Thursday, July 10, 2014

Answering IVF patient's questions

I enjoy answering questions from IVF patients. It keeps me on my toes; I am happy to share my knowledge; and I learn a lot from them !

Here's a question I got recently

Dear Dr. Malpani,

Let me start off by saying that I have lived by the information you provide on your website. I have never seen better information in one place.

I have a question that I would really only value your opinion at this point. I just had a failed FET. It was a « perfect » blastocyst. Had a HSG at 35 at 10 days past transfer, which came down to 8 yesterday,and they told me to stop all my medications.

Fine-that’s not the problem.

Why would a clinic only test my beta? What if my progesterone level was low (I was taking suppositories as opposed to injections, which now I feel really guilty about). They only tested my progesterone once, and it was at 2 days past transfer, and it was 8.6 Well, that sounds low to me, but they said it’s fine for Endometrin.

Is it possible for a reputable clinic not to test everything at once when I go in for my beta check? Including Progesterone, Estrogen, as well as my thyroid level given that I am on levothyroxine.  I just feel failed by my clinic. I understand the embryo might have been abnormal, but how will i ever know it wasn’t me? What if the suppositories didn’t produce enough progesterone for me?  I don’t know, it seems common sense to me that a clinic would test me for everything once I’m in for a beta test.

As a side note,  I do have a healthy 2 year old from my fresh cycle on a first try, so I don’t think I have some autoimmunie issue, etc…
This is a very well-informed patient, who is looking for additional answers.

Here are my thoughts.

 1. I'd like to see a photo of the blastocyst; as well as medical details of the IVF cycle ( including endometrial thickness and texture) so I can review the medical details

 2. I don't think measuring progesterone levels helps at all. These measure the levels in the blood - and there is  little correlation between progesterone levels in the endometrium
( which is what we are really interested in ) and the blood levels

3. There's no need to feel guilty for not taking progesterone injections. They are very painful - and less effective than the suppositories, which deliver the progesterone directly to the uterine lining through the vagina

4. It's easy for a clinic to do lots of tests, but the fact is that more tests do not always help. In fact, they can create more problems ( because of false positives ,which lead doctors and patients astray because they start chasing red herrings of no clinical importance)

5. You need to be kinder to your clinic. I understand you are upset, but why would the clinic want your cycle to fail ?  Their interests are aligned with yours - every good doctor wants their patients to do well !

6. You should be more assertive proactively, rather than have regrets afterwards ( which does not help, and just adds to your burden of guilt). You could always ask the clinic to do more tests, if you wanted them . No good clinic would refuse, if you made a request which was reasonable.

7. Why good looking embryos do not implant is still one of those things we do not understand - it is
one of medicine's unsolved mysteries . Human reproduction is not very efficient . Don’t forget that even fertile couples take time to make a baby in their bedroom ! Please don't get disheartened - your chances remain good. Sometimes you just need to be patient until you get lucky !

Got questions ?
Please send me your medical details by filling in the form at so I can guide you sensibly ?

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