Comments on IVF Authority: Embryo Transfer: The Critical Step in IVF

Dear Dr Sher, I am 32 and we fall under the unexp...

2011-01-07T19:42:28.851-08:00

Dear Dr Sher,

I am 32 and we fall under the unexplained category. Last year we had 1 failed fresh and 2 failed frozen cycles. All embryos were "perfect"" in the eyes of the scientists thus the negative results were crushing. My clinic doesn't use guided u/s transfers. When questioned my specialist said that as he does all of his own u/s he is very aware of my uterus dimensions. I also have a slightly curved cervix which does make transfer difficult. Would a guided u/s make a huge difference? I have requested that I take valium prior to the next cycle due to start end of January to relax me as well. I really love my RE and it has only been one failed round of IVF I don't really want to change clinics at this stage. Is there anything else you can suggest?

You are most welcome

2010-07-20T16:18:48.289-07:00

You are most welcome

Thank you for your response! Kendra

2010-07-15T20:03:24.793-07:00

Thank you for your response!

Kendra

I doubt that the method of ET would affect the ris...

2010-07-14T00:03:53.863-07:00

I doubt that the method of ET would affect the risk of a chemical pregnancy. This having been said, in this day and age there is no justification (in my opinion) for not doing US-guided ET's.

Geoff Sher

My first IVF was a success. We are now trying to ...

2010-07-07T11:43:09.999-07:00

My first IVF was a success. We are now trying to conceive #2 and because I had a c-sect I now have scar tissue where the cervix meets the uterus. My RE does not use ultrasound guided transfer and because of my c-sect scar the 2 transfers I just had done (a FET and fresh IVF) have been "tricky". Both cycles resulted in a chemical pregnancy.

My question is, do you think these 2 chemical pregnancies are the result of improper placement of embryo since my RE does not use ultrasound guided transfer? Or does the fact that the embryos initially implanted indicate they were in fact properly placed and they just arrested for other reasons?

I am trying to decide if I should switch to and RE that uses ultrasound guided transfer for the mere fact that I now have a c-sect scar that makes transfers "tricky". (though I've had success with this RE)

Thanks and looking forward to your reply.

Kendra

Since the risk of a high-order multiple pregnancy ...

2010-05-12T14:43:40.002-07:00

Since the risk of a high-order multiple pregnancy (tripletes) at 42 is well under 5%, I would take all embryos to day 5-6 and then transfer 3 blastocysts. Remember, those that don't make it that far are almost always chromosomally abnormal, anyway.

Geoff Sher

In your opinion, how many good quality embryo'...

2010-05-10T01:09:22.908-07:00

In your opinion, how many good quality embryo's would be reasonable to transfer in a 42 year old woman with three failed attempts & normal FSH? We produced a total of 6 good quality & 4 top quality embryo's (although only 2 were 8-cells at 3 days with the others a bit less -- but no fertilized eggs failed to develop into good quality embryo's). Two were replaced at a time, fresh or frozen, but no pregnancies have resulted. This time we will try assisted hatching, and it appears we will have a good number of embryo's. We don't want to be reckless, but we would like to maximize our chances of a pregnancy. Given the older age & 3 failed attempts, it is difficult to sort out the appropriate number. What would your clinic generally do? Thank you very much for your time & consideration.

You are most welcfome! Geoff Sher

2009-10-20T14:05:09.338-07:00

You are most welcfome!

Geoff Sher

Thank you as always for your time and expertise.

2009-10-20T12:49:06.836-07:00

Thank you as always for your time and expertise.

Of course the hCG of pregnancy would exacerbate th...

2009-10-20T11:34:59.095-07:00

Of course the hCG of pregnancy would exacerbate the risk of ovarian hyperstimulation syndrome. Thus if a transfer were to be done it would be wise to restrict this to fewer embryos. Whether at all to take the chance of doing an ET would however depend upon the hormonal, clinical and metabolic parameters as vdetermined just prior to performing the procedure.

Please read my blog on OHSS.

Geoff Sher

In your opinion, should an embryo transfer be done...

2009-10-20T10:58:13.754-07:00

In your opinion, should an embryo transfer be done on a patient who is already exhibiting signs of OHSS, pain and bloating? I had my ET scheduled 48 hours after my ER (this is standard practice at the clinic where I go). The doctor decided to only transfer one embryo (grade A) as opposed to two (two being the maximum in the country where I reside) for the risk of even more severe OHSS.

I did not receive any sedative and after reading your post, wonder if my emotional and physical state contributed to the failure to implant.

Thank you