycle. It involves instilling a sterile saline solution into th uterus, followed by a pelvic ultrasound to map the contour of the uterine cavity.
• Laparoscopy: This is a procedure that is sometimes needed. It is usually performed under general anesthesia in an ambulatory surgical center. Here, a telescope like instrument is passed into the abdominal cavity to allow thorough inspection of pelvic structures. It is usually confined to cases where symptoms and signs backed up by pelvic ultrasound findings, suggest significant underlying organic pelvic pathology (e.g. advanced endometriosis/fibroids, tubal disease and pelvic adhesions
• Hysteroscopy: Women suspected on the basis of symptoms and/or signs, (usually following ultrasound assessment or HSN) of having intrauterine pathology (fibroids/polyps/scar tissue) that might interfere with embryo implantation are sometimes required to undergo a hysteroscopy. This involves introducing a thin telescope-like instrument via the vagina and cervix into the uterus in order to allow visualization of the uterine cavity and surgical repair. It can be performed under local anesthesia with sedation in an ambulatory center orin-office. In some cases general anesthesia is needed.
• Testing the urine LH surge…for impending ovulation: Commencing at least 17 days before the expected menstrual period (i.e.; usually about 10 days following the initiation of menstruation), urine should be collected twice daily and tested for the onset of the spontaneous luteinizing hormone (LH) surge. The initiation of the LH surge usually precedes ovulation by 8 to 36 hours.  In order to detect the onset of the LH surge accurately, an early morning urine specimen is needed. Ideally, the bladder should be emptied first thing in the morning, upon awakening. About one half-hour later urine is collected (only a very small amount is required) and tested using an over-the-counter LH – kit (obtainable over the counter, at a drug store). At the earliest sign of a color change the woman should present at her treating physician’s office for:

The 1^st   In-Office Assessment where the following is carried out::

1. 1. 1. A pelvic ultrasound examination to assess for a dominant follicle or for evidence of recent ovulation and for the thickness and pattern of her uterine lining to be assessed (ideally it should measure >8mm with a triple “line” (trilaminar) appearance
      2. Blood should be tested for measurement of estradiol (E2) l level.

A 2^nd  In-Office Assessment is arranged for three (3) days after the first office assessment.  At this visit, a vaginal ultrasound exam is performed to check (or to confirm) that ovulation has occurred (i.e. whether the egg has been released).  The presence of small amount of fluid collecting in the lowermost region of the pelvis, or a change in the shape of the follicle is suggestive of ovulation.

A 3^rd  In-Office Assessment takes place five (5) days after the 2^nd visit.  At this visit, blood is drawn for the measurement of progesterone (P4) and estradiol (E2)

• Assessment for an Immunologic Implantation Dysfunction (IID) This is selectively done at one of about six Reproductive Immunology Reference Laboratories in the United States (I preferentially use Reproductive Immunology Associates (RIA) in Van Nuys, CA). Testing is indicated when:
  1. Autoimmune assessment; In my opinion, this is indicated when here is a personal or family history of autoimmune diseases (e.g. Lupus Erythematosus, Hypothyroidism, Rheumatoid Arthritis etc.), symptoms or signs of endometriosis (e.g. prior surgical visualization of lesions in the pelvis, heavy painful periods and pain during intercourse and/or ovulation) which is associated with immunologic implantation dysfunction (IID) in about 1/3 of cases. Also, when there is a past history of repeated “unexplained” IVF failure. Here, blood is drawn (at any time) from the female partner and sent to a reliable Reproductive Immunology Reference Laboratory for testing of antiphospholipid antibodies (APA), antithyroid antibodies (ATA) and the K-562 Target cell test, otherwise known as a natural killer cell activity test (NKa) test. In some cases, a uterine biopsy is done to test for endometrial cytokines.
  2. Alloimmune assessment: In select cases (especially where there is a history of Recurrent Pregnancy Loss (RPL), or “unexplained” secondary infertility” or where Natural Killer cell activation (NKa) is diagnosed without there being an underlying autoimmune cause., both partners should be tested for alloimmune genetic similarities (DQ alpha and HLA genetic matching).
• A semen analysis is required for accurate measurement of sperm motility and count.  Sperm morphology is assessed employing “strict (Kruger) criteria.”
• Sperm Antibody Test: Selectively we also test the man and/or the woman’s blood for anti-sperm antibodies (ASA) using the indirect Immunobead test (IBT). This is particularly important in cases of “unexplained” infertility (where the blood of both partners should ideally be tested) in men when there is a history of a prior vasectomy or sperm microscopy reveals significant sperm-to-sperm attachment (agglutination).
• Sperm Chromatin Structure Assay (SCSA): In selected cases, semen should also be sent for a Sperm Chromatin Structure Assay (SCSA) to assess the DNA Fragmentation Index (DFI) which ideally should be <15%, but 15%-30%
• Hormonal assessment of the man: in an ambulatory surgical center, performed In men where a semen analysis reveals a low count/motility/morphology, blood id collected from the man for FSH, LH, TSH, testosterone and prolactin measurement
• Male Urology Visit: In selected cases (the man is referred to an Urologist for further testing or testicular biopsy.

________________________________________________________________

ADDITIONAL INFORMATION:

I am attaching online links to two E-books which I recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

1.From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) “

https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

• If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or go to concierge@sherivf.com .
• Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!

Respectfully,

I do not believe your sad loss had anything to do with the high progesterone.

Geoff Sher

________________________________________________________________________

ADDITIONAL INFORMATION:

I am attaching online links to two E-books which I recently  co-authored with  my partner at SFS-NY  (Drew Tortoriello MD)……. for your reading pleasure:

1.From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS) “

https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

1. “Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view

• If you are interested in having an online consultation with me, please contact my assistant, Patti Converse at 702-533-2691 or go to concierge@sherivf.com .
• Also, I have just started a new Podcast https://rumble.com/c/c-3304480. Feel free to take a look-see……… And please spread the word!

Understanding the Power of Receptiva Test

The Receptiva Test is often inconclusive but would do no harm. However, 30% of endometriosis is associated with an immunologic implantation dysfunction (IID). If present and there is evidence of increased natural killer cell activity (NKa) and/or antiphospholipid antibodies, this could cause IID. Have her blood tested at one of 3 laboratories in the USA that are capable of doing such testing reliably (I advocate using ReproSource Laboratory in Boston, MA. If you test positve, it is my opinion that treatment is necessary (see the attached links to books I have written below, which will provide more information).

Receptiva Test for Endometriosis

Endometriosis is a condition that occurs when the uterine lining (endometrium) grows not only in the interior of the uterus but in other areas, such as the Fallopian tubes, ovaries, and the bowel. Endometriosis is a complex condition where the lack or relative absence of an overt anatomical barrier to fertility often belies the true extent of reproductive problem(s). More than half of women who have endometriosis harbor antiphospholipid antibodies (APA) that can compromise development of the embryo’s root system (trophoblast). In addition and far more serious, is the fact that in about one-third of cases endometriosis, regardless of its severity is associated with NKa and cytotoxic uterine lymphocytes (CTL) which can seriously jeopardize implantation. This immunologic implantation dysfunction (IID) is diagnosed by testing the woman’s blood for APA, for NKa (using the K-562 target cell test or by endometrial biopsy for cytokine activity) and, for CTL (by a blood immunophenotype). Activated NK cells 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 rejection of the embryo even before the pregnancy is diagnosed and sometimes, in a chemical pregnancy or 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”.

Women who harbor APA’s often experience improved IVF birth rates when heparinoids (Clexane/Lovenox) are administered from the onset of ovarian stimulation with gonadotropins until the 10th week of pregnancy. NKa is treated with a combination of Intralipid (IL) and steroid therapy: Intralipid (IL) is a solution of small lipid droplets suspended in water. When administered intravenously, IL provides essential fatty acids, linoleic acid (LA), an omega-6 fatty acid, alpha-linolenic acid (ALA), an omega-3 fatty acid.IL is made up of 20% soybean oil/fatty acids (comprising linoleic acid, oleic acid, palmitic acid, linolenic acid and stearic acid), 1.2% egg yolk phospholipids (1.2%), glycerin (2.25%) and water (76.5%).IL exerts a modulating effect on certain immune cellular mechanisms largely by down-regulating NKa.

The therapeutic effect of IL/steroid therapy is likely due to an ability to suppress pro-inflammatory cellular (Type-1) cytokines such as interferon gamma and TNF-alpha. IL/steroids down-regulate NKa within 2-3 weeks of treatment the vast majority of women experiencing immunologic implantation dysfunction. In this regard IL is just as effective as Intravenous Gamma globulin (IVIg) but at a fraction of the cost and with a far lower incidence of side-effects. Its effect lasts for 4-9 weeks when administered in early pregnancy.

The toxic pelvic environment caused by endometriosis, profoundly reduces natural fertilization potential. As a result normally ovulating infertile women with endometriosis and patent Fallopian tubes are much less likely to conceive naturally, or by using fertility agents alone (with or without intrauterine (IUI) insemination. The only effective way to bypass this adverse pelvic environment is through IVF. I am not suggesting here that all women who have endometriosis require IVF! Rather, I am saying that in cases where the condition is further compromised by an IID associated with NKa and/or for older women (over 35 years old) who have diminished ovarian reserve (DOR) where time is of the essence, it is my opinion that IVF is the treatment of choice.

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I am attaching online links to two E-books that I recently co-authored with my partner at SFS-NY (Drew Tortoriello MD) for your reading pleasure:

1. From In Vitro Fertilization to Family: A Journey with Sher Fertility Solutions (SFS)

https://sherfertilitysolutions.com/sher-fertility-solutions-ebook.pdf

2. Recurrent Pregnancy Loss and Unexplained IVF Failure: The Immunologic Link

https://drive.google.com/file/d/1iYKz-EkAjMqwMa1ZcufIloRdxnAfDH8L/view