What do you do if your IVF cycle failed, even though high quality embryos were transferred into your uterus?
The first requirement for pregnancy success in IVF is to have a quality embryo. The second requirement is to have that embryo properly transferred into the uterus.

The third requirement is that the uterus must be receptive at the proper moment.

When implantation fails in a fresh cycle after a good quality embryo is transferred, the most likely culprit is a problem with the lining of the uterus. This lining is called the endometrium.

The embryo and endometrium must be synchronized in order for viable pregnancy to occur. Ovarian stimulation can disturb this synchrony. The endometrium can advance in a stimulated cycle so that an embryo may miss the endometrium’s advanced implantation window.

One potential treatment for this is to freeze embryos and transfer them in an unstimulated cycle when endometrial development can be controlled.

Of course this works best in a facility that has a good embryo cryopreservation program. At the Fertility Center of Las Vegas, we have a very successful embryo cryopreservation program with some of the highest success rates found anywhere. We have found this to be a very successful approach for patients who have had unsuccessful fresh transfer.

Multiple pregnancy is associated with certain increased risks for both mother and fetus. Many couples would prefer to avoid the risk of multiple pregnancy, but find themselves in a dilemma because they also want a high probability of success.

In IVF, multiple embryos are normally transferred in order to achieve acceptable success rates. Back in the days when implantation rates were 5% or 10%, it was common to transfer 3 or more embryos in hopes of getting at least one implantation.

Of course, the transfer of many embryos incurs the risk that many will implant.

The key to reducing the risks of multiple pregnancy is to increase the implantation rate (the proportion of transferred embryos that implant in the uterine wall) so that a good rate of success can be obtained with fewer transferred embryos. Ideally, just one embryo would be transferred in couples seeking to avoid the risk of twin pregnancy.

According to the Society for Assisted Reproductive Technologies (SART) report for 2008, The Fertility Center of Las Vegas achieved an implantation rate of more than 50% in fresh non-donor cycles in patients less than 35 years of age. This means that more than half of the embryos we transferred resulted in a fetus with an observed fetal heartbeat.

However, we can do better than that. We and others have have found that the uterine environment is compromised by ovarian stimulation, making it less receptive in fresh non-donor cycles. To get around this, we can freeze the entire cohort of embryos. In these dedicated freeze-thaw cycles, we have found the implantation rate to exceed 60% per transferred embryo in patients less than 35 years of age. That is, almost 2/3 of transferred embryos resulted in a fetus with a fetal heartbeat.
These rates were achieved without genetic screening of the embryos. With genetic screening, it appears to be possible to achieve even greater implantation rates.

With these high implantation rates, the transfer of a single embryo is a very appealing and successful proposition.

What do you do when you have had an IVF cycle that failed with fresh transfer, and have been told that high quality embryos were transferred into the uterus.

The first prerequisite for pregnancy success in IVF is to have produced at least one good quality embryo.   The second important requirement is to be able to transfer the embryo into the uterus in an atraumatic fashion and the third thing that needs to occur is the attachment of that embryo to the uterus.

In a fresh cycle when attachment doesn’t occur after the transfer of a good quality embryo, the most likely culprit is the lining of the uterus called the endometrium.

The endometrium however,  can advance in a spontaneous cycle so that an embryo transferred in the same cycle may miss the implantation window.  The implantation window is the time period within which the embryo needs to implant.  If it arrives too early or too late, it cannot attach to the endometrium effectively.

One potential treatment for this is to freeze embryos and transfer them into a thaw cycle where the endometrial development can be controlled.

Of course this needs to occur in a facility that has a good embryo cryopreservation program.  At the Fertility Center of Las Vegas, we have a very successful embryo cryopreservation program and have found this to be a very useful protocol for patients who have had previous unsuccessful fresh transfers.

Bruce Shapiro M.D.,Ph.D.,HCLD

I am attending the annual international American Society of  Reproductive Medicine ( ASRM ) conference in Orlando Florida.   We are presenting a paper entitled ” Greater birthweight in autologous cycles using Frozen-Thawed embryos, when compared to cycles using fresh embryos , is not an embryonic effect of cryopreservation”.

In our ongoing research into the role of the uterus and endometrial receptivity in fertility, we compared the effects of frozen embryo transfer on birthweight in autologous and oocyte donation cycles in order to determine the potential embryonic effects of freezing from other potential effects.  We found the mean birthweight following frozen embryo transfer was 143g heavier compared to fresh embryo transfer.    The exciting finding in our study was that this higher birthweight was consistent with an enhanced uterine environment in frozen-thawed embryo transfer cycles.

A very interesting talk was presented which revealed the importance of nutrition in fertility and pregnancy.  The research in this field has revealed that the nutritional environment during egg growth can disturb DNA integrity and can have long term effects on offspring.  

This illuminating talk highlights the importance of nutrition in the journey to conception.  We stress nutrition in our discussions with our patients and we recommend all patients to meet with our nutritionist Lori Hayon.   Will give you all another update soon from the conference.

Dr. D

When you are celebrating twenty-three years of birthdays, you must celebrate in a big way. This year The Fertility Center of Las Vegas marked 23 fruitful years with A Family Fun Faire patient reunion. FCLV families past and present gathered, once again, at the Grove at Silk Purse for a day full of fun and games. FCLV staff greeted and welcomed families as they entered The Grove. The first stop was the craft area. Children were provided with a color page featuring the smiling faces of our doctors. Next, three different bounce houses offered a way to jump for joy. On to games: booths were set up with games for all ages and prizes, too. If you fancied, you could have your face painted, visit with Elmo & Tigger or have a balloon hat fashioned just for you. Inside the banquet hall the festive party décor welcomed hungry guests as they enjoyed a picnic-style lunch. Family photos were taken in front of a charming backdrop, the doctors even got in to the act for a few snapshots. The DJ kept set the tone for an energetic afternoon. A menagerie of fanciful mini Bundt cakes was beautifully displayed at the dessert table. An added surprise was an ice cream truck serving up cool treats. A group photo was taken to commemorate the event. The doctors and staff of The Fertility Center of Las Vegas are already planning the 24^nd patient reunion-See you there!

Last weekend,  I was at the park with my 3 children and as they played,  I reflected on what drives and motivates me in my career.      Despite fertility struggles,   I have been blessed with 3 daughters and every instance that I meet my patients,  I can understand their burning desire to have a family.    To one day, gaze at their children playing in the park.     Beyond the scientific rigor of everyday research and practice,   there is a fire within me to do everything in my power to help my patients in their journey to conception.        

The greatest reward a fertility specialist could have is to see their patient finally reaching their goal of having children and overcoming the struggles with infertility.      Every physician needs to put themselves in their patients shoes to understand the emotional, physical and financial toll infertility can have in their lives:    During my fellowship training at UCLA,  I told a group of training residents that my wish for one day would be for the doctors to wear the patients gowns and understand the emotional component of their condition.  

One of the worst things in life is a missed opportunity:   I would never want to miss an opportunity to help my patients.     This is what drives and motivates us to perform research and publish our findings and this is what motivates us to hold our patients’ hands through this journey to conception.     

Said Daneshmand M.D., FACOG