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Implantation Failure

Some Possible Reasons Why IVF Cycles Fail When They Shouldn’t

November 7, 2006 - Tuesday
3:43 PM to (EST)
Guest Speakers: Dr. Michael Feinman
Huntington Reproductive Center

Categories
Donor Egg • Infertility • IVF • Pregnancy Loss


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deb Welcome to tonight's Online Education Session. As always, we will start promptly at 8pm Eastern and end at 9pm. Tonight's guest is Dr. Michael Feinman from Huntington Reproductive Center. He will be talking about implantation failure and some possible reasons why IVF cycles might fail.
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deb Dr. Feinman, a graduate of UCLA Medical School, has been in practice since 1986 and is board certified in both Reproductive Endocrinology and Ob/Gyn. He is a member of numerous professional associations and a sought after speaker and a prolific writer.
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Dr_Freinman Dr. Feinman
deb Welcome, Dr. Feinman. We are so happy to have you with us tonight. I would like to ask you to make some opening comments.
Dr_Freinman Implantation failure represents the ultimate cause of infertility in many patients and by definition is the cause of IVF failures. The science of implantation failure is not well developed, but there are some tests to explore the causes of implantation failure and some are quite controversial.
deb Dr. Feinman is ready to answer your questions. Feel free to jump in at any time.
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deb Welcome Maddie!
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deb Dr. Feinman, can you give me a an example of a test that a patient might undergo to address implantion failure.
Dr_Freinman Yes, Deb. One simple thing that is tragically overlooked on occasion is a uterine septum. Many patients have had HSG that have been read as normal and when we review the films, a septum is present.
Dr_Freinman Some patients with implantation failure may benefit from a hysterosopy to rule out a septum.
smiley at what point is AH considered??
Dr_Freinman Smiley, there is weak evidence that AH is effective. It is typically done for women over forty or repeat ivf failures.
Dr_Freinman Before using AH empirically, other testing might be appropriate.
Dr_Freinman Some of the tests that might make sense like the SCSA (sperm chromatin structure affay) would be something I would consider before AH.
smiley what is the nature of the SCSA test? what are your thoughts on bromelain to aid implantation?
Dr_Freinman SCSA tests the quality of DNA in sperm. Poor SCSA results are associated with lower implantation rates and higher miscarriage rates.
Dr_Freinman I am not familiar with bromelain-can you give me more info on it.
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Dr_Freinman and why your doc is using it.
smiley my doc is not using it....i have done my own research...it is the chemical found in pineapple and supposedly aids in implantation
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Dr_Freinman Since I have not seen this in my practice or in any medical literature, I can not comment on it.
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smiley ok thank you
deb Please feel free to jump in with your questions for Dr. Feinman. He is really ready, willing and able to answer your questions.
smiley what are your thoughts on rest after transfer?? do you recommend it? also, does implantation take place days 4 to 6 after 3 day transfer??
Dr_Freinman I don't believe that your physical behavior affects the outcome. What little research has been done supports my belief. Also, we have many patients that come to us from around the world for egg donation. Many of these women fly home soon after the embryo transfer with very good results.
smiley is there anything that we can do to increase chances of implantation??
Dr_Freinman Not to seem insensitive, we encourage two days of 'taking it easy' if possible. Implantation occurs day six or after. Day three embryos stay in the uterus before implantation.
maddie1702 Hi, I am going thru my 4th ivf cycle,I am 39. !st ivf misscarried at 8wks. Last two tries pgd, great blasts,normal embies with extended panel of 12. last two tries did not stick. we are using lovenox this time empirically .Should this help? Also I asked My Re to do the SCSA test on my spouse, He said that it was not the sperm more likely the egg.
Dr_Freinman First, we have to understand why the implantation failure has occured. If embryo quality seems adequate, and test like SCSA are normal, then the failure may be due to factors in the uterus or endometrium. This is where there controvesy begins.
smiley can a HSG test detect possible uterine scarring from prior D&C?
Dr_Freinman Well, lovenox is not a proven implantation enhancer. In theroy it only works if there is known immunological or sub-clinical clotting disorder. Even when the testing is positive, the benefit of the drug is largely unproven. The fact that you did pgd and have a good blastocys counters the argument that it your eggs. So the SCSA may still be appropriate.
Dr_Freinman yes, the hysteroscopy is still better.
Dr_Freinman oops, but the hysteroscopy is still better.
deb I want to take this opportunity to thank Dr. Feinman for helping us out tonight. We literally couldn't do this without his willingness to share his time and expertise with us.
Dr_Freinman It is my pleasure.
maddie1702 Thank you, Have a good night.
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smiley back to the implantation question--if implantation takes place day 6 or after, then what is the reasoning behind "taking it easy" for the first 2 days?? to me, it would make more sense to "take it easy" from day 5 on....
Dr_Freinman There is another test that I recomend in certain circumstances called the endometrial function test (EST). THis test is done on a biopsy of the endometrium at Yale University. It looks for the presence of absense of implantation markers.
Dr_Freinman Good question. You are right most implantations occur on the disco dance floor! As I said before, I don't think that physical behavior affects the outcome, but many patients fear that the embryos will fall out right after the transfer, so taking it easy allays this fear.
smiley now THAT makes sense!!!
deb We have about 20 more minutes with Dr. Feinman. Please feel free to ask your questions.
deb Dr. Feinman what are the common causes of implantation failure?
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deb We lost Dr. Feinman for a second...but he is logging back on. Hang on!
sandy Are high stim doses like 225 repronex and 225 gonal f harmfull to the egg. My next protocol is antagonist.
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Dr_Feinman I am back...sorry for the techno glitch. But to answer that last question, we categorize the issues into three groups: egg factor, sperm and uterine.
Dr_Feinman No.
deb Without knowing your history, I can not comment on the protocol.
deb Dr. Feinman is on the phone as he is having computer problems.
Dr_Feinman I am back...sorry again.
deb I see you all frantically typing in your questions.
sandy 36yrs. FSH 16, MDL cycle cancelled due to poor response. RE now want to try antagonist. Have not been using bcp this cycle.
deb Check out the next issue of Connections, The AFA's electronic newsletter for an more information on this topic in Dr. Feinman's article.
sandy What should TSH be when trying to get preg?
Dr_Feinman Again, i can't comment on your care, but it does sound like you are going to need an egg donor. Unfortunately, there is no 'magic' protocol.
Dr_Feinman In the normal range, which varies from lab to lab.
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smiley my FSH was 7...i am 40....why is it that some women's FSH are high, even at a young age?
Dr_Feinman Because they have lower numbers of eggs remaining in their ovaries.
deb As a reminder, we are here every week on Tuesdays at 8pm Eastern.
deb Dr. Feinman, we are getting close to the end of our session. We have all learned a lot. Are you available to answer questions if our audience has any?
smiley i've had 2 ivf cycles fail.....i can't help but wonder if the embryos tried to hatch out of their shell but couldn't because the shell was too hard (age 40)....doc says i can try AH after 3 failed cycles.....do you think this could be a legitimate reason why implantation failed??
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Dr_Feinman I would be happy to answer questions. You can call me at 805 374 1737 or email me at feinmanivf@havingbabies.com. I won't be available until next week as I am in NY and thoroughly enjoyed THe AFA's Kokopelli ball.
Dr_Feinman AH is commonly recommended for women in your age group. Please also remember, that a high rate of chromosomal abnormalities is an important cause of implantation failure as well.
deb I am afraid we are out of time. Thank you all for joining us tonight. And thank you, Dr. Feinman for the time to be with us.
deb We'll see you next week! Same bat time, same bat channel!
smiley thank you so much dr feinman
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